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Randle RJ, Liou DZ, Lui NS. Management of Paraesophageal Hernias. Thorac Surg Clin 2024; 34:163-170. [PMID: 38705664 DOI: 10.1016/j.thorsurg.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Paraesophageal hernias are classified according to the altered anatomic relationships between the gastroesophageal junction or stomach and the diaphragmatic hiatus. Herniation of these structures into the mediastinum may produce common complaints such as reflux, chest pain, and dysphagia. The elective repair of these hernias is well tolerated and significantly improves quality of life among patients with symptomatic disease. The hallmarks of a quality repair include the circumferential mobilization of the esophagus to generate 3 cm of tension-free intra-abdominal length and the performance of a fundoplication.
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Affiliation(s)
- Ryan J Randle
- Department of Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Mail Code L223, Portland, OR, USA; Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305, USA. https://twitter.com/radonrandle
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305, USA. https://twitter.com/DouglasLiou
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford School of Medicine, 300 Pasteur Drive, Falk Building, Stanford, CA 94305, USA.
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El-Magd ESA, Elgeidie A, Elmahdy Y, El Sorogy M, Elyamany MA, Abulazm IL, Abbas A. Impact of laparoscopic repair on type III/IV giant paraesophageal hernias: a single-center experience. Hernia 2023; 27:1555-1570. [PMID: 37642773 DOI: 10.1007/s10029-023-02851-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/14/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Giant paraesophageal hernia (GPEH) is a challenging problem for surgeons because of its high recurrence rate. This study was conducted to compare the outcomes in type IV vs. type III GPEHs after laparoscopic repair. Other outcomes included peri-operative morbidity and long-term quality of life. METHODS A retrospective analysis of 130 GPEH patients in a period between 2010 and 2019 underwent a tailored laparoscopic repair in our tertiary center with a minimum follow-up of 48 months. Operative steps included hernial sac excision, crural repair, relaxing incisions, and mesh cruroplasty with special indications. RESULTS The study enrolled 90 patients with type III and 40 patients with type IV GPEH. Type IV GPEH patients were older, more fragile, and scored worse on ASA classification, aside from having a more challenging surgical technique (wider crura, weaker muscles, increased need for release incisions, and mesh cruroplasty).Type IV GPEHs had a prolonged operative durations, and a higher conversion rate. Additionally, the same group showed increased morbidity, mortality, and re-operation rates. With a mean follow-up of 65 months (range 48-150 months), the incidence of recurrence was 20.7%, with an increased incidence in type IV GPEH (37.5% vs. 13.33% in type III GPEH). Type IV GPEH, low pre-operative albumin, larger crural defect, and low surgeon experience were significant risk factors for recurrence after laparoscopic repair of GPEH. CONCLUSION Type IV GPEH has a higher peri-operative morbidity and recurrence rate; so, a more tailored laparoscopic repair with a high surgeon experience is needed.
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Affiliation(s)
- E-S A El-Magd
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.
- Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Mansoura, 35511, Al Dakahlia Governorate, Egypt.
| | - A Elgeidie
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Y Elmahdy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M El Sorogy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M A Elyamany
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - I L Abulazm
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - A Abbas
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Sovpel IV, Sedakov IE, Sovpel OV, Shapovalova YA, Balaban VV. [Surgical treatment of hiatal hernia complicated by short esophagus: a prospective study]. Khirurgiia (Mosk) 2023:31-38. [PMID: 37186648 DOI: 10.17116/hirurgia202305131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To analyze immediate and long-term postoperative results in patients with hiatal hernia complicated by short esophagus. MATERIAL AND METHODS We prospectively analyzed postoperative outcomes in 113 patients with hiatal hernia who underwent surgery between 2013 and 2021. The main group consisted of 54 patients with length of intra-abdominal segment of esophagus <4 cm who underwent Collis procedure or esophagus >4 cm and indications for Nissen fundoplication cuff. The control group consisted of 59 patients and indications for esophageal lengthening procedure only if length of intra-abdominal segment of esophagus was less than 2 cm. This surgery was started with anterolateral vagotomy, and Collis procedure was performed in case of ineffective vagotomy. Nissen fundoplication was performed for abdominal segment of esophagus >2 cm. RESULTS In the main group, 17 (31.5%) patients with intra-abdominal segment of esophagus <4 cm required Collis procedure. In the control group, length of intra-abdominal segment of esophagus <2 cm was observed in 6 (10.2%) patients. In all cases, anterolateral vagotomy was performed. Surgery time was 189 (80-290) and 136 (90-320) min, respectively (p=0.001). Postoperative complications in the main group occurred in 8 (14.8%) patients, in the control group - 4 (6.8%) patients (p=0.281). One (1.7%) patient died in the control group. The follow-up period was 38 (12-66) months. In long-term period, recurrence developed in 2 (3.7%) and 11 (20%) patients, respectively (p=0.026). High satisfaction with postoperative outcomes was observed in 51 (94.4%) and 46 (79.3%) patients, respectively (p=0.038). CONCLUSION Uncorrected shortening of the esophagus can be one of the main risk factors of recurrence in long-term period. Expanding the indications for Collis gastroplasty can reduce the incidence of poor outcomes without affecting the incidence of postoperative complications.
