Top

Published in:

Open Access 01-01-2011

Tailored or Routine Addition of an Antireflux Fundoplication in Laparoscopic Large Hiatal Hernia Repair: A Comparative Cohort Study

Authors: Edgar J. B. Furnée, Werner A. Draaisma, Hein G. Gooszen, Eric J. Hazebroek, Andre J. P. M. Smout, Ivo A. M. J. Broeders

Published in: World Journal of Surgery | Issue 1/2011

Abstract

Background

There is controversy about the tailored or routine addition of an antireflux fundoplication in large hiatal hernia (type II–IV) repair. We investigated the strategy of selective addition of a fundoplication in patients with a large hiatal hernia and concomitant gastroesophageal reflux disease.

Methods

Between 2002 and 2008, 60 patients with a large hiatal hernia were evaluated preoperatively and 12 months after surgery by reflux-related symptoms, upper endoscopy, and esophageal 24-h pH monitoring. In patients with preoperatively documented gastroesophageal reflux disease, an antireflux fundoplication was added during hiatal hernia repair.

Results

An antireflux procedure was added in 35 patients and 25 patients underwent hiatal hernia repair only. Preoperative symptoms were improved or resolved in 31 patients (88.6%) in the group who had fundoplication and in 20 patients (87.0%) in the group who did not have fundoplication. In patients with fundoplication, esophagitis was present in 6 patients (22.2%) after surgery and abnormal esophageal acid exposure persisted in 11 (39.3%). Seven patients (38.9%) with hernia repair only developed abnormal esophageal acid exposure, and esophagitis was postoperatively generated in five (27.8%). In neither group did patients have new onset of daily heartburn or dysphagia.

Conclusions

In patients with a large hiatal hernia associated with gastroesophageal reflux disease, addition of a fundoplication during hernia repair yields acceptable reduction of symptoms and does not generate symptomatic side effects. Objective control of reflux, however, is only moderate. Omission of an antireflux procedure in the absence of gastroesophageal reflux disease induced esophagitis in 28% and abnormal esophageal acid exposure in 39% of patients. Therefore, routine addition of an antireflux fundoplication should be recommended.

van der Peet DL, Klinkenberg-Knol EC, Alonso PA et al (2000) Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment. Surg Endosc 14:1015–1018CrossRefPubMed

Watson DI, Davies N, Devitt PG et al (1999) Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 134:1069–1073CrossRefPubMed

Draaisma WA, Gooszen HG, Tournoij E et al (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19:1300–1308CrossRefPubMed

Myers GA, Harms BA, Starling JR (1995) Management of paraesophageal hernia with a selective approach to antireflux surgery. Am J Surg 170:375–380CrossRefPubMed

Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13:497–502CrossRefPubMed

Swanstrom LL, Jobe BA, Kinzie LR et al (1999) Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 177:359–363CrossRefPubMed

Casabella F, Sinanan M, Horgan S et al (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 171:485–489CrossRefPubMed

Walther B, DeMeester TR, Lafontaine E et al (1984) Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy. Am J Surg 147:111–116CrossRefPubMed

Williamson WA, Ellis FH Jr, Streitz JM Jr et al (1993) Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56:447–451CrossRefPubMed

10.

Fuller CB, Hagen JA, DeMeester TR et al (1996) The role of fundoplication in the treatment of type II paraesophageal hernia. J Thorac Cardiovasc Surg 111:655–661CrossRefPubMed

11.

Velanovich V, Karmy-Jones R (1998) Measuring gastroesophageal reflux disease: relationship between the Health-Related Quality of Life score and physiologic parameters. Am Surg 64:649–653PubMed

12.

de Boer AG, van Lanschot JJ, Stalmeier PF et al (2004) Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Qual Life Res 13:311–320CrossRefPubMed

13.

Rijnhart-de Jong HG, Draaisma WA, Smout AJ et al (2008) The Visick score: a good measure for the overall effect of antireflux surgery? Scand J Gastroenterol 43:787–793CrossRefPubMed

14.

Lundell LR, Dent J, Bennett JR et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45:172–180CrossRefPubMed

15.

Richter JE, Bradley LA, DeMeester TR et al (1992) Normal 24-hr ambulatory esophageal pH values. Influence of study center, pH electrode, age, and gender. Dig Dis Sci 37:849–856CrossRefPubMed

16.

Weusten BL, Roelofs JM, Akkermans LM et al (1994) The symptom-association probability: an improved method for symptom analysis of 24-hour esophageal pH data. Gastroenterology 107:1741–1745PubMed

17.

Draaisma WA, Rijnhart-de Jong HG, Broeders IA et al (2006) Five-year subjective and objective results of laparoscopic and conventional Nissen fundoplication: a randomized trial. Ann Surg 244:34–41CrossRefPubMed

18.

Jobe BA, Aye RW, Deveney CW et al (2002) Laparoscopic management of giant type III hiatal hernia and short esophagus. Objective follow-up at three years. J Gastrointest Surg 6:181–188CrossRefPubMed

19.

Furnée EJ, Draaisma WA, Simmermacher RK et al (2010) Long-term outcome and radiologic assessment of laparoscopic hiatal hernia repair. Am J Surg 199(5):695–701CrossRefPubMed

20.

Aly A, Munt J, Jamieson GG et al (2005) Laparoscopic repair of large hiatal hernias. Br J Surg 92:648–653CrossRefPubMed

21.

Wo JM, Branum GD, Hunter JG et al (1996) Clinical features of type III (mixed) paraesophageal hernia. Am J Gastroenterol 91:914–916PubMed

Title: Tailored or Routine Addition of an Antireflux Fundoplication in Laparoscopic Large Hiatal Hernia Repair: A Comparative Cohort Study
Authors: Edgar J. B. Furnée
Werner A. Draaisma
Hein G. Gooszen
Eric J. Hazebroek
Andre J. P. M. Smout
Ivo A. M. J. Broeders
Publication date: 01-01-2011
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 1/2011
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0814-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Tailored or Routine Addition of an Antireflux Fundoplication in Laparoscopic Large Hiatal Hernia Repair: A Comparative Cohort Study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2011

Hypothermia does Reduce Postoperative Adhesions: Reply

Decreasing Anastomotic Leakage Rate Following Preoperative Radiotherapy and Low Anterior Resection for Rectal Cancer: Reply

Closure of the Cystic Duct During Laparoscopic Cholecystectomy in Children Using the LigaSure Vessel Sealing System

Single Port Access Laparoscopic Cholecystectomy (with video): Letter to the Editor

Thirty-Day Morbidity and Mortality of the Laparoscopic Ileal Interposition Associated with Sleeve Gastrectomy for the Treatment of Type 2 Diabetic Patients with BMI <35: An Analysis of 454 Consecutive Patients

Mucin 1 and Vascular Endothelial Growth Factor C Expression Correlates with Lymph Node Metastatic Recurrence in Patients with N0 Esophageal Cancer After Ivor-Lewis Esophagectomy