Top

Published in:

Open Access 01-05-2014 | Original Article

Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias

Authors: Georg R. Linke, Tobias Gehrig, Lena V. Hogg, Anna Göhl, Hannes Kenngott, Fritz Schäfer, Lars Fischer, Carsten N. Gutt, Beat P. Müller-Stich

Published in: Surgery Today | Issue 5/2014

Abstract

Purpose

Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative.

Methods

In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months.

Results

The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients.

Conclusions

LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.

Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, et al. Laparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg. 2000;190:553–60.PubMedCrossRef

Soper NJ. Laparoscopic management of hiatal hernia and gastroesophageal reflux. Curr Probl Surg. 1999;36:765–838.PubMedCrossRef

Styger S, Ackermann C, Schuppisser JP, Tondelli P. Reflux disease following gastropexy for para-esophageal hiatal hernia. Schweiz Med Wochenschr. 1995;125:1213–5.PubMed

Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, et al. Evidence-based appraisal of antireflux fundoplication. Ann Surg. 2004;239:325–37.PubMedCentralPubMedCrossRef

Heikkinen TJ, Haukipuro K, Bringman S, Ramel S, Sorasto A, Hulkko A. Comparison of laparoscopic and open Nissen fundoplication 2 years after operation. A prospective randomized trial. Surg. Endosc. 2000;14:1019–23.PubMedCrossRef

Booth MI, Jones L, Stratford J, Dehn TC. Results of laparoscopic Nissen fundoplication at 2–8 years after surgery. Br J Surg. 2002;89:476–81.PubMedCrossRef

Williamson WA, Ellis FH Jr, Streitz JM Jr, Shahian DM. Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg. 1993;56:447–51.PubMedCrossRef

Bonavina L, Evander A, DeMeester TR, Walther B, Cheng SC, Palazzo L, et al. Length of the distal esophageal sphincter and competency of the cardia. Am J Surg. 1986;151:25–34.PubMedCrossRef

Allison PR. Reflux esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg. Gynecol. Obstet. 1951;92:419–31.PubMed

10.

Hill LD. An effective operation for hiatal hernia: an eight year appraisal. Ann Surg. 1967;166:681–92.PubMedCentralPubMedCrossRef

11.

Janssen IM, Gouma DJ, Klementschitsch P, van der Heyde MN, Obertop H. Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease. Br J Surg. 1993;80:875–8.PubMedCrossRef

12.

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80.PubMedCentralPubMedCrossRef

13.

Savary M, Miller G. The oesophagus. Handbook and atlas of endoscopy. Solothurn, Switzerland: Gassmann; 1978. p. 119–59.

14.

Muller-Stich BP, Linke GR, Borovicka J, Marra F, Warschkow R, Lange J, et al. Laparoscopic mesh-augmented hiatoplasty as a treatment of gastroesophageal reflux disease and hiatal hernias-preliminary clinical and functional results of a prospective case series. Am J Surg. 2008;195:749–56.PubMedCrossRef

15.

DeMeester TR, Johnson LF, Joseph GJ, Toscano MS, Hall AW, Skinner DB. Patterns of gastroesophageal reflux in health and disease. Ann Surg. 1976;184:459–70.PubMedCentralPubMedCrossRef

16.

Lundell L, Miettinen P, Myrvold HE, Hatlebakk JG, Wallin L, Malm A, et al. Seven-year follow-up of a randomized clinical trial comparing proton-pump inhibition with surgical therapy for reflux oesophagitis. Br J Surg. 2007;94:198–203.PubMedCrossRef

17.

Peterli R, Merki L, Schuppisser JP, Ackermann C, Herzog U, Tondelli P. Postcholecystectomy complaints one year after laparoscopic cholecystectomy. Results of a prospective study of 253 patients. Chirurg. 1998;69:55–60.PubMedCrossRef

18.

Allison PR. Hiatus hernia: (a 20-year retrospective survey). Ann Surg. 1973;178:273–6.PubMedCentralPubMedCrossRef

19.

Treacy PJ, Jamieson GG. An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg. 1987;57:813–7.PubMedCrossRef

20.

Willekes CL, Edoga JK, Frezza EE. Laparoscopic repair of paraesophageal hernia. Ann Surg. 1997;225:31–8.PubMedCentralPubMedCrossRef

21.

Champion JK, Rock D. Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc. 2003;17:551–3.PubMedCrossRef

22.

Krahenbuhl L, Schafer M, Farhadi J, Renzulli P, Seiler CA, Buchler MW. Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach. J Am Coll Surg. 1998;187:231–7.PubMedCrossRef

23.

Muller-Stich BP, Holzinger F, Kapp T, Klaiber C. Laparoscopic hiatal hernia repair: long-term outcome with the focus on the influence of mesh reinforcement. Surg Endosc. 2006;20:380–4.PubMedCrossRef

24.

Swanstrom LL, Jobe BA, Kinzie LR, Horvath KD. Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg. 1999;177:359–63.PubMedCrossRef

25.

Ellis FH Jr, Crozier RE, Shea JA. Paraesophageal hiatus hernia. Arch Surg. 1986;121:416–20.PubMedCrossRef

26.

Geha AS, Massad MG, Snow NJ, Baue AE. A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery. 2000;128:623–30.PubMedCrossRef

27.

Myers GA, Harms BA, Starling JR. Management of paraesophageal hernia with a selective approach to antireflux surgery. Am J Surg. 1995;170:375–80.PubMedCrossRef

28.

Pitcher DE, Curet MJ, Martin DT, Vogt DM, Mason J, Zucker KA. Successful laparoscopic repair of paraesophageal hernia. Arch Surg. 1995;130:590–6.PubMedCrossRef

29.

Rakic S, Pesko P, Dunjic MS, Gerzic Z. Paraoesophageal hernia repair with and without concomitant fundoplication. Br J Surg. 1994;81:1162–3.PubMedCrossRef

30.

Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg. 2002;137:649–52.PubMedCrossRef

31.

Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140:40–8.PubMedCrossRef

32.

Muller-Stich BP, Koninger J, Muller-Stich BH, Schafer F, Warschkow R, Mehrabi A, et al. Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients. Am J Surg. 2009;198:17–24.PubMedCrossRef

33.

Zaninotto G, Portale G, Costantini M, Fiamingo P, Rampado S, Guirroli E, et al. Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg. 2007;31:2177–83.PubMedCrossRef

34.

Spechler SJ, Lee E, Ahnen D, Goyal RK, Hirano I, Ramirez F, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA. 2001;285:2331–8.PubMedCrossRef

35.

Granderath FA, Schweiger UM, Kamolz T, Pointner R. Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap. Surg Endosc. 2005;19:1439–46.PubMedCrossRef

36.

Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ Jr, Michael BL, Hunter JG, et al. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc. 2009;23:1219–26.PubMedCrossRef

37.

Baladas HG, Smith GS, Richardson MA, Dempsey MB, Falk GL. Esophagogastric fistula secondary to Teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus. 2000;13:72–4.PubMedCrossRef

38.

Carlson MA, Condon RE, Ludwig KA, Schulte WJ. Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg. 1998;187:227–30.PubMedCrossRef

39.

Dally E, Falk GL. Teflon pledget reinforced fundoplication causes symptomatic gastric and esophageal lumenal penetration. Am J Surg. 2004;187:226–9.PubMedCrossRef

40.

Griffith PS, Valenti V, Qurashi K, Martinez-Isla A. Rejection of Goretex mesh used in prosthetic cruroplasty: a case series. Int. J. Surg. 2008;6:106–9.PubMedCrossRef

41.

Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, et al. Complications of laparoscopic paraesophageal hernia repair. J. Gastrointest. Surg. 1997;1:221–7.PubMedCrossRef

42.

Zilberstein B, Eshkenazy R, Pajecki D, Granja C, Brito AC. Laparoscopic mesh repair antireflux surgery for treatment of large hiatal hernia. Dis Esophagus. 2005;18:166–9.PubMedCrossRef

43.

Targarona EM, Bendahan G, Balague C, Garriga J, Trias M. Mesh in the hiatus: a controversial issue. Arch Surg. 2004;139:1286–96.PubMedCrossRef

Title: Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias
Authors: Georg R. Linke
Tobias Gehrig
Lena V. Hogg
Anna Göhl
Hannes Kenngott
Fritz Schäfer
Lars Fischer
Carsten N. Gutt
Beat P. Müller-Stich
Publication date: 01-05-2014
Publisher: Springer Japan
Published in: Surgery Today / Issue 5/2014
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-013-0609-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2014

Severe postoperative hemorrhage caused by antibody-mediated coagulation factor deficiencies: report of two cases

Hepatopancreatoduodenectomy for anastomotic recurrence from residual cholangiocarcinoma: report of a case

Is a small-bore catheter efficient for most pleural pathologies?

Long-term outcome of laparoscopic-assisted right-hemicolectomy with D3 lymphadenectomy versus open surgery for colon carcinoma

Successful lung lobectomy for a lung cancer following thoracic endovascular aortic repair for a thoracic aortic aneurysm: report of a case

Inguinal hernia repair with the mesh plug method is safe after radical retropubic prostatectomy