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De Siena M, Gualtieri L, Varca S, Matteo MV, Pontecorvi V, Bove V, Spada C, Boškoski I. GI snapshot: arrhythmia, dysphagia and weight loss in a 71-year-old man. Gut 2024:gutjnl-2023-331813. [PMID: 38857988 DOI: 10.1136/gutjnl-2023-331813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/25/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Martina De Siena
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Loredana Gualtieri
- Department of Surgical Sciences, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Simone Varca
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Maria Valeria Matteo
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Valerio Pontecorvi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Vincenzo Bove
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Cristiano Spada
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Ivo Boškoski
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
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2
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Jog A, Strauss Starling AL, Kaur I, Um K, Keele LJ, Triggs JR, Altieri MS, Shao JM. Paraesophageal hernia recurrence following repair: making the case for reoperative surgery in a propensity-matched cohort. Surg Endosc 2024; 38:3138-3144. [PMID: 38627258 DOI: 10.1007/s00464-024-10833-8] [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: 01/04/2024] [Accepted: 03/25/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Paraesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation. METHODS After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified. Patient characteristics, preoperative imaging, operative findings, and postoperative outcomes were recorded. A computational generalization of inverse propensity score weight was then used to construct populations of initial and redo PEHR patients with similar covariate distributions. RESULTS A total of 244 patients underwent PEHR (78.7% female, mean age 65.4 ± 12.3 years). Most repairs were performed with crural closure (81.4%) and fundoplication (71.7%) with 14.2% utilizing mesh. Postoperatively, 76.5% of patients had subjective symptom improvement and of 157 patients with postoperative imaging, 52.9% had evidence of radiographic recurrence at a mean follow-up of 10.4 ± 13.6 months. Only 4.9% of patients required a redo operation. Hernia type, crural closure, fundoplication, and mesh usage were not predictors of radiographic recurrence or symptom improvement (P > 0.05). Propensity weight score analysis of 50 redo PEHRs compared to a matched cohort of 194 initial operations revealed lower rates of postoperative symptom improvement (P < 0.05) but no differences in need for revision, complication rates, ED visits, or readmissions. CONCLUSIONS Most PEHR patients have symptomatic improvement with minimal complications and reoperations despite frequent radiographic recurrence. Hernia type, crural closure, fundoplication, and mesh usage were not significantly associated with recurrence or symptom improvement. Compared to initial PEHR, reoperative PEHRs had lower rates of symptom improvement but similar rates of recurrence, complications, and need for reoperation.
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Affiliation(s)
- Aditya Jog
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Isha Kaur
- University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth Um
- University of Pennsylvania, Philadelphia, PA, USA
| | - Luke J Keele
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph R Triggs
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Maria S Altieri
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Jenny M Shao
- Division of Minimally Invasive Surgery, Department of Surgery, University of Michigan, 2926A Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
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Tankel J, Safieddine N, Malthaner R, French D, Johnston B, Finley C, Darling G, Ferri L, Seely A, Gowing S. A trans-Canadian positive deviance seminar for paraesophageal hernia surgery: Reporting national postoperative outcomes and consensus recommendations. World J Surg 2024; 48:673-680. [PMID: 38358091 DOI: 10.1002/wjs.12087] [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: 11/01/2023] [Accepted: 01/06/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations. METHODS A national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center-level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web-based database that