Subjective outcome after laparoscopic hiatal hernia repair for intrathoracic stomach

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Abstract

Purpose

For decades, an intrathoracic stomach (ITS) has been a definite indication for surgery due to the perceived risk of an acute volvulus with perforation, gangrene, or hemorrhage. At the present time, elective laparoscopic repair is the first choice for treatment of ITS. There is a lack of evidence in the long-term quality of life after a hiatal hernia repair for an intrathoracic stomach.

Methods

A retrospective analysis was performed on all patients undergoing a hiatal hernia repair for an intrathoracic stomach between January 2004 and January 2015. Additionally, to a hiatal closure, the patients received an antireflux procedure. Outcome measures included patient characteristics, operative details, complications, and postoperative morbidity and mortality. All patients were sent a quality of life questionnaire to assess long-term quality of life and patient satisfaction. A higher quality of life score represents a better quality of life.

Results

Eighty-six patients underwent laparoscopic repair for ITS, from which, one patient died during surgery. Eighty-five patients were contacted and 81 completed the questionnaire, resulting in a response rate of 95.3 %. At a median follow-up of 2.7 years (range 0.1–9.6), the mean quality of life score was 13.5 (standard deviation 2.8). The mean overall satisfaction was 8.4.

There were four recurrences: three in the first 12 days after surgery and one in 2.4 years.

Conclusions

Very good results in patient satisfaction and symptom reduction were achieved after a median follow-up of 2.7 years in this laparoscopic repair of the intrathoracic stomach single center experience study. The symptomatic recurrence rate was very low.

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Most cited references 20

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Symptomatic reflux disease: the present, the past and the future

Guy E. Boeckxstaens, Hashem El-Serag, André Smout … (2014)

The worldwide incidence of GORD and its complications is increasing along with the exponentially increasing problem of obesity. Of particular concern is the relationship between central adiposity and GORD complications, including oesophageal adenocarcinoma. Driven by progressive insight into the epidemiology and pathophysiology of GORD, the earlier belief that increased gastroesophageal reflux mainly results from one dominant mechanism has been replaced by acceptance that GORD is multifactorial. Instigating factors, such as obesity, age, genetics, pregnancy and trauma may all contribute to mechanical impairment of the oesophagogastric junction resulting in pathological reflux and accompanying syndromes. Progression of the disease by exacerbating and perpetuating factors such as obesity, neuromuscular dysfunction and oesophageal fibrosis ultimately lead to development of an overt hiatal hernia. The latter is now accepted as a central player, impacting on most mechanisms underlying gastroesophageal reflux (low sphincter pressure, transient lower oesophageal sphincter relaxation, oesophageal clearance and acid pocket position), explaining its association with more severe disease and mucosal damage. Since the introduction of proton pump inhibitors (PPI), clinical management of GORD has markedly changed, shifting the therapeutic challenge from mucosal healing to reduction of PPI-resistant symptoms. In parallel, it became clear that reflux symptoms may result from weakly acidic or non-acid reflux, insight that has triggered the search for new compounds or minimally invasive procedures to reduce all types of reflux. In summary, our view on GORD has evolved enormously compared to that of the past, and without doubt will impact on how to deal with GORD in the future.

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Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.

R. J. Fitzgibbons, Mohammad Sherif, Vinay K. Mittal … (2009)

Primary laparoscopic hiatal hernia repair is associated with up to a 42% recurrence rate. This has lead to the use of mesh for crural repair, which has resulted in an improved recurrence rate (0-24%). However, mesh complications have been observed. We compiled two cases, and our senior author contacted other experienced esophageal surgeons who provided 26 additional cases with mesh-related complications. Care was taken to retrieve technical operative details concerning mesh size and shape and implantation technique used. Twenty-six patients underwent laparoscopic and two patients open surgery for large hiatal hernia (n = 28). Twenty-five patients had a concomitant Nissen fundoplication, two a Toupet fundoplication, and one a Watson fundoplication. Mesh types placed were polypropylene (n = 8), polytetrafluoroethylene (PTFE) (n = 12), biological mesh (n = 7), and dual mesh (n = 1). Presenting symptoms associated with mesh complications were dysphagia (n = 22), heartburn (n = 10), chest pain (n = 14), fever (n = 1), epigastric pain (n = 2), and weight loss (n = 4). Main reoperative findings were intraluminal mesh erosion (n = 17), esophageal stenosis (n = 6), and dense fibrosis (n = 5). Six patients required esophagectomy, two patients had partial gastrectomy, and 1 patient had total gastrectomy. Five patients did not require surgery. In this group one patient had mesh removal by endoscopy. There was no immediate postoperative mortality, however one patient has severe gastroparesis and five patients are dependent on tube feeding. Two patients died 3 months postoperatively of unknown cause. There is no apparent relationship between mesh type and configuration with the complications encountered. Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.

