A retrospective analysis of hiatal hernia recurrences in a large teaching hospital
EAES Academy. Akmaz B. 07/05/22; 366526; P243
Mrs. Berdel Akmaz
Contributions
Contributions
Abstract
Introduction
The current standard for laparoscopic repair of hiatus hernia (HH) involves crural repair and a Nissen (360°) or Toupet fundoplication (270°). However, literature shows that recurrences of hiatal hernia are still high after hernia surgery (>42%). The most common type of recurrence is located anteriorly. Therefore, literature points out that additional anterior sutures could provide reinforcement. Furthermore, pledgets or mesh can be used to reinforce the crural repair. The effect of these reinforcement methods in the long-term (>1 year) is still uncertain. Therefore, the aim of this study was to investigate the recurrence rate of hiatus hernia after laparoscopic fundoplication in a high-volume teaching hospital. Second, it was analyzed whether reinforcement techniques (mesh, pledgets and/or anterior sutures) lead to lower recurrence in the long-term.
Methods
In this retrospective database research all patients that had a laparoscopic fundoplication between 2012-2019 were included. The most important outcome variables were recurrence of symptoms and whether re-intervention had taken place. Statistical analyses comprised multi- and univariable analyses and chi-square tests.
Results
In total 307 patients were included, 206 (67%) women and 101 (32.9%) men. Patients received a Toupet (n=208), Nissen (n=78), Nissen-Rosetti (n=20) or Dor fundoplication (n=1) during primary surgery. The mean transverse diameter of the HH was 3.7 cm. In 132 patients (43%) anterior sutures were used, in 88 pledgets (28.7%) were used and mesh was used in 22 (7.2%) of the patients. 88 patients (28.7%) reported recurrent symptoms after primary surgery. 54 patients (17.6%) had secondary surgery and 4 (1.3%) patients had tertiary surgery. In the patientgroup with anterior sutures, only 31 (23.5%) reported recurrent symptoms. In the patientgroup with pledgets 21 patients (23.9%) reported recurrent symptoms. Additional significance analyses have yet to be conducted.
Conclusion
The recurrence rate amongst HH patients was 28.7%. 17.6% of the patients had secondary surgery. The Toupet fundoplication was used the most in our hospital and anterior sutures were used in almost half of the patients. Less recurrence was seen in patients with anterior sutures or pledgets. Additional analyses have yet to be conducted.
The current standard for laparoscopic repair of hiatus hernia (HH) involves crural repair and a Nissen (360°) or Toupet fundoplication (270°). However, literature shows that recurrences of hiatal hernia are still high after hernia surgery (>42%). The most common type of recurrence is located anteriorly. Therefore, literature points out that additional anterior sutures could provide reinforcement. Furthermore, pledgets or mesh can be used to reinforce the crural repair. The effect of these reinforcement methods in the long-term (>1 year) is still uncertain. Therefore, the aim of this study was to investigate the recurrence rate of hiatus hernia after laparoscopic fundoplication in a high-volume teaching hospital. Second, it was analyzed whether reinforcement techniques (mesh, pledgets and/or anterior sutures) lead to lower recurrence in the long-term.
Methods
In this retrospective database research all patients that had a laparoscopic fundoplication between 2012-2019 were included. The most important outcome variables were recurrence of symptoms and whether re-intervention had taken place. Statistical analyses comprised multi- and univariable analyses and chi-square tests.
Results
In total 307 patients were included, 206 (67%) women and 101 (32.9%) men. Patients received a Toupet (n=208), Nissen (n=78), Nissen-Rosetti (n=20) or Dor fundoplication (n=1) during primary surgery. The mean transverse diameter of the HH was 3.7 cm. In 132 patients (43%) anterior sutures were used, in 88 pledgets (28.7%) were used and mesh was used in 22 (7.2%) of the patients. 88 patients (28.7%) reported recurrent symptoms after primary surgery. 54 patients (17.6%) had secondary surgery and 4 (1.3%) patients had tertiary surgery. In the patientgroup with anterior sutures, only 31 (23.5%) reported recurrent symptoms. In the patientgroup with pledgets 21 patients (23.9%) reported recurrent symptoms. Additional significance analyses have yet to be conducted.
Conclusion
The recurrence rate amongst HH patients was 28.7%. 17.6% of the patients had secondary surgery. The Toupet fundoplication was used the most in our hospital and anterior sutures were used in almost half of the patients. Less recurrence was seen in patients with anterior sutures or pledgets. Additional analyses have yet to be conducted.