tracks postoperative outcomes was presented. The top two performing centers with regards to these metrics were chosen and surgeons from these hospitals discussed elements of their treatment pathways that contributed to these outcomes. Consensus recommendations were then identified with participants independently rating their level of agreement. RESULTS Twenty-eight surgeons form 8 centers took part in the seminar across 5 Canadian provinces. Of the 680 included patients included, Clavien-Dindo grade I and II/III/IV/V complications occurred in 121/39/12/2 patients (17.8%/5.7%/1.8%/0.3%). Respiratory complications were the most common (effusion 12/680, 1.7% and pneumonia 9/680, 1.3%). Esophageal and gastric perforation occurred in 7 and 4/680, (1.0% and 0.6% respectively). Median LOS varied significantly between institutions (1 day, range 1-3 vs. 7 days, 3-8, p < 0.001). A strong level of agreement was achieved for 10/12 of the consensus statements generated. CONCLUSION PD seminars provide a supportive forum for centers to review best evidence and experience and generate recommendations based on expert opinion. Further research is ongoing to determine if this approach effectively accomplishes this objective.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Najib Safieddine
- Division of Thoracic Surgery, Department of Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rick Malthaner
- Division of Thoracic Surgery, Schulich School of Medicine and Dentistry, London Health Sciences Center, Western University, London, Ontario, Canada
| | - Danny French
- Division of Thoracic Surgery, Department of Surgery, Queen Elizabeth II Hospital (Victoria Campus), Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brian Johnston
- Division of Thoracic Surgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Christian Finley
- Division of Thoracic Surgery, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Gail Darling
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Andrew Seely
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Stephen Gowing
- Section of Thoracic Surgery, Department of Surgery, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada
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4
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Nurminen NMJ, Järvinen TKM, Kytö VJ, Salo SAS, Egan CE, Andersson SE, Räsänen JV, Ilonen IKP. Malpractice claims after antireflux surgery and paraesophageal hernia repair: a population-based analysis. Surg Endosc 2024; 38:624-632. [PMID: 38012443 PMCID: PMC10830758 DOI: 10.1007/s00464-023-10572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The complication rate of modern antireflux surgery or paraesophageal hernia repair is unknown, and previous estimates have been extrapolated from institutional cohorts. METHODS A population-based retrospective cohort study of patient injury cases involving antireflux surgery and paraesophageal hernia repair from the Finnish National Patient Injury Centre (PIC) register between Jan 2010 and Dec 2020. Additionally, the baseline data of all the patients who underwent antireflux and paraesophageal hernia operations between Jan 2010 and Dec 2018 were collected from the Finnish national care register. RESULTS During the study period, 5734 operations were performed, and the mean age of the patients was 54.9 ± 14.7 years, with 59.3% (n = 3402) being women. Out of all operations, 341 (5.9%) were revision antireflux or paraesophageal hernia repair procedures. Antireflux surgery was the primary operation for 79.9% (n = 4384) of patients, and paraesophageal hernia repair was the primary operation for 20.1% (n = 1101) of patients. A total of 92.5% (5302) of all the operations were laparoscopic. From 2010 to 2020, 60 patient injury claims were identified, with half (50.0%) of the claims being related to paraesophageal hernia repair. One of the claims was made due to an injury that resulted in a patient's death (1.7%). The mean Comprehensive Complication Index scores were 35.9 (± 20.7) and 47.6 (± 20.8) (p = 0.033) for antireflux surgery and paraesophageal hernia repair, respectively. Eleven (18.3%) of the claims pertained to redo surgery. CONCLUSIONS The rate of antireflux surgery has diminished and the rate of paraesophageal hernia repair has risen in Finland during the era of minimally invasive surgery. Claims to the PIC remain rare, but claims regarding paraesophageal hernia repairs and redo surgery are overrepresented. Additionally, paraesophageal hernia repair is associated with more serious complications.
