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




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Surgery Today

, Volume 44, Issue 5, pp 820–826

First Online: 14 May 2013Received: 12 November 2012Accepted: 04 March 2013

Abstract

PurposeLaparoscopic 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.

MethodsIn 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.

ResultsThe 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.

ConclusionsLMAH 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.

KeywordsGastroesophageal reflux disease Anti-reflux surgery Laparoscopic mesh-augmented hiatoplasty Fundoplication Mesh reinforcement G.R. Linke and T. Gehrig contributed equally to this work.

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Author: Georg R. Linke - Tobias Gehrig - Lena V. Hogg - Anna Göhl - Hannes Kenngott - Fritz Schäfer - Lars Fischer - Carsten N

Source: https://link.springer.com/article/10.1007/s00595-013-0609-2



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