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Affiliation(s)
- I V Sovpel
- Gorky Donetsk National Medical University, Donetsk, Russia
- Professor Bondar Republican Cancer Center, Donetsk, Russia
| | - I E Sedakov
- Gorky Donetsk National Medical University, Donetsk, Russia
- Professor Bondar Republican Cancer Center, Donetsk, Russia
| | - O V Sovpel
- Gorky Donetsk National Medical University, Donetsk, Russia
- Professor Bondar Republican Cancer Center, Donetsk, Russia
| | - Yu A Shapovalova
- Gorky Donetsk National Medical University, Donetsk, Russia
- Professor Bondar Republican Cancer Center, Donetsk, Russia
| | - V V Balaban
- Sechenov First Moscow State Medical University, Moscow, Russia
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True Short Esophagus in Gastroesophageal Reflux Disease: Old Controversies With New Perspectives. Ann Surg 2021; 274:331-338. [PMID: 31490280 DOI: 10.1097/sla.0000000000003582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To explore the true short esophagus (TSE) frequency and long-term results of patients undergoing gastroesophageal reflux disease (GERD) or hiatus hernia (HH) surgery. BACKGROUND The existence and treatment of TSE during GERD/HH surgery is controversial. Satisfactory long-term results have been achieved with and without surgical techniques dedicated to TSE. METHODS In 311 consecutive patients undergoing minimally invasive surgery for GERD/HH, the distance between the endoscopically-localized gastroesophageal junction (GEJ) and the apex of the diaphragmatic hiatus after maximal thoracic esophagus mobilization was measured. A standard Nissen fundoplication (SN) was performed in cases with an abdominal length >1.5 cm; in cases of TSE (abdominal length <1.5 cm), a Collis-Nissen (CN) or stomach around the stomach fundoplication (SASF) in elderly patients was performed. The fundoplication superior margin was fixed below the hiatus, but over the GEJ. The patients' symptoms, and radiological and endoscopic data were pre/postoperatively recorded. RESULTS After intrathoracic esophageal mobilization (median 9 cm), TSE was diagnosed in 31.8% of 311 cases. With a median follow-up of 96 months (309 patients), HH relapse was radiologically diagnosed in 3.2% of patients, with excellent, good, fair, and poor outcomes in 45.6%, 44.3%, 6.2%, and 3.9% of cases, respectively, and no significant differences among SN (68.5%), CN (26.4%), and SASF (5.2%). CONCLUSIONS TSE was present in 31.8% of patients routinely submitted to GERD/HH surgery. In the presence of TSE, CN and SASF performed according to determined surgical principles may achieve similar satisfactory results. This finding warrants confirmation with a prospective multicenter study.
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Sovpel IV, Ishchenko RV, Sedakov IE, Sovpel OV, Balaban VV. [Collis gastroplasty in surgical treatment of hiatal hernia]. Khirurgiia (Mosk) 2021:30-37. [PMID: 34029033 DOI: 10.17116/hirurgia202106130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the early and long-term postoperative outcomes after Collis gastroplasty in the treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease and shortening of the esophagus. MATERIAL AND METHODS Postoperative outcomes after Collis gastroplasty were analyzed in 22 patients with hiatal hernia and shortening of the esophagus. The control group consisted of 166 patients after simple repair of hiatal hernia without Collis procedure. RESULTS In case of Collis gastroplasty, surgery time was 185 (160-250) min. Intraoperative complications were observed in 3 (13.6%) patients, incidence of postoperative complications - 18.2%. There were no lethal outcomes in this group of patients. Mild functional dysphagia was observed in 2 (9.1%) patients. Length of hospital stay was 7.8±2.4 days. Mean follow-up was 34 (6-52) months. There were no anatomical recurrences. A relapse of gastroesophageal reflux was noted in 1 (4.6%) case. GERD-HRQL score was 4.8±2.2 points. Additional Collis gastroplasty did not affect the immediate and long-term results of surgical treatment in comparison with simple cruroraphy and fundoplication. CONCLUSION Unreduced shortening of the esophagus may be followed by high incidence of recurrent hiatal hernia and GERD in long-term period. In case of shortening of the esophagus, surgery should include Collis gastroplasty. This effective and safe procedure does not impair treatment outcomes. Indications and optimal technique of Collis gastroplasty require clarification and further research.