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Affiliation(s)
- Nelli M J Nurminen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Tommi K M Järvinen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ville J Kytö
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Silja A S Salo
- Gastrointestinal Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Caitlin E Egan
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | | | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ilkka K P Ilonen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
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Patti MG, Herbella FAM. Mesh and Hiatal Hernia Repair-The Never-Ending Saga. JAMA Surg 2024; 159:18. [PMID: 37819634 DOI: 10.1001/jamasurg.2023.4965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Affiliation(s)
- Marco G Patti
- Department of Surgery, University of Virginia, Charlottesville
| | - Fernando A M Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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Nickel F, Müller PC, Cizmic A, Häberle F, Muller MK, Billeter AT, Linke GR, Mann O, Hackert T, Gutschow CA, Müller-Stich BP. Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias. Langenbecks Arch Surg 2023; 409:15. [PMID: 38123861 PMCID: PMC10733223 DOI: 10.1007/s00423-023-03190-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Symptomatic and large hiatal hernia (HH) is a common disorder requiring surgical management. However, there is a lack of systematic, evidence-based recommendations summarizing recent reviews on surgical treatment of symptomatic HH. Therefore, this systematic review aimed to create evidence mapping on the key technical issues of HH repair based on the highest available evidence. METHODS A systematic review identified studies on eight key issues of large symptomatic HH repair. The literature was screened for the highest level of evidence (LE from level 1 to 5) according to the Oxford Center for evidence-based medicine's scale. For each topic, only studies of the highest available level of evidence were considered. RESULTS Out of the 28.783 studies matching the keyword algorithm, 47 were considered. The following recommendations could be deduced: minimally invasive surgery is the recommended approach (LE 1a); a complete hernia sac dissection should be considered (LE 3b); extensive division of short gastric vessels cannot be recommended; however, limited dissection of the most upper vessels may be helpful for a floppy fundoplication (LE 1a); vagus nerve should be preserved (LE 3b); a dorso-ventral cruroplasty is recommended (LE 1b); routine fundoplication should be considered to prevent postoperative gastroesophageal reflux (LE 2b); posterior partial fundoplication should be favored over other forms of fundoplication (LE 1a); mesh augmentation is indicated in large HH with paraesophageal involvement (LE 1a). CONCLUSION The current evidence mapping is a reasonable instrument based on the best evidence available to guide surgeons in determining optimal symptomatic and large HH repair.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| | - Philip C Müller
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Amila Cizmic
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Frida Häberle
- Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Markus K Muller
- Department of Surgery, Cantonal Hospital Thurgau, Frauenfeld, Switzerland
| | - Adrian T Billeter
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
| | - Georg R Linke
- Department of Surgery, Hospital STS Thun AG, Thun, Switzerland
| | - Oliver Mann
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Christian A Gutschow
- Department of Visceral and Transplant Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Beat P Müller-Stich
- Department of Digestive Surgery, University Digestive Healthcare Center Basel, Basel, Switzerland
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7
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Nguyen CL, Tovmassian D, Zhou M, Seyfi D, Isaacs A, Gooley S, Falk GL. Recurrence in Paraesophageal Hernia: Patient Factors and Composite Surgical Repair in 862 Cases. J Gastrointest Surg 2023; 27:2733-2742. [PMID: 37962716 PMCID: PMC10837213 DOI: 10.1007/s11605-023-05856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Repair of giant paraesophageal hernia (PEH) is associated with a considerable hernia recurrence rate by objective measures. This study analyzed a large series of laparoscopic giant PEH repair to determine factors associated with anatomical recurrence. METHOD Data was extracted from a single-surgeon prospective database of laparoscopic repair of giant PEH from 1991 to 2021. Upper endoscopy was performed within 12 months postoperatively and selectively thereafter. Any supra-diaphragmatic stomach was defined as anatomical recurrence. Patient and hernia characteristics and technical operative factors, including "composite repair" (360° fundoplication with esophagopexy and cardiopexy to right crus), were evaluated with univariate and multivariate analysis. RESULTS Laparoscopic primary repair was performed in 862 patients. The anatomical recurrence rate was 27.3% with median follow-up of 33 months (IQR 16, 68). Recurrence was symptomatic in 45% of cases and 29% of these underwent a revision operation. Hernia recurrence was associated with younger age, adversely affected quality of life, and were associated with non-composite repair. Multivariate analysis identified age < 70 years, presence of Barrett's esophagus, absence of "composite repair", and hiatus closure under tension as independent factors associated with recurrence (HR 1.27, 95%CI 0.88-1.82, p = 0.01; HR 1.58, 95%CI 1.12-2.23, p = 0.009; HR 1.72, 95%CI 1.2-2.44, p = 0.002; HR 2.05, 95%CI 1.33-3.17, p = 0.001, respectively). CONCLUSION Repair of giant PEH is associated with substantial anatomical recurrence associated with patient and technique factors. Patient factors included age < 70 years, Barrett's esophagus, and hiatus tension. "Composite repair" was associated with lower recurrence rate.
