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Degrandi O, Laurent E, Najah H, Aldajani N, Gronnier C, Collet D. Laparoscopic Surgery for Recurrent Hiatal Hernia. J Laparoendosc Adv Surg Tech A 2020; 30:883-886. [PMID: 32208044 DOI: 10.1089/lap.2020.0118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Surgical treatment of hiatal hernia (HH) is well standardized. However, recurrence is observed in 15%-60% of cases, and is challenging to manage. The aim of this study was to analyze the causes of surgical failure and provide some guidelines for treatment. The symptoms of recurrent HH vary widely, and include persistent reflux, dysphagia, and permanent discomfort, leading to a marked change in the quality of life. Morphological and functional pretherapeutic evaluation is necessary to determine whether the symptoms are due to recurrent HH, and to understand the cause of failure. Redo surgery is technically difficult and challenging, and should only be used in symptomatic patients whose symptoms are definitively those of recurrent HH.
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Affiliation(s)
- Olivier Degrandi
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
| | - Eva Laurent
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
| | - Haythem Najah
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
| | - Nour Aldajani
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
| | - Denis Collet
- Centre for Digestive System Diseases, Department of Oesogastric and Endocrine Surgery, Magellan, University Hospital of Bordeaux, Pessac, France.,Department of Tissus Engineering, University of Bordeaux, Bordeaux, France
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Bonrath EM, Grantcharov TP. Contemporary management of paraesophaegeal hernias: establishing a European expert consensus. Surg Endosc 2014; 29:2180-95. [PMID: 25361649 DOI: 10.1007/s00464-014-3918-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/22/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND The surgical treatment of paraesophageal hernias remains a challenge due to the lack of consensus regarding principles of operative treatment. The objectives of this study were to achieve consensus on key topics through expert opinion using a Delphi methodology. METHODS A Delphi survey combined with a face-to-face meeting was conducted. A panel of European experts in foregut surgery from high-volume centres generated items in the first survey round. In subsequent rounds, the panel rated agreement with statements on a 5-point Likert-type scale. Internal consistency (consensus) was predefined as Cronbach's α > .80. Items that >70 % of the panel either rated as irrelevant/unimportant, or relevant/important were selected as consensus items, while topics that did not reach this cut-off were termed "undecided/controversial". RESULTS Three survey rounds were completed: 19 experts from 10 countries completed round one, 18 continued through rounds two and three. Internal consistency was high in rounds two and three (α > .90). Fifty-eight additional/revised items derived from comments and free-text entries were included in round three. In total, 118 items were rated; consensus agreement was achieved for 70 of these. Examples of consensus topics are the relevance of the disease profile for assessing surgical urgency and complexity, the role of clinical history as the mainstay of patient follow-up, indications for revision surgery, and training and credentialing recommendations. Topics with the most "undecided/controversial" items were follow-up, postoperative care and surgical technique. CONCLUSIONS This Delphi study achieved expert consensus on key topics in the operative management of paraesophageal hernias, providing an overview of the current opinion among European foregut surgeons. Moreover, areas with substantial variability in opinions were identified reflecting the current lack of empirical evidence and opportunities for future research.
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Affiliation(s)
- E M Bonrath
- University of Toronto, 30 Bond Street, Toronto, ON, M5B1W8, Canada,
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Seetharamaiah R, Romero RJ, Kosanovic R, Gallas M, Verdeja JC, Rabaza J, Gonzalez AM. Robotic repair of giant paraesophageal hernias. JSLS 2014; 17:570-7. [PMID: 24398199 PMCID: PMC3866061 DOI: 10.4293/108680813x13654754534594] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This report suggests that robotic repair of giant para-esophageal hernia has a lower recurrence rate than standard laparoscopic methods, but complications and mortality are similar to standard laparoscopic approaches. Background and Objectives: Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair. Methods: We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System. Results: Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40–97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96–395 minutes) and 4.3 days (range, 2–22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series. Conclusion: In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results.
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Affiliation(s)
- Rupa Seetharamaiah
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Rey Jesús Romero
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Radomir Kosanovic
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Michelle Gallas
- Center for Research & Grants, Baptist Health South Florida, Miami, FL, USA
| | - Juan-Carlos Verdeja
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Jorge Rabaza
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Anthony Michael Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, 7800 SW 87th Ave, Ste B210, Miami, FL 33173, USA.