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Affiliation(s)
- I V Sovpel
- Gorky Donetsk National Medical University, Donetsk, Ukraine.,Bondar Republican Oncology Center, Donetsk, Ukraine
| | - R V Ishchenko
- Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies, Moscow, Russia
| | - I E Sedakov
- Gorky Donetsk National Medical University, Donetsk, Ukraine.,Bondar Republican Oncology Center, Donetsk, Ukraine
| | - O V Sovpel
- Gorky Donetsk National Medical University, Donetsk, Ukraine.,Bondar Republican Oncology Center, Donetsk, Ukraine
| | - V V Balaban
- Sechenov First Moscow State Medical University, Moscow, Russia
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Lal P, Tang A, Sarvepalli S, Raja S, Thota P, Lopez R, Murthy S, Ray M, Gabbard S. Manometric Esophageal Length to Height (MELH) Ratio Predicts Hiatal Hernia Recurrence. J Clin Gastroenterol 2020; 54:e56-e62. [PMID: 31985712 DOI: 10.1097/mcg.0000000000001316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION The shortened esophagus is poorly defined and is determined intraoperatively, as there exists no objective test to identify a shortened esophagus before surgical hiatal hernia repair. We devised a unique manometric esophageal length to height (MELH) ratio to define the presence of a shortened esophagus and examined the role of esophageal length in hiatal hernia recurrence. PATIENTS AND METHODS A retrospective review identified 254 patients with hiatal hernia who underwent preoperative esophageal manometry and either an open hernia repair with Collis gastroplasty and fundoplication (with Collis) or laparoscopic repair and fundoplication without Collis gastroplasty (without Collis) from 2005-2016. The MELH ratio was calculated by measuring the upper to lower esophageal sphincter distance divided by the patient's height. RESULTS Of 245 patients, 157 underwent repair with Collis, while 97 underwent repair without Collis. The Collis group had a shorter manometric esophageal length (20.2 vs. 22.4 cm, P<0.001) and lower MELH (0.12 vs. 0.13, P<0.001). The Collis group had fewer hernia recurrences (18% vs. 55%, log-rank P<0.001) and fewer reoperations for recurrence (0% vs. 10%, log-rank P<0.001) at 5 years. A 33% decrease in risk of hernia recurrence was seen for every 0.01 U increment in MELH ratio (hazard ratio: 0.67; 95% confidence interval: 0.55-0.83, P<0.001) while repair without Collis (hazard ratio: 6.1; 95% confidence interval: 3.2-11.7, P<0.001) was associated with increased risk of hernia recurrence. CONCLUSION MELH ratio is an objective predictor of a shortened esophagus preoperatively. Lower MELH is associated with increased risk of recurrence and the risk associated with shortened esophagus can be mitigated with an esophageal lengthening procedure such as Collis gastroplasty.
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Affiliation(s)
| | | | | | | | | | - Rocio Lopez
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
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Lu R, Addo A, Broda A, Sanford Z, Weltz A, Zahiri HR, Park A. Update on the Durability and Performance of Collis Gastroplasty For Chronic GERD and Hiatal Hernia Repair At 4-Year Post-Intervention. J Gastrointest Surg 2020; 24:253-261. [PMID: 31768831 DOI: 10.1007/s11605-019-04438-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/19/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Collis gastroplasty (CG) remains an important procedure to lengthen the esophagus when indicated in patients undergoing fundoplication for longstanding refractory gastroesophageal reflux disease (GERD) or large hiatal hernias. Concerns over potential sequelae of CG such as dysphagia and worsening heartburn as well as questions regarding the durability of the procedure remain a subject of debate. In this study, 3 and 4-year postoperative data is presented assessing patient quality of life (QOL) measures for those undergoing laparoscopic antireflux surgery (LARS) with and without CG. METHODS Comparative review of a prospectively maintained GERD patient database was conducted between patients undergoing LARS with CG versus non-CG (NC) at two institutions between October 2004 and February 2019. Patient demographic, perioperative, and QOL data was analyzed at 3 and 4 years postoperatively using four validated instruments: the Reflux Symptom Index (RSI), Laryngopharyngeal Reflux QOL (LPR-QOL), Swallowing QOL (SWAL), and Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQOL) surveys. RESULTS A total of 214 CG and 798 NC patients were included in this study. The CG group was older (66.1 ± 12.9 vs. 59.0 ± 14.1, p < 0.001), had a higher frequency of ASA class 3 patients (39.7% vs. 29.7%), and had greater proportion of comorbid disease compared to NG. The groups were parallel in BMI (Collis 28.4 ± 5.2 kg/m2 vs. non-Collis 28.6 ± 5.3 kg/m2, p = 0.673). Subset analysis revealed persistent benefits through 4 years reflected by survey results in both groups. There were no statistically significant differences in QOL outcomes between CG and NC. A majority of patients in both groups reported discontinuation of antireflux medications and satisfaction with surgical outcomes and symptom control. CONCLUSION Long-term QOL outcomes after laparoscopic CG are comparable to patients treated with fundoplication alone in cases of long-standing GERD and hiatal hernias. Furthermore, CG patients enjoyed equivalent durability of the procedure without risk of subsequent dysphagia. Collis gastroplasty remains an important tool in the armamentarium of foregut surgeons.