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Affiliation(s)
- Chu Luan Nguyen
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - David Tovmassian
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Michael Zhou
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Doruk Seyfi
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Anna Isaacs
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Suzanna Gooley
- Sydney Heartburn Clinic, Lindfield, NSW, 2070, Australia
| | - Gregory L Falk
- Department of Upper Gastrointestinal Surgery, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.
- Department of Surgery, The University of Sydney, Camperdown, NSW, 2050, Australia.
- Sydney Heartburn Clinic, Lindfield, NSW, 2070, Australia.
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8
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Salvador R, Vittori A, Capovilla G, Riccio F, Nezi G, Forattini F, Provenzano L, Nicoletti L, Moletta L, Costantini A, Valmasoni M, Costantini M. Antireflux Surgery's Lifespan: 20 Years After Laparoscopic Fundoplication. J Gastrointest Surg 2023; 27:2325-2335. [PMID: 37580489 PMCID: PMC10661768 DOI: 10.1007/s11605-023-05797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/29/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Renato Salvador
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy.
| | - Arianna Vittori
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Giovanni Capovilla
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Federica Riccio
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Giulia Nezi
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Francesca Forattini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Luca Provenzano
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Loredana Nicoletti
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Lucia Moletta
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Andrea Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, School of Medicine, UOC Chirurgia Generale 1, Azienda Ospedale Università, Padova, Italy
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9
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Liu DS, Allan Z, Wong DJ, Goh SK, Stevens S, Aly A, Bright T, Watson DI. Pre-existing hiatal mesh increases morbidity during and after revisional antireflux surgery: A retrospective multicenter study. Surgery 2023; 174:549-557. [PMID: 37369605 DOI: 10.1016/j.surg.2023.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Revisional antireflux surgery, including hiatus hernia repair, is increasingly common. Mesh-augmented hiatal closure at the time of index operation is controversial but commonly performed. Although a meta-analysis of randomized data has demonstrated no additional benefit of routine mesh placement, it is unclear whether this practice results in harm, particularly at the time of revisional antireflux surgery. We determined whether pre-existing mesh at the hiatus increases morbidity during and after revisional antireflux surgery. METHODS Analysis of prospectively-maintained databases of all elective revisional antireflux surgery cases in 36 hospitals across Australia took place over 10 years. Intraoperative and postoperative outcomes of patients with and without prior hiatal mesh were compared. Propensity score-matched analysis was used to validate primary findings. RESULTS A total of 346 revisional cases (35 with pre-existing mesh) were analyzed. The 2 groups had comparable baseline characteristics. In total, 77 (22.2%) patients had 148 intraoperative adverse events. Pre-existing mesh was associated with a higher risk of intraoperative complications (48.6% vs 22.5%, odds ratio 3.25, 95% confidence interval 1.63-6.38, P = .002), secondary to bleeding, and lacerations to pleura, lung, and liver. Overall, 63 (18.2%) patients developed postoperative complications. Pre-existing mesh was associated with increased postoperative morbidity (37.1% vs 16.1%, odds ratio 3.09, 95% confidence interval 1.50-6.43, P = .005), particularly due to bleeding and respiratory complications. Importantly, pre-existing mesh independently predicted the occurrence of intraoperative and postoperative complications. CONCLUSION Prior hiatal mesh significantly increases morbidity during and after revisional antireflux surgery. Given that revisional surgery is increasingly being performed, our findings discourage routine mesh use during primary antireflux surgery.
