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Lee MS, Lee DK, Han HY, Kim JH. Mesh migration into esophagogastric junction after laparoscopic hiatal hernia repair; how to prevent it? A case report. JOURNAL OF MINIMALLY INVASIVE SURGERY 2024; 27:109-113. [PMID: 38887002 PMCID: PMC11187609 DOI: 10.7602/jmis.2024.27.2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/27/2023] [Accepted: 11/16/2023] [Indexed: 06/20/2024]
Abstract
Although the use of mesh reinforcement during large hiatal hernia repair may reduce the rate of recurrence, various mesh-related complications have been reported. A 65-year-old woman presented with dysphagia. The patient was diagnosed with a large hiatal hernia and treated with laparoscopic fundoplication and Collis gastroplasty with mesh repair. Six months after surgery, the patient presented with dysphagia and vomiting. Esophagogastroduodenoscopy showed migration of mesh material into the esophagogastric junction. We performed a proximal gastrectomy with mesh removal. The patient was discharged without any postoperative complications. Herein, we encountered a rare case requiring surgical treatment to resolve mesh-induced esophagogastric perforation after hiatal hernia repair. Mesh-associated complications, such as erosion or migration, should be considered as they may be more common than previously reported. Additionally, these complications are currently underscored in clinical practice. Regarding mesh applications, symptoms of mesh-related complications, such as dysphagia, should be carefully monitored for early detection.
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Affiliation(s)
- Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon, Korea
| | - Dong Kyu Lee
- Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hyun-Young Han
- Department of Radiology, Eulji University Hospital, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University Hospital, Daejeon, Korea
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Rajkomar K, Wong CS, Gall L, MacKay C, Macdonald A, Forshaw M, Craig C. Laparoscopic large hiatus hernia repair with mesh reinforcement versus suture cruroplasty alone: a systematic review and meta-analysis. Hernia 2023:10.1007/s10029-023-02783-2. [PMID: 37010656 DOI: 10.1007/s10029-023-02783-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/18/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND To compare the difference in outcomes in laparoscopic large hiatus hernia (LHH) repair using suture-based and mesh-based repair techniques. METHODS A systematic search of articles was conducted in PubMed, Medline and Embase using the PRISMA guidelines. Studies comparing recurrences and reoperations in those patients with large hiatal hernia repair (> 30% stomach in the chest, > 5 cm hiatal defect, hiatal surface area > 10 cm2) who had mesh vs no mesh were assessed quantitatively. The impact of mesh on significant intraoperative/postoperative surgical complications was qualitatively assessed. RESULTS Pooled data included six randomized controlled trials and thirteen observational studies with 1670 patients (824 with no mesh, 846 with mesh). There was a significant reduction in the total recurrence rate with mesh (OR 0.44, 95% CI 0.25-0.80, p = 0.007). Mesh use did not cause significant reduction in recurrences > 2 cm (OR 0.94, 95% CI 0.52-1.67, p = 0.83) or in reoperation rates (OR 0.64, 95% CI 0.39-1.07, p = 0.09). None of the specific meshes assessed were found to be superior in the reduction of recurrence or reoperation rates. Cases of mesh erosion with eventual foregut resection were noted and were associated with synthetic meshes only. CONCLUSION Mesh reinforcement seemed protective against total recurrence in LHH although this has to be interpreted with caution given the level of heterogeneity introduced by the inclusion of observational studies in the analysis. There was no significant reduction in large recurrences (> 2 cm) or reoperation rate. If the synthetic mesh is to be used patients need to be informed of the risk of mesh erosion.