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Affiliation(s)
- Richard Lu
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - Alex Addo
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - Andrew Broda
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - Zachary Sanford
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - Adam Weltz
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - H Reza Zahiri
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA
| | - Adrian Park
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, 21401, USA.
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Vidal Piñeiro L, Pascotto B, Azagra Soria JS. Robotic approach for Collis gastroplasty. Cir Esp 2020; 98:288-291. [PMID: 31980153 DOI: 10.1016/j.ciresp.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
Abstract
The true short esophagus is an entity of controversy among surgeons. Studies have been published about its diagnosis and laparoscopic treatment, without existing to date, publication of the treatment with robotic approach. We present, as a case report, our experience in robotic surgery for hiatal hernia with true short esophagus treated with Collis gastroplasty and Toupet fundoplication. Robotic surgery on the true short esophagus can facilitate mediastinal dissection and allow a more accurate suture technique. Studies are needed to compare the long-term results of this surgical technique between the conventional laparoscopic approach and the robotic approach.
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Affiliation(s)
- Laura Vidal Piñeiro
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo.
| | - Beniamino Pascotto
- Departamento de Cirugía General y Visceral, Centro Hospitalario de Luxemburgo, Luxemburgo, Luxemburgo
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Manrique-Mendoza AR, González-Muñoz A, Reyes Ó, González JR. Herniorrafia hiatal y fundoplicatura laparoscópica de Toupet en un paciente con esófago corto. REVISTA COLOMBIANA DE CIRUGÍA 2019. [DOI: 10.30944/20117582.522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
El esófago corto es una complicación infrecuente del reflujo gastroesofágico, polémico para algunos autores. Su diagnóstico se hace de manera intraoperatoria, ante la imposibilidad de conservar un esofago intrabdominal mayor a tres centímetros desde el hiato diafragmático. Algunos expertos niegan la existencia de esta entidad, argumentando que se debe a una mala disección del esófago.
En este artículo, se presenta el caso de un paciente sometido a herniorrafia hiatal con colocación de malla, con gran dificultad para conservar una adecuada longitud del esófago abdominal, y que no requirió gastroplastia.
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Radovanovic D, Pavlovic M, Canovic D, Lazic D, Cvetkovic A, Spasic M, Stojanovic B, Milosevic B. The Collis Procedure and the Acquired Short Esophagus. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.1515/sjecr-2016-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
One of the most intriguing problems in modern esophageal surgery is the acquired short esophagus. While some authors recognize this entity, others deny its existence. There is a consensus about types of the short esophagus, its etiology and pathophysiology. Definitive diagnosis can be established only intraoperatively. There are a few surgical procedures for this problem, and most frequently is used Collis gastroplasty with fundoplication. In this review we emphasize recent literature data and further perspectives of the Collis procedure.
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Affiliation(s)
- Dragce Radovanovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Mladen Pavlovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Dragan Canovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Dejan Lazic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Aleksandar Cvetkovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Marko Spasic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Bojan Stojanovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Bojan Milosevic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
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Shrestha AK, Joshi M, DeBono L, Naeem K, Basu S. Laparoscopic repair of type III/IV giant para-oesophageal herniae with biological prosthesis: a single centre experience. Hernia 2019; 23:387-396. [PMID: 30661178 DOI: 10.1007/s10029-019-01888-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 01/09/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Repair of giant paraoesophageal herniae (GPEH) is technically challenging and requires significant experience in advanced foregut surgery. Controversy continues on suture versus mesh cruroplasty with the most recent systematic review and meta-analysis putting the onus on the operating surgeon. Study aim was to review whether the biological prosthesis (non-cross-linked bovine pericardium and porcine dermis) and the technique adopted for patients with GPEH had an influence on clinical and radiological recurrences. METHOD A retrospective analysis of a prospectively collected data of 60 consecutive patients with confirmed 5 cm hiatus hernia and ≥ 30% stomach displacement in the thorax that were operated in the upper gastrointestinal unit of a large district general hospital between September 2010 and August 2017. Pre and post-surgery Gastro-Oesophageal Reflux Disease Questionnaire [(GORD-HRQOL)] and a follow up contrast study were completed. RESULTS 60 included 2 (3%) and 58 (97%) emergency and elective procedures respectively with a male: female ratio of 1:3, age 71* (Median) (42-89) years, BMI 29* (19-42) and 26 (43%) with ASA III/IV. Investigations confirmed 46* (37-88) mm and 42* (34-77) mm transverse and antero-posterior hiatal defect respectively with 60* (30-100)% displacement of stomach into chest. Operative time and length of stay was 180* (120-510) minutes and 2* (1-30) days respectively. One (2%) converted for bleeding and 2 (3%) peri-operative deaths. Five (8%), 5 (8%) and 4 (7%) have dysphagia, symptomatic and radiological recurrences respectively. GORD-HRQOL recorded preoperatively was 27* (10-39) dropping significantly postoperatively to 0* (0-21) (P < 0.005) with 95% patient satisfaction at a follow up of 60* (36-84) months. CONCLUSIONS Our technique of laparoscopic GPEH repair with biological prosthesis is safe with a reduced symptomatic and radiological recurrence and an acceptable morbidity and mortality.