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Affiliation(s)
- David S Liu
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia; Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia.
| | - Zexi Allan
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Darren J Wong
- General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia; Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia
| | - Su Kah Goh
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia
| | - Sean Stevens
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; General and Gastrointestinal Surgery Research and Trials Group, The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Ahmad Aly
- Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Heidelberg, Victoria, Australia; The University of Melbourne, Department of Surgery, Austin Precinct, Austin Health, Heidelberg, Victoria, Australia
| | - Tim Bright
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia; Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
| | - David I Watson
- Oesophagogastric Surgery Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia; Discipline of Surgery, College of Medicine and Public Health, Flinders University, South Australia, Australia
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10
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Schlottmann F. Response to: Comment on "Laparoscopic Paraesophageal Hernia Repair: to Mesh or Not to Mesh". ANNALS OF SURGERY OPEN 2023; 4:e315. [PMID: 37746620 PMCID: PMC10513240 DOI: 10.1097/as9.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/25/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Francisco Schlottmann
- From the Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
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11
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Amundson JR, Kuchta K, Wu H, VanDruff VN, Haggerty SP, Linn J, Ujiki MB. A 13-year experience with biologic and biosynthetic absorbable mesh reinforced laparoscopic paraesophageal hernia repair. Surg Endosc 2023; 37:7271-7279. [PMID: 37407714 DOI: 10.1007/s00464-023-10248-x] [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: 03/27/2023] [Accepted: 06/23/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Mesh reinforced cruroplasty during laparoscopic paraesophageal hernia repair remains controversial due to wide variation in surgical technique and mesh composition. This study aims to review outcomes and rates of recurrence following laparoscopic paraesophageal hernia repair (LPEHR) with mesh reinforced cruroplasty utilizing absorbable mesh at a single institution. METHODS A retrospective review of all patients who underwent LPEHR with mesh was performed. Medical records were reviewed for patient reported, radiographic or endoscopic evidence of recurrence, defined as > 2 cm of vertical intrathoracic stomach. If no studies were available for review, patients were considered to have no recurrence. Outcomes and mesh-related complications were also reviewed. RESULTS Between 10/2008 and 9/2021, 473 patients underwent LPEHR with absorbable mesh; 1.3% type 2 hernias, 86.0% type 3 hernias, 12.7% type 4 hernias. Three types of mesh were used: initially biologic mesh (n = 83), then heavyweight synthetic bioabsorbable mesh (n = 261), and finally lightweight synthetic bioabsorbable mesh (n = 111). There were no significant differences in age, ASA, BMI, gender, smoking status, chronic steroid use, preoperative acid suppression, hernia type, or recurrent hernia between groups. There were no significant differences in 30-day postoperative outcomes. Reflux Symptom Index, GERD-HRQL, and Dysphagia Scores at 1- and 2-year postoperative timepoints were not significantly different. The overall recurrence rate was 16.7%, with no significant differences in recurrence rates between biologic, heavyweight or lightweight biosynthetic absorbable mesh through 2 years after surgery. A shorter median time to recurrence (10 months, p = 0.016) was seen in the lightweight group. CONCLUSION LPEHR with absorbable mesh reinforced cruroplasty is feasible and safe, with equivalent patient-reported outcomes, including dysphagia, up to 2-years postop regardless of mesh choice. No significant differences in recurrence rates between biologic, heavyweight, or lightweight synthetic bioabsorbable mesh were seen up to 2 years after LPEHR.
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Affiliation(s)
- Julia R Amundson
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA.