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Affiliation(s)
- K Rajkomar
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK.
| | - C S Wong
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
| | - L Gall
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
| | - C MacKay
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
| | - A Macdonald
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
| | - M Forshaw
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
| | - C Craig
- Upper GI Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G40SF,, UK
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Wang Y, Lv Y, Liu Y, Xie C. The effect of surgical repair of hiatal hernia (HH) on pulmonary function: a systematic review and meta-analysis. Hernia 2023:10.1007/s10029-023-02756-5. [PMID: 36826630 PMCID: PMC10374806 DOI: 10.1007/s10029-023-02756-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Hiatal hernia is renowned for the symptom of reflux, and few physicians associate a hiatal hernia with pulmonary issues. It is widely acknowledged that a hiatal hernia can be treated with surgery. However, less is known about how the surgical procedure would benefit pulmonary function. Thus, the aim of this study was to determine whether surgical repair can improve pulmonary function in patients with hiatal hernias. METHODS We registered the protocol on the PROSPERO (International Prospective Register of Systematic Reviews) platform (no. CRD42022369949). We searched the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases for cohort studies that reported on the pulmonary function of patients with hiatal hernias. The quality of each cohort study was evaluated using the Newcastle-Ottawa scale (NOS). We then calculated mean differences (MDs) with 95% confidence intervals for these continuous outcomes. Each study's consistency was appraised using the I2 statistic. The sensitivity analysis was performed using the trim-and-fill method. Publication bias was confirmed using the funnel plot visually and Egger regression test statistically. RESULTS A total of 262 patients from 5 cohorts were included in the meta-analysis. The quality evaluation revealed that, of these 5 papers, 3 received 8 NOS stars out of 9 stars, 1 received 9, and the other received 7, meaning all included cohort studies were of high quality. The results showed that surgical repair for a hiatal hernia significantly improved forced expiratory volume in 1 s (FEV1; weighted mean difference [WMD]:0.200; 95% CI 0.047-0.353; I2 = 71.6%; P = 0.010), forced vital capacity (FVC; WMD: 0.242; 95% CI 0.161-0.323; I2 = 7.1%; P = 0.000), and total lung capacity (TLC; WMD: 0.223; 95% CI 0.098-0.348; I2 = 0.0%; P = 0.000) but had little effect on residual volume (RV; WMD: -0.028; 95% CI -0.096 to 0.039; I2 = 8.7%; P = 0.411) and the diffusing capacity carbon monoxide (DLCO; WMD: 0.234; 95% CI -0.486 to 0.953; I2 = 0.0%; P = 0.524). CONCLUSION For individuals with hiatal hernias, surgical repair is an efficient technique to improve respiratory function as measured by FEV1, FVC, and TLC.
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Affiliation(s)
- Y Wang
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Y Lv
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Y Liu
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - C Xie
- General Surgery Department, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
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Liu X, Ma Q, Chen J, Yang H. A protocol for developing core outcome sets for laparoscopic hiatal hernia repair. Trials 2022; 23:907. [PMID: 36303243 PMCID: PMC9612608 DOI: 10.1186/s13063-022-06845-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Hiatal hernias negatively damage patients’ health and life quality. Laparoscopic hiatal hernia repair is currently the gold standard for the treatment of hiatal hernia (LHHR). Numerous clinical trials on laparoscopic hiatal hernia repair have been done, but the published findings are highly variable due to the lack of unique outcome sets. Basic outcome sets have ever been established over the previous decade for a few procedures, but not for hiatal hernia repair yet. This protocol outlines the procedure to develop a core outcome set for laparoscopic hiatal hernia repair COS-LHHR). COS-LHHR will provide a unique criteria for clinical investigations. Methods This study will be conducted in four phases: (1) scoping reviews of existing qualitative studies and outcome reporting in randomized controlled trials to develop a list of potential outcome domains; (2) qualitative interviews with patients to explore the impact of laparoscopic hiatal hernia repair and the outcomes that they care most; (3) a multi-round e-Delphi study to achieve preliminary consensus on the core outcome set; and (4) an evidence-based consensus on a core outcome set will be achieved through a structured group consensus meeting, recommending best assessment outcome sets. Discussion The development the COS-LHHR will guide clinical research of laparoscopic hiatal hernia repair with unique outcome assessment. This would improve comparative analyses among studies.