Introduction
The current standard for laparoscopic repair of hiatus hernia (HH) involves crural repair and a Nissen (360°) or Toupet fundoplication (270°). However, literature shows that recurrences of hiatal hernia are still high after hernia surgery (>42%). The most common type of recurrence is located anteriorly. Therefore, literature points out that additional anterior sutures could provide reinforcement. Furthermore, pledgets or mesh can be used to reinforce the crural repair. The effect of these reinforcement methods in the long-term (>1 year) is still uncertain. Therefore, the aim of this study was to investigate the recurrence rate of hiatus hernia after laparoscopic fundoplication in a high-volume teaching hospital. Second, it was analyzed whether reinforcement techniques (mesh, pledgets and/or anterior sutures) lead to lower recurrence in the long-term.
Methods
In this retrospective database research all patients that had a laparoscopic fundoplication between 2012-2019 were included. The most important outcome variables were recurrence of symptoms and whether re-intervention had taken place. Statistical analyses comprised multi- and univariable analyses and chi-square tests.
Results
In total 307 patients were included, 206 (67%) women and 101 (32.9%) men. Patients received a Toupet (n=208), Nissen (n=78), Nissen-Rosetti (n=20) or Dor fundoplication (n=1) during primary surgery. The mean transverse diameter of the HH was 3.7 cm. In 132 patients (43%) anterior sutures were used, in 88 pledgets (28.7%) were used and mesh was used in 22 (7.2%) of the patients. 88 patients (28.7%) reported recurrent symptoms after primary surgery. 54 patients (17.6%) had secondary surgery and 4 (1.3%) patients had tertiary surgery. In the patientgroup with anterior sutures, only 31 (23.5%) reported recurrent symptoms. In the patientgroup with pledgets 21 patients (23.9%) reported recurrent symptoms. Additional significance analyses have yet to be conducted.
Conclusion
The recurrence rate amongst HH patients was 28.7%. 17.6% of the patients had secondary surgery. The Toupet fundoplication was used the most in our hospital and anterior sutures were used in almost half of the patients. Less recurrence was seen in patients with anterior sutures or pledgets. Additional analyses have yet to be conducted.
The current standard for laparoscopic repair of hiatus hernia (HH) involves crural repair and a Nissen (360°) or Toupet fundoplication (270°). However, literature shows that recurrences of hiatal hernia are still high after hernia surgery (>42%). The most common type of recurrence is located anteriorly. Therefore, literature points out that additional anterior sutures could provide reinforcement. Furthermore, pledgets or mesh can be used to reinforce the crural repair. The effect of these reinforcement methods in the long-term (>1 year) is still uncertain. Therefore, the aim of this study was to investigate the recurrence rate of hiatus hernia after laparoscopic fundoplication in a high-volume teaching hospital. Second, it was analyzed whether reinforcement techniques (mesh, pledgets and/or anterior sutures) lead to lower recurrence in the long-term.
Methods
In this retrospective database research all patients that had a laparoscopic fundoplication between 2012-2019 were included. The most important outcome variables were recurrence of symptoms and whether re-intervention had taken place. Statistical analyses comprised multi- and univariable analyses and chi-square tests.
Results
In total 307 patients were included, 206 (67%) women and 101 (32.9%) men. Patients received a Toupet (n=208), Nissen (n=78), Nissen-Rosetti (n=20) or Dor fundoplication (n=1) during primary surgery. The mean transverse diameter of the HH was 3.7 cm. In 132 patients (43%) anterior sutures were used, in 88 pledgets (28.7%) were used and mesh was used in 22 (7.2%) of the patients. 88 patients (28.7%) reported recurrent symptoms after primary surgery. 54 patients (17.6%) had secondary surgery and 4 (1.3%) patients had tertiary surgery. In the patientgroup with anterior sutures, only 31 (23.5%) reported recurrent symptoms. In the patientgroup with pledgets 21 patients (23.9%) reported recurrent symptoms. Additional significance analyses have yet to be conducted.
Conclusion
The recurrence rate amongst HH patients was 28.7%. 17.6% of the patients had secondary surgery. The Toupet fundoplication was used the most in our hospital and anterior sutures were used in almost half of the patients. Less recurrence was seen in patients with anterior sutures or pledgets. Additional analyses have yet to be conducted.
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