Herbert M Hedberg, MD1, Tyler Hall, BS2, John Linn, MD2, Stephen Haggerty2, Woody Denham, MD2, JoAnn Carbray2, Michael B Ujiki, MD2. 1University of Chicago Medical Center, 2NorthShore University HealthSystem
Laparoscopic fundoplication (LF) is the treatment of choice for symptomatic hiatal hernia (HH). Mesh-reinforced curaplasty has considerably decreased recurrence rates for both large and small hernias, and newer synthetic absorbable meshes seem decrease rates even further. In this study, hiatal hernia repairs in an institutional database were analyzed for factors contributing to recurrence.
A retrospective review of a prospectively collected database was performed. Queried patients underwent LF from 2009 to 2016. Emergent operations, fundoplications after Heller myotomy, and individuals without HH were excluded. Demographics, intraoperative, and postoperative variables were compared between the groups with Student’s t-test, Mann-Whitney U test, or Fisher’s Exact test. The cohort was also divided by groups according to mesh type (including no mesh). Comparisons were made among the groups using Chi-squared analysis.
A total of 249 patients were included in the analysis (no recurrence = 216, recurrence = 33). Demographic analysis revealed BMI to be significantly different (29.77 vs 27.79, respectively, p=0.04). Intraoperatively, the recurrence group had higher EBL (39.35ml vs 83ml, p=0.004) and intraoperative complication rate (0.93% vs 12.12%, p=0.003). Postoperatively, recurrence was associated with increased length of stay (52.35hrs vs 107.31hrs, p=0.03), increased time to activities of daily living (6.2 vs 9.13, p=0.03), ED visit within 30 days (8.8% vs 27.27%, p=0.005), and readmission within 30 days (5.09% vs 21.21%, p=0.004). Analyzing the cohort by mesh type, 94 patients received synthetic absorbable, 60 received biologic, and 94 received curaplasty without mesh. Recurrence rates for the respective groups were 8.51%, 16.67%, and 10.10%, although these differences were not significant (p=0.22). Time to recurrence was significantly different, respectively 0.81, 2.55, and 1.22 years (p=0.016).
Although this study was not powered to show lower recurrence rates with synthetic absorbable as compared to biologic, the 8.51% recurrence rate is consistent with other series utilizing this mesh. It is interesting to note the difference in time to recurrence. These results suggest that while synthetic absorbable mesh may result in lower recurrence rates, recurrence seems to occur earlier. The results also suggest that deconditioning (lower BMI), and difficult cases and/or recovery may predispose to recurrence. These findings can help inform LF mesh selection and predict which patients are at higher risk of recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88415
Program Number: P424
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster