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Hernia
Published in: Hernia 2/2019

Open Access 01-04-2019 | Esophagography | Original Article

Short-term results after laparoscopic repair of giant hiatal hernias with pledgeted sutures: a retrospective analysis

Authors: M. Weitzendorfer, R. Pfandner, S. A. Antoniou, C. Schwaiger-Hengstschläger, K. Emmanuel, O. O. Koch

Published in: Hernia | Issue 2/2019

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Abstract

Purpose

This study investigates if pledgeted sutures for hiatal closure could be an alternative to mesh for the surgical treatment of large hiatal hernia.

Methods

Forty-one patients who underwent laparoscopic 270° Toupet fundoplication with pledgeted sutured crura between September 2014 and April 2017 were evaluated with regard to recurrence of hiatal hernia at 3 months and 1 year after surgery. Indication for pledgets was a hiatal surface area of at least 5.60 cm2, or migration of more than 1/3 of the stomach into the thorax or preoperative hernia size > 5 cm. The integrity of repair was assessed using a barium swallow test 3 months and 1 year after surgery.

Results

All operations could be completed laparoscopically with no intraoperative complications. Until study end no complications related to the pledgets have occurred. Forty-four of 50 patients (88.0%) completed the follow-up radiographic examination 3 months (mean 12.7 weeks) after surgery, and 37 patients (74.0%; mean 55.1 weeks) 1 year after surgery. Postoperative recurrence was diagnosed in 3/44 patients (6.8%) at 3 months, and in 4/37 patients (10.8%) at 1 year follow-up. Only one patient was symptomatic, 1 year after surgery (2.7%). All other patients with reherniations were asymptomatic at time of the study.

Conclusions

Utilization of pledgets to reinforce hiatal sutures seems safe and shows a quite low early recurrence rate compared to other methods. Long-term data will allow firm conclusions as to whether pledgeted sutures are an appropriate solution for the treatment of giant hiatal hernias.
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Metadata
Title
Short-term results after laparoscopic repair of giant hiatal hernias with pledgeted sutures: a retrospective analysis
Authors
M. Weitzendorfer
R. Pfandner
S. A. Antoniou
C. Schwaiger-Hengstschläger
K. Emmanuel
O. O. Koch
Publication date
01-04-2019
Publisher
Springer Paris
Published in
Hernia / Issue 2/2019
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-019-01890-3

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