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Affiliation(s)
- Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Huiqi Yang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Varvoglis DN, Farrell TM. Poor Gastric Emptying in Patients with Paraesophageal Hernias: Pyloroplasty, Per-Oral Pyloromyotomy, BoTox, or Wait and See? J Laparoendosc Adv Surg Tech A 2022; 32:1134-1143. [PMID: 35939274 DOI: 10.1089/lap.2022.0342] [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: 10/15/2022] Open
Abstract
Gastric emptying delay may be caused with both functional and anatomic derangements. Gastroparesis is suspected in patients presenting with certain foregut symptoms without anatomic obstruction. Data are still emerging regarding the best treatment of this condition. In cases where large paraesophageal hernias alter the upper gastrointestinal anatomy, it is difficult to know if gastroparesis also exists. Management of hiatal hernias is also still evolving, with various strategies to reduce recurrence being actively investigated. In this article, we present a systematic review of the existing literature around the management of gastroparesis and the management of paraesophageal hernias when they occur separately. In addition, since there are limited data to guide diagnosis and management of these conditions when they are suspected to coexist, we provide a rational strategy based on our own experience in patients with paraesophageal hernias who have symptoms or studies that raise suspicion for a coexisting functional disorder.
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Affiliation(s)
- Dimitrios N Varvoglis
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Timothy M Farrell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
Background Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates. Results We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes. Conclusions First, we propose strict criteria to define nomenclature in LHH and discuss ways of subcategorising them. Next, we discuss preoperative workup strategies, paying particular attention to any relevant often atypical symptoms, indications for surgery, timing of surgery, role of surgery in the elderly and emphasizing the key role of a preoperative CT imaging in evaluating the mediastinum. Some key dissection methods are then discussed with respect to approach to the mediastinal sac, techniques to avoid/deal with pleural breach and rationale to avoid Collis gastroplasty. The issues pertaining to the repair phase are also discussed by evaluating the merits of the cruroplasty, fundoplication types and gastropexy. We end up debating the role of mesh reinforcement and assess the evidence with regards to recurrence, reoperation rate, complications, esophageal dilatation, delayed gastric emptying and mortality. Lastly, we propose a rationale for routine postoperative investigations.
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Date AR, Goh YM, Goh YL, Rajendran I, Date RS. Quality of life after giant hiatus hernia repair: A systematic review. J Minim Access Surg 2021; 17:435-449. [PMID: 33885030 PMCID: PMC8486064 DOI: 10.4103/jmas.jmas_233_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Elective surgery is the treatment of choice for symptomatic giant hiatus hernia (GHH), and quality of life (QoL) has become an important outcome measure following surgery. The aim of this study is to review the literature assessing QoL following repair of GHH. METHODOLOGY A systematic literature search was performed by two reviewers independently to identify original studies evaluating QoL outcomes after GHH surgery. MeSH terms such as paraoesophageal; hiatus hernia; giant hiatus hernia and quality of life were used in the initial search. Original studies in English language using validated questionnaires on humans were included. Review articles, conference abstracts and case reports and studies with duplicate data were excluded. RESULTS Two hundred and eight articles were identified on initial search, of which 38 studies (4404 patients) were included. Studies showed a significant heterogeneity in QoL assessment tools, surgical techniques and follow-up methods. All studies assessing both pre-operative and post-operative QoL (n = 31) reported improved QoL on follow-up after surgical repair of GHH. Improvement in QoL following GHH repair was not affected by patient age, surgical technique or the use of mesh. Recurrence of GHH after surgery may, however, adversely impact QoL. CONCLUSION Surgical repair of GHH improved QoL scores in all the 38 studies. The impact of recurrence on QoL needs further assessment. The authors also recommend uniform reporting of surgical outcomes in future studies.