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA.
| | - Kristine Kuchta
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - Hoover Wu
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Vanessa N VanDruff
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
- Department of Surgery, University of Chicago Medical Center, 5841 S. Maryland Ave, Chicago, IL, 60637, USA
| | - Stephen P Haggerty
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - John Linn
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
| | - Michael B Ujiki
- Department of Surgery, NorthShore University Health System, 2650 Ridge AveGCSI Suite B665, Evanston, IL, 60201, USA
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Aiolfi A, Bona D, Bonitta G, Manara M, Bonavina L. Comment on "Laparoscopic Paraesophageal Hernia Repair: to Mesh or Not to Mesh". ANNALS OF SURGERY OPEN 2023; 4:e304. [PMID: 37746622 PMCID: PMC10513235 DOI: 10.1097/as9.0000000000000304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- Alberto Aiolfi
- From the I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Davide Bona
- From the I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Bonitta
- From the I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Michele Manara
- From the I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Luigi Bonavina
- From the I.R.C.C.S. Ospedale Galeazzi – Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Milan, Italy
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13
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Aiolfi A, Sozzi A, Bona D. Comment to: Laparoscopic posterior cruroplasty: a patient tailored approach. Authors' reply. Hernia 2023; 27:717-718. [PMID: 36947310 DOI: 10.1007/s10029-023-02777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/05/2023] [Indexed: 03/23/2023]
Affiliation(s)
- A Aiolfi
- I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso N.173, Zip Code, 20151, Milan, Italy.
| | - A Sozzi
- I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso N.173, Zip Code, 20151, Milan, Italy
| | - D Bona
- I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio Hospital, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso N.173, Zip Code, 20151, Milan, Italy
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Novel "starburst" mesh configuration for paraesophageal and recurrent hiatal hernia repair: comparison with keyhole mesh configuration. Surg Endosc 2023; 37:2239-2246. [PMID: 35902405 DOI: 10.1007/s00464-022-09447-9] [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: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Controversy exists over the use of mesh, its type and configuration in repair of hiatal hernia. We have used biological mesh for large or recurrent hiatal hernias. We have developed a mesh configuration to better enhance the tensile strength of the hiatus by folding the mesh over the edge of the hiatus-entitled the "starburst" configuration. We report our experience with the starburst configuration, comparing it to our results with the keyhole configuration. METHODS Medical records of all patients undergoing either the keyhole or starburst mesh configuration hiatal hernia repair were reviewed between 2017 and 2021. Data gathered included age, sex, type of hernia (sliding, paraesophageal, or recurrent), fundoplication type (none, Nissen, Toupet, Dor, Collis-Nissen, Collis-Toupet, or magnetic sphincter augmentation [MSA]), 30-day complications, and long-term outcomes (hiatal hernia recurrence, reflux-symptom recurrence, dysphagia, dilations, reoperations). RESULTS From 7/2017 to 8/2019, 51 cases using the keyhole mesh were completed. Sliding hiatal hernia comprised 4%, paraesophageal hernia (PEH) 64% and recurrent hiatal hernia (RHH) 34% of cases. Distribution of fundoplication type: 2% none, 41% Nissen, 41% Toupet, 8% Dor, 2% Collis-Nissen, and 6% Collis-Toupet. 30-day complication rate 31%. Long-term outcomes: recurrent hiatal hernia 16%, dysphagia 12%, dysphagia requiring dilation(s) 10%, recurrent GERD symptoms 4%, and reoperation 14%. From 10/2020 to 8/2021, 58 cases using the starburst configuration were completed. PEH comprised 60% and RHH 40%. Distribution of fundoplication type: 10% none, 40% Nissen, 43% Toupet, 5% MSA, 2% Collis-Toupet. 30-day complication rate 16%. Long-term outcomes: recurrent hiatal hernia 19%, dysphagia 14%, dilations 5%, recurrent GERD symptoms 9%, and reoperations 3%. CONCLUSION The starburst mesh configuration compares favorably with the keyhole configuration with respect to postoperative dysphagia, need for esophageal dilation, and GERD symptom recurrence, with similar recurrence rates. We are continuing to further refine this technique and study the long-term outcomes.