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Affiliation(s)
- A K Shrestha
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - M Joshi
- Department of General Surgery, East Kent Hospitals University NHS Foundation Trust (EKHUFT), Ashford, Kent, UK
| | - L DeBono
- Department of Surgery, One Ashford Hospital, Willesborough, Ashford, Kent, UK
| | - K Naeem
- Department of Radiology, EKHUFT, Ashford, Kent, UK
| | - S Basu
- Department of Surgery, EKHUFT, Ashford, Kent, UK. .,Department of Surgery, William Harvey Hospital, Ashford, Kent, TN24 0LZ, UK.
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Alzaghal AA, Salman R, Berjawi G, Haddad M, Naffaa L. The short esophagus: Review of a neglected entity. Clin Imaging 2018; 50:43-50. [DOI: 10.1016/j.clinimag.2017.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/22/2017] [Accepted: 12/12/2017] [Indexed: 10/18/2022]
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Patients are well served by Collis gastroplasty when indicated. Surgery 2017; 162:568-576. [DOI: 10.1016/j.surg.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/21/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023]
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Hiatal hernia repair with or without esophageal lengthening: is there a difference? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 8:341-7. [PMID: 24346582 DOI: 10.1097/imi.0000000000000012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The need for esophageal lengthening (EL) as part of hiatal hernia (HH) repair is perceived to elevate perioperative risk and provide functionally inferior outcomes. Our objectives were to determine the risk factors of undergoing EL and to compare outcomes between operations with and without EL. We hypothesized that operative and functional outcomes for HH repair were similar in patients whether they required EL or not. METHODS We reviewed institutional experience with EL as part of HH repair. The patients underwent symptom evaluation before and after surgery using a validated tool. RESULTS Between 1999 and 2009, a total of 375 patients underwent HH repair. The operative approach was thoracotomy, 153 (41%); laparotomy, 18 (5%); laparoscopy, 167 (44%); or combined, 37 (10%). Of these, 168 (45%) required EL. There was a higher need for thoracotomy in the patients undergoing EL (79/168 vs 74/207, χ = 4.88, P = 0.034). The incidence of perioperative complications (leak, pneumonia, ileus, respiratory failure, and bleeding) was similar between the groups. Sixty-five selected patients undergoing EL were compared with 63 patients with comparable demographics not requiring EL. In a well-validated questionnaire that assessed symptoms before and after surgery, the patients undergoing EL showed significant improvement in their heartburn (76.8%), dysphagia (67.6%), regurgitation (71.7%), chest pain (91.9%), and nausea (86.5%) (P < 0.05). The patients not undergoing EL also showed significant improvement in their heartburn (81.1%), dysphagia (71.1%), regurgitation (64.4%), chest pain (64.1%), and nausea (61.0%) (P < 0.05). Improvement in symptoms, the continued use of antacid medications, and overall surgery satisfaction score were statistically similar between the two groups. CONCLUSIONS Operative and functional outcomes for HH repair with or without EL are acceptable and comparable. Thoracic surgeons should use EL without reservations for appropriate indications.
