Abstract
BACKGROUND: The approach to repair of paraesophageal hernias (PEHs) is controversial. Recent data suggest that mesh repair leads to recurrence rates similar to non-mesh approaches, while subjecting patients to mesh-associated complications. Routine fundoplication during PEH repair has been favored despite significant dysphagia rates. We present our multicenter prospective data on laparoscopic PEH repairs using a modified Boerema anterior gastropexy without fundoplication.
METHODS: We prospectively followed patients after modified Boerema PEH repair at three institutions. Patient demographics, perioperative data, and postoperative outcomes were evaluated. Subjective and objective outcomes were assessed via clinical assessment, follow-up questioning, endoscopy, and radiographic swallow studies.
RESULTS: A total of 101 patients were followed a mean of 10.8 (median, 12) months. We encountered 9 (8.9 %) intraoperative complications and 13 (12.9 %) postoperative complications. There was no mortality. Reflux symptoms were absent in 71 patients (70.3 %) postoperatively. Of the remaining subjects, 8 (7.9 %) had mild intermittent reflux without the need for proton pump inhibitors (PPI), 12 (11.9 %) had moderate reflux necessitating PPI as needed, and 10 (9.9 %) had reflux requiring daily PPI. Our recurrence rate, assessed at postoperative endoscopy/barium swallow, was 16.8 %. Of these, 10 (9.9 %) were small segmental recurrences and 7 (6.9 %) were large recurrences.
CONCLUSION: Herein, we demonstrate a favorable recurrence rate while avoiding the potential major complications associated with mesh hiatoplasty. Our data tend to support a tailored approach to incorporation of fundoplication during PEH repair. Postoperative acid reflux was absent in most of our patients, and pharmacotherapy alone was sufficient for those experiencing reflux symptoms.
Originalsprog | Engelsk |
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Tidsskrift | Surgical Endoscopy |
Vol/bind | 29 |
Udgave nummer | 7 |
Sider (fra-til) | 1856-61 |
ISSN | 0930-2794 |
DOI | |
Status | Udgivet - 2015 |