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Use of Mesh in Laparoscopic Paraesophageal Hernia Repair: A Meta-Analysis and Risk-Benefit Analysis

Beat Müller-Stich, Hannes Kenngott, Matthias Gondan … (2015)

Introduction Mesh augmentation seems to reduce recurrences following laparoscopic paraesophageal hernia repair (LPHR). However, there is an uncertain risk of mesh-associated complications. Risk-benefit analysis might solve the dilemma. Materials and Methods A systematic literature search was performed to identify randomized controlled trials (RCTs) and observational clinical studies (OCSs) comparing laparoscopic mesh-augmented hiatoplasty (LMAH) with laparoscopic mesh-free hiatoplasty (LH) with regard to recurrences and complications. Random effects meta-analyses were performed to determine potential benefits of LMAH. All data regarding LMAH were used to estimate risk of mesh-associated complications. Risk-benefit analysis was performed using a Markov Monte Carlo decision-analytic model. Results Meta-analysis of 3 RCTs and 9 OCSs including 915 patients revealed a significantly lower recurrence rate for LMAH compared to LH (pooled proportions, 12.1% vs. 20.5%; odds ratio (OR), 0.55; 95% confidence interval (CI), 0.34 to 0.89; p = 0.04). Complication rates were comparable in both groups (pooled proportions, 15.3% vs. 14.2%; OR, 1.02; 95% CI, 0.63 to 1.65; p = 0.94). The systematic review of LMAH data yielded a mesh-associated complication rate of 1.9% (41/2121; 95% CI, 1.3% to 2.5%) for those series reporting at least one mesh-associated complication. The Markov Monte Carlo decision-analytic model revealed a procedure-related mortality rate of 1.6% for LMAH and 1.8% for LH. Conclusions Mesh application should be considered for LPHR because it reduces recurrences at least in the mid-term. Overall procedure-related complications and mortality seem to not be increased despite of potential mesh-associated complications.

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Author and article information

Contributors

M. C. G. Van de Poll: +31 (0)43 387 6543 , mcg.vandepoll@maastrichtuniversity.nl

J. F. Smulders: +31 (0)40 239 9111 , frans.smulders@catharinaziekenhuis.nl

Journal

Journal ID (nlm-ta): Langenbecks Arch Surg

Journal ID (iso-abbrev): Langenbecks Arch Surg

Title: Langenbeck's Archives of Surgery

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 1435-2443

ISSN (Electronic): 1435-2451

Publication date (Electronic): 9 November 2016

Publication date PMC-release: 9 November 2016

Publication date (Print): 2017

Volume: 402

Issue: 3

Pages: 521-530

Affiliations

[1 ]ISNI 0000 0004 0398 8384, GRID grid.413532.2, Departement of Surgery, , Catharina Hospital Eindhoven, ; Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands

[2 ]Departement of Surgery, MUMC+, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands

[3 ]Department of Intensive Care Medicine, MUMC+, P. Debeyelaan 25, 6229 HX Maastricht, The Netherlands

[4 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, School of Nutrition and Translational Research in Medicine, , Maastricht University, ; Maastricht, The Netherlands

Article

Publisher ID: 1504

DOI: 10.1007/s00423-016-1504-2

PMC ID: 5410206

PubMed ID: 27830367

SO-VID: 2d4b8513-cbd2-475b-aa67-d042b7d79e51

License:

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 10 February 2016

Date accepted : 4 July 2016

Custom metadata

ScienceOpen disciplines: Surgery

Keywords: intrathoracic stomach,hiatal hernia,nissen,fundoplication,quality of life,long-term follow-up

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ScienceOpen disciplines: Surgery

Keywords: intrathoracic stomach, hiatal hernia, nissen, fundoplication, quality of life, long-term follow-up

Subjective outcome after laparoscopic hiatal hernia repair for intrathoracic stomach

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Karger: Oncology

Most cited references 20

Symptomatic reflux disease: the present, the past and the future

Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series.

Use of Mesh in Laparoscopic Paraesophageal Hernia Repair: A Meta-Analysis and Risk-Benefit Analysis

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