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Puri V, Jacobsen K, Bell JM, Crabtree TD, Kreisel D, Krupnick AS, Patterson GA, Meyers BF. Hiatal Hernia Repair with or without Esophageal Lengthening. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Kyle Jacobsen
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Jennifer M. Bell
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Traves D. Crabtree
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Alexander S. Krupnick
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - G. Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
| | - Bryan F. Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO USA
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Modern treatment of paraesophageal hernia: preoperative evaluation and technique for laparoscopic repair. Surg Laparosc Endosc Percutan Tech 2012; 22:297-303. [PMID: 22874677 DOI: 10.1097/sle.0b013e31825831af] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews the preoperative evaluation of patients with paraesophageal hernia (PEH) and details the principles and components of a laparoscopic PEH repair. Complete hernia sac dissection and excision, adequate esophageal mobilization, reapproximation of the crura, and creation of an antireflux barrier make up the key steps in any repair and are described. Although the preferred operative approach to PEH has undergone significant modification, especially since the introduction of minimally invasive laparoscopic techniques, many controversies still exist. The decision of whether to use mesh to reinforce the crural closure remains an unresolved issue in the surgical literature, and further evolution in this and other areas of PEH surgery is sure to occur in the near future.
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Juhasz A, Sundaram A, Hoshino M, Lee TH, Mittal SK. Outcomes of surgical management of symptomatic large recurrent hiatus hernia. Surg Endosc 2011; 26:1501-8. [DOI: 10.1007/s00464-011-2072-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 11/09/2011] [Indexed: 12/13/2022]
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Caygill CPJ, Dvorak K, Triadafilopoulos G, Felix VN, Horwhat JD, Hwang JH, Upton MP, Li X, Nandurkar S, Gerson LB, Falk GW. Barrett's esophagus: surveillance and reversal. Ann N Y Acad Sci 2011; 1232:196-209. [PMID: 21950814 DOI: 10.1111/j.1749-6632.2011.06052.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The following on surveillance and reversal of Barrett's esophagus (BE) includes commentaries on criteria for surveillance even when squamous epithelium stains normally with a variety of biomarkers; the long-term follow-up of surgery versus endoscopic ablation of BE; the recommended surveillance intervals in patients without dysplasia; the sampling problems related to anatomic changes following fundoplication; the value of tissue spectroscopy and optical coherence tomography; the cost-effectiveness of biopsy protocols for surveillance; the quality of life of Barrett's patients; and risk stratification and surveillance strategies.
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Affiliation(s)
- Christine P J Caygill
- UK Barrett's Oesophagus Registry, UCL, Division of Surgery and Interventional Science, Royal Free and University College Medical School, London, United Kingdom
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21
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Short esophagus: selection of patients for surgery and long-term results. Surg Endosc 2011; 26:704-13. [DOI: 10.1007/s00464-011-1940-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/31/2011] [Indexed: 12/13/2022]
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22
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Beduschi T, Bigolin AV, Cavazzola LT. Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus? Acta Cir Bras 2011; 26:214-9. [PMID: 21537524 DOI: 10.1590/s0102-86502011000300010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 02/14/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate different approaches performed to obtain a more significant esophageal length. METHODS An experimental model using 28 cadavers was conceived. Randomized groups: Group A (n=10) underwent laparotomic transhiatal approach; Group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. RESULTS Final length variations for Group A were 2.12cm and 3.29cm and for Group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. In Group C length gain observed was 3.81 cm. The mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. CONCLUSION The mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.
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Affiliation(s)
- Thiago Beduschi
- Division of Transplantation, Indiana University School of Medicine, United States
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Abstract
Practically, hiatal hernias are divided into sliding hiatal hernias (type I) and PEH (types II, III, or IV). Patients with PEH are usually symptomatic with GERD or obstructive symptoms, such as dysphagia. Rarely, patients present with acute symptoms of hernia incarceration, such as severe epigastric pain and retching. A thorough evaluation includes a complete history and physical examination, chest radiograph, UGI series, esophagogastroscopy, and manometry. These investigations define the patient's anatomy, rule out other disease processes, and confirm the diagnosis. Operable symptomatic patients with PEH should be repaired. The underlying surgical principles for successful repair include reduction of hernia contents, removal of the hernia sac, closure of the hiatal defect, and an antireflux procedure. Debate remains whether a transthoracic, transabdominal, or laparoscopic approach is best with good surgical outcomes being reported with all three techniques. Placement of mesh to buttress the hiatal closure is reported to reduce hernia recurrence. Long-term follow-up is required to determine whether the laparoscopic approach with mesh hiatoplasty becomes the procedure of choice.
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Frantzides CT, Madan AK, Carlson MA, Zeni TM, Zografakis JG, Moore RM, Meiselman M, Luu M, Ayiomamitis GD. Laparoscopic revision of failed fundoplication and hiatal herniorraphy. J Laparoendosc Adv Surg Tech A 2009; 19:135-9. [PMID: 19216692 DOI: 10.1089/lap.2008.0245] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication. BACKGROUND Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006. METHODS A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication. RESULTS Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5 +/- 1.0 days. Mean follow-up was 22 months (range, 6-42), during which failure of the redo procedure was noted in 9 patients (13.23%). CONCLUSION Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations.