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Affiliation(s)
- Akshay R. Date
- Department of Orthopaedic Surgery, Basildon and Thurrock University Hospital, Basildon, Essex, UK
| | - Yan Mei Goh
- Department of Surgery, Imperial College London, St Mary’s Hospital, London, UK
| | - Yan Li Goh
- National Bowel Research Centre (NBRC), Blizzard Institute, Queen Mary University of London, London, UK
| | - Ilayaraja Rajendran
- Department of Upper GI Surgery, Lancashire Teaching Hospital NHS Foundation Trust, Chorley, UK
| | - Ravindra S. Date
- Department of Upper GI Surgery, The University of Manchester, Manchester Academic Health Science Centre, Lancashire Teaching Hospital NHS Foundation Trust, Chorley, UK
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Laxague F, Sadava EE, Herbella F, Schlottmann F. When should we use mesh in laparoscopic hiatal hernia repair? A systematic review. Dis Esophagus 2021; 34:6041174. [PMID: 33333552 DOI: 10.1093/dote/doaa125] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/21/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
The use of mesh in laparoscopic hiatal hernia repair (LHHR) remains controversial. The aim of this systematic review was to determine the usefulness of mesh in patients with large hiatal hernia (HH), obesity, recurrent HH, and complicated HH. We performed a systematic review of the current literature regarding the outcomes of LHHR with mesh reinforcement. All articles between 2000 and 2020 describing LHHR with primary suturing, mesh reinforcement, or those comparing both techniques were included. Symptom improvement, quality of life (QoL) improvement, and recurrence rates were evaluated in patients with large HH, obesity, recurrent HH, and complicated HH. Reported outcomes of the use of mesh in patients with large HH had wide variability and heterogeneity. Morbidly obese patients with HH should undergo a weight-loss procedure. However, the benefits of HH repair with mesh are unclear in these patients. Mesh reinforcement during redo LHHR may be beneficial in terms of QoL improvement and hernia recurrence. There is scarce evidence supporting the use of mesh in patients undergoing LHHR for complicated HH. Current data are heterogeneous and have failed to find significant differences when comparing primary suturing with mesh reinforcement. Further research is needed to determine in which patients undergoing LHHR mesh placement would be beneficial.
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Affiliation(s)
- Francisco Laxague
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Emmanuel E Sadava
- Department of Surgery, Hospital Alemán of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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Balagué C, Fdez-Ananín S, Sacoto D, Targarona EM. Paraesophageal Hernia: To Mesh or Not to Mesh? The Controversy Continues. J Laparoendosc Adv Surg Tech A 2019; 30:140-146. [PMID: 31657667 DOI: 10.1089/lap.2019.0431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Introduction: Paraesophageal hernias represent 5%-10% of all primary hiatal hernias and are becoming increasingly more common with the aging of the population. Surgical treatment includes closure of the wide hiatal gap. Achieving tension-free closure is difficult, and several studies have reported lower recurrence rates with the use of mesh reinforcement. The use of this technique, however, is controversial. Objective and Materials and Methods: Narrative revision of the literature revising: (1) evidence-based surgery and clinical studies, (2) what the experts say (Delphi), (3) complications of mesh, and (4) long-term results of laparoscopic treatment impact on the quality of life. Results: Consensus about the type of mesh continues to be elusive, and we clearly need a higher level of evidence to address the controversy. Conclusion: Mesh reinforcement can effectively reduce the hernia recurrence rate. Mesh-associated complications are few, but because they are serious, most experts recommend mesh use only in specific circumstances, particularly those in relation to the size of the hiatal defect and the quality of the crura.
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Affiliation(s)
- Carmen Balagué
- Gastrointestinal and Hematological Surgical Unit, Hospital Santpau, Autonomous University of Barcelona (UAB) Medical School, Barcleona, Spain
| | - Sonia Fdez-Ananín
- Gastrointestinal and Hematological Surgical Unit, Hospital Santpau, Autonomous University of Barcelona (UAB) Medical School, Barcleona, Spain
| | - David Sacoto
- Gastrointestinal and Hematological Surgical Unit, Hospital Santpau, Autonomous University of Barcelona (UAB) Medical School, Barcleona, Spain
| | - Eduardo M Targarona
- Gastrointestinal and Hematological Surgical Unit, Hospital Santpau, Autonomous University of Barcelona (UAB) Medical School, Barcleona, Spain
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