Clinical and Quality of Life Assessment of Patients Undergoing Laparoscopic Hiatal Hernia Repair.

Hiatal hernia repair (HHR) and fundoplication are similarly performed among all hiatal hernia types with similar techniques. This study evaluates the effect of HHR using a standardized technique for cruroplasty with a reinforcing polyglycolic acid and trimethylene carbonate mesh (PGA/TMC) on patient symptoms and outcomes. A retrospective review of patient perioperative characteristics and postoperative outcomes was conducted for cases of laparoscopic hiatal hernia repair (LHHR) using a PGA/TMC mesh performed over 21 months. Gastroesophageal reflux disease symptom questionnaire responses were compared between preoperative and three postoperative time points. Ninety-six patients underwent LHHR with a PGA/TMC mesh. Postoperatively, the number of overall symptoms reported by patients decreased across all postoperative periods (P < 0.001). Patients reported a significant reduction in antacid use long term (P < 0.001). Laryngeal and regurgitation symptoms decreased at all time points (P < 0.05). There was no difference in dysphagia preoperatively and postoperatively at any time point. Individuals undergoing HHR with PGA/TMC mesh experienced improved regurgitation and laryngeal symptoms, and decreased use of antacid medication.

Outcomes after Ventral Hernia Repair Using the Rives-Stoppa, Endoscopic, and Open Component Separation Techniques.

Complex ventral hernias remain a challenge for general surgeons despite advances in minimally invasive surgical techniques. This study compares outcomes following Rives-Stoppa (RS) repair, components separation technique with mesh (CST-M) or without mesh (CST), and endoscopic components separation technique (ECST). A retrospective review of patients undergoing open ventral hernia repair between 2006 and 2011 was performed. Analysis included patient demographics, surgical site occurrences, hernia recurrence, hospital readmission, and mortality. The search was limited to open repairs, specifically the RS, CST-M, CST, and ECST with mesh techniques. A total of 362 patients underwent repair with RS (66), CST-M (126), CST (117), or ECST (53). The groups were demographically similar. ECST was more frequently used for patients with a history of two or more recurrences (P < 0.001). The RS method had the lowest rate of recurrence (9.1%) compared with CST and CST-M with 28 and 25 per cent recurrences, respectively (P = 0.011). The RS recurrence rate was not significantly different than ECST (15%). There were no significant differences between groups for surgical site occurrences (P = 0.305), hospital readmission (P = 0.288), or death (P = 0.197). When components separation is necessary for complex ventral hernia repair, ECST is a viable option without added morbidity or mortality.

Revisional paraesophageal hernia repair outcomes compare favorably to initial operations.

BACKGROUND: Recurrent paraesophageal hernia (PEH) repair is performed for symptomatic recurrent hiatal hernia and/or reflux with little understanding as to outcomes related to perioperative and subjective patient variables. The aim of this study was to understand what differences exist between patients undergoing initial paraesophageal hernia (IPEH) repair and those undergoing redo paraesophageal hernia (RPEH) repair. METHODS: A review of PEH repairs between 2009 and 2013 was performed from a single institution. RPEH patients were identified and analyzed for demographic information, perioperative/intraoperative details, and postoperative outcomes. A similar comparison group of IPEH patients was randomly selected from the same sample as a control. A phone questionnaire was administered to the RPEH group. RESULTS: Among 336 total PEH repairs from 2009 to 2013, 34 RPEH patients were identified. A matched cohort of 76 patients was identified. RPEH and IPEH groups had similar DeMeester score, incidence of Barrett's esophagus, incidence of gastritis, and LOS. Readmission rates (15 vs. 24 %, p = 0.283) and recurrence rate (4 vs. 12 %, p = 0.201) were not statistically different between IPEH and RPEH repairs, respectively. Operative times (163 vs. 209 min, p < 0.001), incidence of Collis gastroplasty (1 vs. 24 %, p < 0.001), and EBL > 10 cc (25 vs. 51 %, p < 0.023) differed between IPEH and RPEH repairs, respectively. Recurrent symptoms included chest pain (37 %), solid dysphagia (42 %), nausea (58 %), vomiting (32 %), bloating (63 %), and hoarseness (21 %). 21 % of patients required ongoing antacid therapy. Patient satisfaction via phone questionnaires demonstrated 88 % of patients were completely satisfied. CONCLUSIONS: Recurrent PEH repair is performed with similar outcomes to IPEH repair with the exception of increased operative time and blood loss. Collis gastroplasty is required more frequently in RPEH patients. Persistent symptoms exist following RPEH repair. Despite recurrent symptomatology, patient satisfaction is high. RPEH repair may be safely performed in patients with recurrent paraesophageal hernias with outcomes similar to IPEH repairs.