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Affiliation(s)
- Constantine T Frantzides
- Department of Surgery, Northwestern University, Chicago Institute of Minimally Invasive Surgery, Skokie, Illinois, USA.
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Herbella FAM, Patti MG, Del Grande JC. When did the esophagus start shrinking? The history of the short esophagus. Dis Esophagus 2009; 22:550-8. [PMID: 19302223 DOI: 10.1111/j.1442-2050.2009.00956.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Even though the history of this condition extends for almost 100 years, the short esophagus (SE) is still one of the most controversial topics in esophageal surgery with its existence still denied by some distinguished surgeons. We reviewed the evolution behind the diagnosis and treatment of the SE and the persons who wrote its history, from the first descriptions by radiologists, endoscopists, and surgeons to modern treatment.
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Affiliation(s)
- F A M Herbella
- Department of Surgery, Esophagus Division, Escola Paulista de Medicina, UNIFESP, Rua Napoleão de Barros, São Paulo, Brazil.
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Yano F, Stadlhuber RJ, Tsuboi K, Garg N, Filipi CJ, Mittal SK. Preoperative predictability of the short esophagus: endoscopic criteria. Surg Endosc 2008; 23:1308-12. [DOI: 10.1007/s00464-008-0155-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 08/06/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
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Bochkarev V, Lee YK, Vitamvas M, Oleynikov D. Short esophagus: how much length can we get? Surg Endosc 2008; 22:2123-7. [PMID: 18553196 DOI: 10.1007/s00464-008-9999-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 03/19/2008] [Accepted: 04/05/2008] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Laparoscopic antireflux surgery requires an adequate length of intra-abdominal esophagus. Short esophagus can cause wrap herniation and poor clinical outcomes. The aim of the study is to measure maximum length of esophageal elongation with transhiatal mediastinal dissection. METHODS This is a review of a prospective database created in the tertiary referral center between 2003 and 2006. One hundred and six patients with gastroesophageal reflux disease and suspected short esophagus on barium swallow were studied. Patients underwent antireflux surgery with extended transhiatal mediastinal dissection to elongate short esophagus. Routine measurement of intra-abdominal esophageal segment length with intraoperative esophagogastroscopy and laparoscopy was utilized to define the gastroesophageal junction (GEJ) in order to quantify total intra-abdominal esophageal length. Postoperative 24-h pH manometry, UGI series, and symptom scores were recorded to document the clinical outcomes. The aim of the dissection was to mobilize>or=3 cm of intra-abdominal esophagus. RESULTS Total esophageal elongation was achieved with a mean of 2.65 (range 2-18) cm. Resultant intra-abdominal esophageal length was measured with a mean of 3.15 (range of 3 to 5) cm. None of the preoperative "short esophagus" required Collis' gastroplasty post extended mediastinal dissection. All preoperative symptom scores showed significant improvements with mean follow-up of 18 (9-36) months. Mean distal esophageal acid exposure normalized in all patients studied postoperatively. CONCLUSION Short esophagus can be safely elongated with extended mediastinal esophageal dissection. This technique can obviate the need for Collis' gastroplasty and improve overall outcome after antireflux surgery. We recommend that extended transhiatal mediastinal dissection be performed to establish 3 cm of intra-abdominal esophagus at the time of antireflux procedures.
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Affiliation(s)
- Victor Bochkarev
- Department of Surgery, University of Nebraska Medical Center, 983280 Nebraska Medical Center, Omaha, NE 68198-3280, USA
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Bochkarev V, Iqbal A, Lee YK, Vitamvas M, Oleynikov D. One hundred consecutive laparoscopic Nissen’s without the use of a bougie. Am J Surg 2007; 194:866-70; discussion 870-1. [DOI: 10.1016/j.amjsurg.2007.08.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 12/26/2022]
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Houghton SG, Deschamps C, Cassivi SD, Nichols FC, Allen MS, Pairolero PC. The influence of transabdominal gastroplasty: early outcomes of hiatal hernia repair. J Gastrointest Surg 2007; 11:101-6. [PMID: 17390195 DOI: 10.1007/s11605-006-0059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of our study was to review our experience with transabdominal gastroplasty to determine the safety and short-term efficacy of the procedure. METHODS Retrospective review of all patients that underwent transabdominal hiatal hernia repair with concurrent gastroplasty for shortened esophagus between October 1999 and May 2004. RESULTS There were 63 patients, 27 men and 36 women. Median age was 68 years. The hiatal hernia was classified as type-I in 6 patients, type-II in 10, type-III in 43, and type-IV in 4. The operative approach was laparoscopic in 44 patients and laparotomy in 19. A Nissen fundoplication was performed in 62 patients and a Toupet fundoplication in 1. Wedge gastroplasty was performed in 47 patients and modified Collis gastroplasty in 16. Median hospitalization was 3 days (range, 2-10). Intraoperative complications occurred in 11 patients (17%). One laparoscopic approach (2%) was converted to laparotomy. Postoperative complications occurred in 12 patients (19%), there were no operative deaths. Median follow-up was 12 months (range, 0 to 64). One patient (2%) was found to have a recurrent hiatal hernia diagnosed 14 months, postoperatively. Functional results were excellent in 41 (68%), good in 6 (10%), fair in 12 (20%), and poor in 1 (2%). CONCLUSION Transabdominal gastroplasty can be performed safely, with good functional results and a low incidence of recurrent herniation during the short-term follow-up period.
