Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate1
| Autor: | Jeffrey H. Peters, Marcus L. Quek, Peter F. Crookes, Jeffrey A. Hagen, Tom R. DeMeester, Lelan F. Sillin, Cedric G. Bremner, Jörg Theisen, Steven R. DeMeester, James E. Huprich, Majid Hashemi |
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| Rok vydání: | 2000 |
| Předmět: |
Laparoscopic surgery
medicine.medical_specialty medicine.diagnostic_test business.industry General surgery medicine.medical_treatment Paraesophageal Hiatal Hernia medicine.disease digestive system diseases Surgery Hiatal hernia Laparoscopic hiatal hernia repair Laparotomy medicine Hernia Collis gastroplasty Laparoscopy business |
| Zdroj: | Journal of the American College of Surgeons. 190:553-560 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/s1072-7515(00)00260-x |
| Popis: | Background: Recent studies based on symptomatic outcomes analyses have shown that laparoscopic repair of large type III hiatal hernias is safe, successful, and equivalent to open repair. These outcomes analyses were based on a relatively short followup period and lack objective confirmation that the hernia has not recurred. The aim of this study was to compare the outcomes of laparoscopic and open repair of large type III hiatal hernia using both symptomatic evaluation and barium study to assess the integrity of the repair. Study Design: Fifty-four patients underwent repair of a large type III hiatal hernia between 1985 and 1998. The surgical approach was laparotomy in 13, thoracotomy in 14, and laparoscopy in 27. An antireflux procedure was included in all patients. Symptomatic outcomes were assessed using a structured questionnaire at a median of 24 months and was complete in 51 of 54 patients (94%). A single radiologist, without knowledge of the operative procedure, assessed the integrity of the repair using video esophagram. Videos were performed at a median of 27 months (35 months open and 17 laparoscopic) and were completed in 41 of 54 patients (75%). Results: Symptomatic outcomes were similar in both groups with excellent or good outcomes in 76% of the patients after laparoscopic repair and 88% after an open repair. Reherniation was present in 12 patients and was asymptomatic in 7. A recurrent hernia was present in 12 of the 41 patients (29%) who returned for a followup video esophagram. Forty-two percent (9 of 21) of the laparoscopic group had a recurrent hernia compared with 15% (3 of 20) of the open group (p Conclusions: Laparoscopic repair of type III hiatal hernias is associated with a disturbingly high (42%) prevalence of recurrent hernia. More than half such recurrences have few, if any, symptoms. |
| Databáze: | OpenAIRE |
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