Abstract
Background
Recurrent hiatal hernia with or without intrathoracic wrap migration (“slipping Nissen”) is one of the most common complications after laparoscopic Nissen fundoplication (LNF). Therefore, we decided to reinforce the hiatal crura using a prostetic mesh prothesis in an attempt to reduce recurrent hiatal hernia.
Methods
The current nonrandomized study compares the surgical outcome, including quality of life data [Gastrointestinal Quality of Life Index (GIQLI)] and subjective degree of dysphagia, in a total of 200 patients with (n=100) or without (n=100) mesh prothesis for a follow-up for at least 1 year.
Results
There are no significant differences between groups in postoperative DeMeester score or lower esophageal sphincter pressure. In the group without mesh prothesis, in 6 cases laparoscopic redo surgery was necessary due to severe and persistent dysphagia (n=2) or a slipping Nissen (n=4). Additionally, in 5 patients we found recurrent hiatal hernia, but patients have been without symptoms for at least 1 year. In the group with mesh prothesis, laparoscopic refundoplication was performed in only 1 patient due to a slipping Nissen. In this group, recurrent hiatal hernia was not found in endoscopy. After laparoscopic antireflux surgery, GIQLI showed an equal improvement in both groups with an outcome comparable to that for healthy individuals. Postoperative dysphagia was significantly higher in the group with mesh prothesis within the 3 first months after surgery. One year after surgery no differences could be found.
Conclusions
Our findings suggest that LNF with reinforcement of the hiatal crura reduces the risk of recurrent hiatal hernia with or without wrap migration. In addition, LNF with mesh prothesis improves patient’s quality of life significantly to the same level as that in patients without mesh prothesis. Postoperative dysphagia is higher in the early period after surgery, but this is only temporary. Long-term results of a randomized tiral must be obtained before a general standardization can be discussed.
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Kamolz, T., Granderath, F.A., Bammer, T. et al. Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prostetic reinforcement of the hiatal crura. Surg Endosc 16, 572–577 (2002). https://doi.org/10.1007/s00464-001-9136-0
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DOI: https://doi.org/10.1007/s00464-001-9136-0