Wedge gastroplasty and reinforced crural repair: Important components of laparoscopic giant or recurrent hiatal hernia repair
| Autor: | Chuong D. Hoang, Michael A. Maddaus, Adam K. Boettcher, Bryan A. Whitson, Rafael S. Andrade, Peter S. Dahlberg |
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| Rok vydání: | 2006 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Diaphragm Nissen fundoplication Asymptomatic Hiatal hernia Stomach surgery medicine Humans Hernia Laparoscopy Retrospective Studies medicine.diagnostic_test business.industry Stomach Middle Aged medicine.disease Symptomatic relief Endoscopy Surgery Hernia Hiatal Female medicine.symptom business Cardiology and Cardiovascular Medicine |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 132(5):1196-1202.e3 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2006.07.007 |
| Popis: | Objective Laparoscopic repair of a giant hiatal hernia (>50% of the stomach above the diaphragm) is associated with short-term recurrence rates of 12% to 42%. Recurrent hiatal hernias often have significantly altered anatomy, making laparoscopic repair challenging. We hypothesized that increasing intra-abdominal esophageal length by means of Collis wedge gastroplasty, complete fat-pad dissection, hernia-sac excision, and primary reinforced crural repair would minimize short-term recurrence and provide adequate symptomatic relief. Methods From January 1, 2001, though May 1, 2005, 61 patients underwent laparoscopic repair of a giant or recurrent hiatal hernia with a Collis wedge gastroplasty and Nissen fundoplication. Symptomatic outcomes were assessed with a validated questionnaire (Gastroesophageal Reflux Disease Health-Related Quality of Life). We obtained postoperative radiographic imaging to objectively assess anatomic results at a median of 1.13 years. Results Of the 61 patients, 12 (20%) were referred to our institution after previous repairs. Operating time averaged 308 ± 103 minutes. The median hospital stay was 4 days. Postoperative complications occurred in 5 (8.2%) patients. One (1.6%) patient died of cardiac complications. Postoperatively, 52 (85%) patients completed the questionnaire with mean a Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire score of 1.15 ± 2.78 (scale, 0-45; 0=asymptomatic). Overall, 51 (98%) of the 52 respondents were satisfied with their surgical outcome. Postoperative radiographic data were available for 54 (89%) patients. We identified no recurrences at 1-month follow-up, and only 4.7% (2/42) had evidence of radiographic recurrence at 1 year or more. Conclusions Consistent use of a Collis wedge gastroplasty with reinforced crural repair minimizes short-term recurrence after minimally invasive giant hiatal hernia repair. Symptomatic results are excellent in most patients. |
| Databáze: | OpenAIRE |
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