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Affiliation(s)
- Scott G Houghton
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Abstract
Paraesophageal hernias are difficult surgical problems that often need repair. Meticulous work-up and surgical technique are required for optimal results. A laparoscopic approach is associated with reduced morbidity and, if combined with the use of biologic mesh, provides relief of symptoms and a durable repair.
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Affiliation(s)
- Patrick S Wolf
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA
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Gangopadhyay N, Perrone JM, Soper NJ, Matthews BD, Eagon JC, Klingensmith ME, Frisella MM, Brunt LM. Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery 2006; 140:491-8; discussion 498-9. [PMID: 17011895 DOI: 10.1016/j.surg.2006.07.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 07/10/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study examines the impact of age and comorbidities on complications and outcomes of laparoscopic (Lap) paraesophageal hernia (PEH) repair. METHODS Data were collected prospectively on all patients who underwent Lap PEH repair from January 1995 through June 2005. Pre- and postoperative variables including complications were analyzed. Patients were stratified by age (Group [Gr.] 1, <65 years; Gr. 2, 65 to 74 years; Gr. 3, >/=75 years) and American Society of Anesthesiology (ASA) class (1 and 2 vs 3 and 4). Statistical analysis was performed using 1-way ANOVA, chi-square, and Fisher exact test. RESULTS Overall, 171 patients underwent Lap PEH repair. Mean patient age was 65 +/- 15 years, mean ASA class 2.4 +/- 0.5, gender 72% female, and mean operating time 173 +/- 49 min. Patients in Gr. 3 had a significantly higher ASA class (Gr. 1, 2.3 +/- 0.6; Gr. 2, 2.5 +/- 0.5; Gr. 3, 2.6 +/- 0.5) and longer postoperative length of stay (LOS) compared with Gr. 1 (P < 0.05). Esophageal lengthening was required in 10.4% of patients in Gr. 3 versus 2.6% in Gr. 1 and 2.1% in Gr. 2 (P = 0.079). Total complication rates were 17.1% in Gr. 1, 22.4% in Gr. 2, and 27.7% in Gr. 3 (P = not significant [NS]). Most complications were minor; grade 2 or higher complications occurred in 10.5% of patients in Gr. 1, 8.3% in Gr. 2, and 8.5% in Gr. 3 (P = NS). There was 1 death (Gr. 2) on postoperative day 18 due to a myocardial infarction (mortality rate = 0.6%). Mean follow-up was 25.3 +/- 20.6 months. Postoperative symptoms of heartburn and regurgitation were similar between groups as was antisecretory medication use. Anatomic failure of the repair occurred in 23.7% of patients with adequate follow-up: 26.7% in Gr. 1, 15.4% in Gr. 2, and 27.8% in Gr. 3 (P = NS). Reoperation was performed in 1 of 32 (3.1%) failures. CONCLUSIONS Lap PEH repair is safe in elderly and properly selected high-risk patients, although complication rates are higher than in younger patients. Most patients have a good symptomatic outcome irrespective of their age, but the anatomic recurrence rates remain a concern for all age groups.
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Affiliation(s)
- Noopur Gangopadhyay
- Department of Surgery and Institute for Minimally Invasive Surgery Washington University School of Medicine, St. Louis, MO, USA
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Awad ZT. The myth of the short esophagus. Surg Endosc 2005; 18:1819; author reply 1820. [PMID: 15809798 DOI: 10.1007/s00464-004-8103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Laparoscopic repair of paraesophageal hernias is rapidly replacing the traditional open approach. Regardless of the approach, certain aspects of repairing paraesophageal hernias have proven to be beneficial and others remain controversial. This article addresses the effectiveness of the laparoscopic approach, the accepted and controversial technical aspects of repair, and which patients should undergo surgical correction of the hernia.
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Affiliation(s)
- Dave R Lal
- Department of Surgery, Center for Videoendoscopic Surgery, University of Washington Medical Center, 959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA
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Madan AK, Frantzides CT, Patsvas KL. The authors reply. Surg Endosc 2004. [DOI: 10.1007/s00464-004-8220-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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