Pledgeted repair of giant hiatal hernia provides excellent long-term results

Kang, Thomas, Urrego, Hernan, Gridley, Asahel and Richardson, William S. (2014) Pledgeted repair of giant hiatal hernia provides excellent long-term results. Journal of Laparoendoscopic and Advanced Surgical Techniques, 24 10: 684-687. doi:10.1089/lap.2013.0447


Author Kang, Thomas
Urrego, Hernan
Gridley, Asahel
Richardson, William S.
Title Pledgeted repair of giant hiatal hernia provides excellent long-term results
Journal name Journal of Laparoendoscopic and Advanced Surgical Techniques   Check publisher's open access policy
ISSN 1092-6429
1557-9034
Publication date 2014-10-01
Sub-type Article (original research)
DOI 10.1089/lap.2013.0447
Volume 24
Issue 10
Start page 684
End page 687
Total pages 4
Place of publication New Rochelle, NY, United States
Publisher Mary Ann Liebert
Collection year 2015
Language eng
Formatted abstract
Background: Use of mesh in hiatal hernia repairs is a topic of debate. We present our experience in laparoscopic primary (nonmesh) repair of giant hiatal hernia.

Materials and Methods: All laparoscopic antireflux procedures done by a single surgeon from November 1997 to October 2006 were retrospectively reviewed. Inclusion criteria were primary crural closure with pledgets and giant hiatal hernia (greater than one-third of the stomach in the chest by esophagram, greater than 5 cm in length endoscopically, or greater than one-third of the stomach in the chest operatively). We attempted to reach all patients who met inclusion criteria and administered the Reflux Symptom Index (RSI) and Quality of Life Scale for Gastroesophageal Reflux Disease (QLSGR) questionnaires.

Results: In total, 89 patients met inclusion criteria. The male-to-female ratio was 32:57. Average age was 62.7 years. Average body mass index was 29.3 kg/m2. Average length of stay was 2 days, and mean clinic follow-up was 161 days. At the most recent follow-up, 62% of patients were asymptomatic. The most common postoperative symptoms were dysphagia (16%), reflux/emesis (5%), bloating (5%), nausea (4%), epigastric pain (4%), and heartburn (3%). There were six (6.7%) recurrences on esophagogastroduodenoscopy or upper gastrointestinal examination. Five patients with recurrence were symptomatic. Of the 89 patients, 29 (33%) completed the questionnaire, with a mean follow-up of 69.7 months. Average RSI score was 12 (maximum possible score, 45). In six of nine categories, the average score was less than 1 (possible score, 0–5). Average QLSGR score was 12 (maximum possible score, 45). For satisfaction with the present condition, the average score was 4.34 (maximum score, 5), and 82.7% of respondents were satisfied or very satisfied with their present condition.

Conclusions: Laparoscopic primary repair of giant hiatal hernia provides excellent long-term results. We found that 62% of patients were asymptomatic at the last follow-up and that 82% of respondents were satisfied or very satisfied. The recurrence rate was 6.7%.
Keyword Laparoscopic mesh hiatoplasty
Paraesophageal hernia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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