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Gastroesophageal reflux disease and dysphagia. Dysphagia 2023. [DOI: 10.1016/b978-0-323-99865-9.00011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Temperley HC, Davey MG, O'Sullivan NJ, Ryan ÉJ, Donlon NE, Donohoe CL, Reynolds JV. What works best in hiatus hernia repair, sutures alone, absorbable mesh or non-absorbable mesh? A systematic review and network meta-analysis of randomized clinical trials. Dis Esophagus 2022:6958659. [PMID: 36563005 DOI: 10.1093/dote/doac101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/19/2022] [Indexed: 12/24/2022]
Abstract
Laparoscopic hiatal hernia repair (HHR) and fundoplication is a common low risk procedure providing excellent control of gastro-oesophageal reflux disease and restoring of normal anatomy at the hiatus. HHR may fail, however, resulting in hiatus hernia (HH) recurrence, and the use of tension-free mesh-augmented hernioplasty has been proposed to reduce recurrence. Previous research on this topic has been heterogeneous, including study methods, mesh type used and technique performed. A systematic review and network meta-analysis were carried out. An electronic systematic research was carried out using 'PUBMED', 'EMBASE', 'Medline (OVID)' and 'Web of Science', of articles identifying HHR with suture cruroplasty, non-absorbable mesh (NAM) and absorbable mesh (AM) reinforcement. Eight RCTs with 766 patients were evaluated. NAM had significantly (P < 0.05) lower early recurrence rates (OR: 0.225, 95% CI 0.0342, 0.871) compared with suture repair alone; however, no differences in late recurrences were evident. For AM, no difference in early (0.508, 95% CI 0.0605, 4.81) or late (1.07. 95% CI 0.116, 11.4) recurrence rates were evident compared with the suture only group. Major complication rates were similar in all groups. NAM reinforcement significantly reduced early HH recurrence when compared with sutured cruroplasty alone; however, late recurrence rates were similar with all techniques. Given the limited data in comparing AM with NAM, this study was unable to conclude which composition was significant. We emphasize caution when interpreting small sample size RCTs, and recommend more research with larger randomized studies.
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Affiliation(s)
- Hugo C Temperley
- Department of Surgery, Trinity College and St James's Hospital, Dublin D08 NHY1, Ireland
| | - Matthew G Davey
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Niall J O'Sullivan
- Department of Surgery, Tallaght University Hospital, Dublin DO2 YN77, Republic of Ireland
| | - Éanna J Ryan
- Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Noel E Donlon
- Department of Surgery, Trinity College and St James's Hospital, Dublin D08 NHY1, Ireland.,Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Republic of Ireland
| | - Claire L Donohoe
- Department of Surgery, Trinity College and St James's Hospital, Dublin D08 NHY1, Ireland
| | - John V Reynolds
- Department of Surgery, Trinity College and St James's Hospital, Dublin D08 NHY1, Ireland
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Hung CM, Lee PH, Lu K, Chiu CC. Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials". ANNALS OF SURGERY OPEN 2022; 3:e173. [PMID: 37601144 PMCID: PMC10431498 DOI: 10.1097/as9.0000000000000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Chao-Ming Hung
- From the Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Po-Huang Lee
- College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Kang Lu
- Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chong-Chi Chiu
- From the Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Education and Research, E-Da Cancer Hospital, Kaohsiung, Taiwan
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18
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Patient-tailored algorithm for laparoscopic cruroplasty standardization: comparison with hiatal surface area and medium-term outcomes. Langenbecks Arch Surg 2022; 407:2537-2545. [PMID: 35585260 DOI: 10.1007/s00423-022-02556-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/11/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Different methods have been described for laparoscopic hiatoplasty and hiatus hernia (HH) repair. All techniques are not standardized and the choice to reinforce or not the hiatus with a mesh is left to the operating surgeon's preference. Hiatal surface area (HSA) has been described as an attempt at standardization; in case the area is > 4 cm2, a mesh is used to reinforce the repair. OBJECTIVE The aim of this study was to describe a new patient-tailored algorithm (PTA), compare its performance in predicting crura