Fundic gastropexy for high risk of recurrence laparoscopic hiatal hernia repair and esophageal sphincter augmentation (LINX) improves outcomes without altering perioperative course.
GERD
Gastropexy
Hiatal hernia
LINX
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
08
04
2020
accepted:
02
07
2020
pubmed:
19
7
2020
medline:
30
9
2021
entrez:
19
7
2020
Statut:
ppublish
Résumé
The aim of this study is to show that the addition of a fundic gastropexy to a laparoscopic hiatal hernia repair (HHR) and magnetic sphincter augmentation (MSA) with LINX (Johnson and Johnson, New Brunswick, NJ) in patients with high risk for hiatal hernia recurrence improves outcomes without altering perioperative course. An IRB approved, single institution retrospective review of patient outcomes after hiatal hernia repair with magnetic sphincter augmentation was performed. Data were obtained from the electronic health record and stored in a REDCap database. Using statistical software, the patient data were analyzed and stratified to assess the specific variables of the perioperative and postoperative course focusing on the high risk of hiatal hernia recurrence group (HRHR) and low risk hiatal hernia of recurrence group (LRHR). The HRHR group received a gastropexy and were defined using the following variables: comorbid state increasing abdominal pressure, gastric herniation > 30%, maximum transverse crural diameter > 4 cm, age 70 years or older, previous hiatal or abdominal wall hernia repair, BMI > 34, heavy weight bearing job/hobby, and/or emergent repair. Hiatal hernia repair with magnetic sphincter augmentation was performed on 137 patients. The HRHR group (N = 86) and the LRHR group (N = 51) were compared and there was a difference observed with acute hernia recurrence, dysphagia (p value = 0.008), and number of post-op EGDs (p value = 0.005) in favor of the HRHR group. Other postoperative variables observed (i.e., length of stay and PPI use) showed no significant difference between the two groups. Fundic gastropexy for individuals who are considered high risk for recurrence does not appear to alter the perioperative course in our sample of patients. The HRHR group has the same length of stay experience and improved postoperative outcomes with reference to postoperative EGD, dysphagia and a decreasing trend in hiatal hernia recurrence.
Sections du résumé
BACKGROUND
The aim of this study is to show that the addition of a fundic gastropexy to a laparoscopic hiatal hernia repair (HHR) and magnetic sphincter augmentation (MSA) with LINX (Johnson and Johnson, New Brunswick, NJ) in patients with high risk for hiatal hernia recurrence improves outcomes without altering perioperative course.
METHODS
An IRB approved, single institution retrospective review of patient outcomes after hiatal hernia repair with magnetic sphincter augmentation was performed. Data were obtained from the electronic health record and stored in a REDCap database. Using statistical software, the patient data were analyzed and stratified to assess the specific variables of the perioperative and postoperative course focusing on the high risk of hiatal hernia recurrence group (HRHR) and low risk hiatal hernia of recurrence group (LRHR). The HRHR group received a gastropexy and were defined using the following variables: comorbid state increasing abdominal pressure, gastric herniation > 30%, maximum transverse crural diameter > 4 cm, age 70 years or older, previous hiatal or abdominal wall hernia repair, BMI > 34, heavy weight bearing job/hobby, and/or emergent repair.
RESULTS
Hiatal hernia repair with magnetic sphincter augmentation was performed on 137 patients. The HRHR group (N = 86) and the LRHR group (N = 51) were compared and there was a difference observed with acute hernia recurrence, dysphagia (p value = 0.008), and number of post-op EGDs (p value = 0.005) in favor of the HRHR group. Other postoperative variables observed (i.e., length of stay and PPI use) showed no significant difference between the two groups.
CONCLUSIONS
Fundic gastropexy for individuals who are considered high risk for recurrence does not appear to alter the perioperative course in our sample of patients. The HRHR group has the same length of stay experience and improved postoperative outcomes with reference to postoperative EGD, dysphagia and a decreasing trend in hiatal hernia recurrence.