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Namgoong JM, Kim DY, Kim SC, Hwang JH. Hiatal hernia in pediatric patients: laparoscopic versus open approaches. Ann Surg Treat Res 2014; 86:264-9. [PMID: 24851228 PMCID: PMC4024937 DOI: 10.4174/astr.2014.86.5.264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/30/2013] [Accepted: 02/04/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the surgical outcomes of laparoscopic approach for hiatal hernia (HH) in pediatric patients. METHODS This was a retrospective study of 33 patients younger than 18 years who underwent an operation for HH between January 1999 and December 2012. RESULTS The HH symptoms were various and included regurgitation, vomiting, weight loss, cough, hoarseness, and cyanosis. Among the 33 patients, there were 25 sliding types, 1 paraesophageal type, and 7 mixed types. Open surgery (OS) and laparoscopic surgery (LS) were used in 16 and 17 patients, respectively. There were no statistically significant differences in sex, age, or body weight between the groups. The median operating time was longer in the LS group (150 minutes; range, 90-250 minutes vs. 125 minutes; range, 66-194 minutes; P = 0.028). Time to oral intake was shorter in the LS group than in the OS group (1 day; range, 1-3 days vs. 2 days; range, 1-7 days; P = 0.001) and time to full feeding was shorter in the LS group than in the OS group (6 days; range, 3-16 days vs. 10 days; range, 3-33 days; P = 0.048). There were no differences in length of hospital stay and complications between the two groups. There was no perioperative mortality or recurrence of HH. CONCLUSION A good surgical outcome for laparoscopic correction of HH was seen in pediatric patients.
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Affiliation(s)
- Jung-Man Namgoong
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Dae-Yeon Kim
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Seong-Chul Kim
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
| | - Ji-Hee Hwang
- Division of Pediatric Surgery, Department of Surgery, Asan Medical Center, Seoul, Korea
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Gebhart A, Vu S, Armstrong C, Smith BR, Nguyen NT. Initial Outcomes of Laparoscopic Paraesophageal Hiatal Hernia Repair with Mesh. Am Surg 2013. [DOI: 10.1177/000313481307901013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The use of mesh in laparoscopic paraesophageal hiatal hernia repair (LHR) may reduce the risk of late hernia recurrence. The aim of this study was to evaluate initial outcomes and recurrence rate of 92 patients who underwent LHR reinforced with a synthetic bioabsorbable mesh. Surgical approaches included LHR and Nissen fundoplication (n = 64), LHR without fundoplication (n = 10), reoperative LHR (n = 9), LHR with a bariatric operation (n = 6), and emergent LHR (n = 3). The mean length of hospital stay was 2 ± 3 days (range, 1 to 30 days). There were no conversions to open laparotomy and no intraoperative complications. One of 92 patients (1.1%) required intensive care unit stay. The 90-day mortality was zero. Minor complications occurred in 3.3 per cent, major complications in 2.2 per cent, and late complications in 5.5 per cent of patients. There were no perforations or early hernia recurrence. The 30-day reoperation rate was 1.1 per cent. For patients with available 1-year follow-up, the overall recurrence rate was 18.5 per cent with a mean follow-up of 30 months (range, 12 to 51 months). LHR repair with mesh is associated with low perioperative morbidity and no mortality. The use of bioabsorbable mesh appears to be safe with no early hiatal hernia recurrence or late mesh erosion. Longer follow-up is needed to determine the long-term rate of hernia recurrence associated with LHR with mesh.
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Affiliation(s)
- Alana Gebhart
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Steven Vu
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Chris Armstrong
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Brian R. Smith
- Department of Surgery, University of California Irvine Medical Center, Orange, California
| | - Ninh T. Nguyen
- Department of Surgery, University of California Irvine Medical Center, Orange, California
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Parker DM, Rambhajan A, Johanson K, Ibele A, Gabrielsen JD, Petrick AT. Urgent laparoscopic repair of acutely symptomatic PEH is safe and effective. Surg Endosc 2013; 27:4081-6. [DOI: 10.1007/s00464-013-3064-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
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