mesh buttressing to HSA, and analyze outcomes. METHODS Retrospective, single-center, descriptive study (September 2018-September 2021). Adult patients (≥ 18 years old) who underwent laparoscopic HH repair. Outcomes and quality of life measured with the disease-specific gastroesophageal reflux disease health-related quality of life (GERD-HRQL) and reflux symptom index (RSI) were analyzed. RESULTS Fifty patients that underwent laparoscopic hiatoplasty and Toupet fundoplication were included. The median age was 61 years (range 32-83) and the median BMI was 26.7 (range 17-36). According to the PTA, 27 patients (54%) underwent simple suture repair while crural mesh buttressing with Phasix-ST® was used in 23 (46%). According to the HSA, the median hiatus area was 4.7 cm2 while 26 patients had an HSA greater than 4 cm2. The overall concordance rate between PTA and HSA was 94% (47/50). The median hospital stay was 1.9 days (range 1-8) and the 90-day complication rate was 4%. The median follow-up was 18.6 months (range 1-35). Hernia recurrence was diagnosed in 6%. Postoperative dysphagia occurred in one patient (2%). The GERD-HRQL (p < 0.001) and RSI (p = 0.001) were significantly improved. CONCLUSIONS The application of PTA for cruroplasty standardization in the setting of HH repair seems effective. While concordance with HSA is high, the PTA seems easier and promptly available in the operative theater with a potential increase in procedure standardization, reproducibility, and teaching.
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Aiolfi A, Cavalli M, Sozzi A, Lombardo F, Lanzaro A, Panizzo V, Bonitta G, Mendogni P, Bruni PG, Campanelli G, Bona D. Medium-term safety and efficacy profile of paraesophageal hernia repair with Phasix-ST ® mesh: a single-institution experience. Hernia 2022; 26:279-286. [PMID: 34716832 DOI: 10.1007/s10029-021-02528-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/17/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hernia recurrence after laparoscopic repair is a perplexing problem. In an effort to reduce anatomical and clinical recurrences, different type of meshes have been used to bolster the esophageal hiatus. OBJECTIVE The aim of this study was to assess safety, medium-term efficacy, and quality of life improvement after laparoscopic repair of hiatal hernia reinforced with a biosynthetic absorbable mesh (Phasix-ST®). METHODS Observational single-center retrospective single-arm cohort study (November 2015-February 2021). We included all adult patients (> 18 years old) who underwent laparoscopic paraesophageal hernia repair with Phasix-ST® mesh and Toupet fundoplication. RESULTS Sixty-eight patients were included. The median postoperative stay was 3.2 days (range 2-9) and the postoperative complication rate was 11.7%. The median follow-up time was 27 months (range 1-53). No mesh-related complications were detected. Hernia recurrence was diagnosed in six patients (8.8%). The recurrence-free probability at 34 months was 0.89 (95% CI 0.807-0.988) while at 60 months was 0.86 (95% CI 0.76-0.97). Hernia recurrences were mostly observed between 21 and 36 months after the operation. None of the patients required surgical revision and all were managed with PPI. Postoperative dysphagia requiring endoscopic balloon dilatation occurred in 2.9% of patients. Compared to baseline, both the GERD-HRQL (15.2 ± 6.2 vs. 3.2 ± 3.1; p = 0.026) and all SF-36 items were significantly improved (p < 0.001). CONCLUSIONS Laparoscopic crura augmentation with Phasix-ST® mesh combined with a Toupet fundoplication is safe and seems effective in the medium-term follow-up. Phasix-ST® crural reinforcement resulted in low hernia recurrence rate with a sustained symptoms and quality of life improvement.
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Affiliation(s)
- A Aiolfi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy.
| | - M Cavalli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - A Sozzi
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - F Lombardo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - A Lanzaro
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - V Panizzo
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - G Bonitta
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - P Mendogni
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
| | - P G Bruni
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - G Campanelli
- Department of Surgery, University of Insubria, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - D Bona
- Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant'Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy
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