Identifiants
pubmed: 32681373
doi: 10.1007/s00464-020-07789-w
pii: 10.1007/s00464-020-07789-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3998-4002Références
Ayazi S, Zheng P, Zaidi AH, Chovanec K, Chowdhury N, Salvitti M, Komatsu Y, Omstead AN, Hoppo T, Jobe BA (2020) Magnetic sphincter augmentation and postoperative dysphagia: characterization, clinical risk factors, and management. J Gastrointest Surg 24:39–49. https://doi.org/10.1007/s11605-019-04331-9
doi: 10.1007/s11605-019-04331-9
pubmed: 31388888
Reynolds JL, Zehetner J, Wu P, Shah S, Bildzukewicz N, Lipham JC (2015) Laparoscopic magnetic sphincter augmentation vs laparoscopic nissen fundoplication: a matched-pair analysis of 100 patients. J Am Coll Surg 221:123–128. https://doi.org/10.1016/j.jamcollsurg.2015.02.025
doi: 10.1016/j.jamcollsurg.2015.02.025
pubmed: 26095560
Dunn C, Bildzukewicz N, Lipham J (2020) Magnetic sphincter augmentation for gastroesophageal reflux disease. Gastrointest Endosc Clin N Am 30:325–342
doi: 10.1016/j.giec.2019.12.010
Jiang Y, Clarke JO (2020) New developments in the diagnosis and management of gastroesophageal reflux. Curr Treat Options Gastroenterol. https://doi.org/10.1007/s11938-020-00275-1
doi: 10.1007/s11938-020-00275-1
pubmed: 32072470
Chan EG, Sarkaria IS, Luketich JD, Levy R (2019) Laparoscopic approach to paraesophageal hernia repair. Thorac Surg Clin 29:395–403
doi: 10.1016/j.thorsurg.2019.07.002
Omura N, Tsuboi K, Yano F (2019) Minimally invasive surgery for large hiatal hernia. Ann Gastroenterol Surg 3:487–495. https://doi.org/10.1002/ags3.12278
doi: 10.1002/ags3.12278
pubmed: 31549008
pmcid: 6749952
Ekeke CN, Vercauteren M, Baker N, Sarkaria I (2019) Surgical techniques for robotically-assisted laparoscopic paraesophageal hernia repair. Thorac Surg Clin 29:369–377
doi: 10.1016/j.thorsurg.2019.06.001
Vage V, Behme J, Jossart G, Andersen JR (2020) Gastropexy predicts lower use of acid-reducing medication after laparoscopic sleeve gastrectomy. A prospective cohort study. Int J Surg 74:113–117
doi: 10.1016/j.ijsu.2019.12.029
Sánchez-Pernaute A, Talavera P, Pérez-Aguirre E, Domínguez-Serrano I, Rubio MÁ, Torres A (2016) Technique of Hill's gastropexy combined with sleeve gastrectomy for patients with morbid obesity and gastroesophageal reflux disease or hiatal hernia. Obes Surg 26:910–912. https://doi.org/10.1007/s11695-016-2076-5
doi: 10.1007/s11695-016-2076-5
pubmed: 26864390
Mozer AB, Speicher JE, Anciano CJ (2018) Thoracic surgery considerations in the mentally Ill or handicapped patient. Thorac Surg Clin 28:59–68
doi: 10.1016/j.thorsurg.2017.08.007
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010
doi: 10.1016/j.jbi.2008.08.010
pubmed: 18929686
pmcid: 18929686
Schizas D, Mastoraki A, Papoutsi E, Giannakoulis VG, Kanavidis P, Tsilimigras D, Ntourakis D, Lyros O, Liakakos T, Moris D (2020) LINX((R)) reflux management system to bridge the "treatment gap" in gastroesophageal reflux disease: a systematic review of 35 studies. World J Clin Cases 8:294–305. https://doi.org/10.12998/wjcc.v8.i2.294
doi: 10.12998/wjcc.v8.i2.294
pubmed: 32047777
pmcid: 7000944
Buckley F III, Buckley F III, Bell R, Bell R, Freeman K, Freeman K, Doggett S, Doggett S, Heidrick R, Heidrick R (2018) Favorable results from a prospective evaluation of 200 patients with large hiatal hernias undergoing LINX magnetic sphincter augmentation. Surg Endosc 32:1762–1768. https://doi.org/10.1007/s00464-017-5859-4
doi: 10.1007/s00464-017-5859-4
pubmed: 28936790
Kuckelman JP, Phillips CJ, Derickson MJ, Faler BJ, Martin MJ (2018) Esophageal magnetic sphincter augmentation as a novel approach to post-bariatric surgery gastroesophageal reflux disease. Obes Surg 28:3080–3086. https://doi.org/10.1007/s11695-018-3292-y
doi: 10.1007/s11695-018-3292-y
pubmed: 29770925
Collet D, Luc G, Chiche L (2013) Management of large para-esophageal hiatal hernias. J Visc Surg 150:395–402. https://doi.org/10.1016/j.jviscsurg.2013.07.002
doi: 10.1016/j.jviscsurg.2013.07.002
pubmed: 24060742
Armijo PR, Pokala B, Misfeldt M, Pagkratis S, Oleynikov D (2019) Predictors of hiatal hernia recurrence after laparoscopic anti-reflux surgery with hiatal hernia repair: a prospective database analysis. J Gastrointest Surg 23:696–701. https://doi.org/10.1007/s11605-018-04073-0
doi: 10.1007/s11605-018-04073-0
pubmed: 30617774
Kao AM, Ross SW, Otero J, Maloney SR, Prasad T, Augenstein VA, Heniford BT, Colavita PD (2019) Use of computed tomography volumetric measurements to predict operative techniques in paraesophageal hernia repair. Surg Endosc. https://doi.org/10.1007/s00464-019-06930-8
doi: 10.1007/s00464-019-06930-8
pubmed: 31407111
Addo A, Sanford Z, Broda A, Zahiri HR, Park A (2020) Age-related outcomes in laparoscopic hiatal hernia repair: is there a "too old" for antireflux surgery? Surg Endosc. https://doi.org/10.1007/s00464-020-07489-5
doi: 10.1007/s00464-020-07489-5
pubmed: 33140157