Lisandro Montorfano, MD, Federico Perez Quirante, MD, Nisha Dhanabalsamy, MD, Joongmin Park, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida
Introduction: Laparoscopic surgery for the treatment of patients with hiatal hernia (HH) is now standard clinical practice. The aim of this study was to analyze the outcomes of surgical treatment of HH at a single institution during 15 year period.
Methods: Medical records of 395 cases of laparoscopic surgeries for treatment of HH (September 2001 December 2014) were reviewed. Complication, recurrence, and reoperation rates were compared according to the type of surgical procedure.
Results: After excluding the concurrent HH repairs in bariatric surgery and Heller myotomy for achalasia, 299 cases of primary HH repair were included. The patients who underwent interrupted suture repair had higher rate of recurrence, reoperation, and perioperative complications than the patients who underwent continuous suture technique with barbed suture (p=0.001, p<0.001, and p<0.001). There were no differences in recurrence and reoperation rates when mesh was used (p=0,729, p=0.197) whereas perioperative complication rate was significantly higher when mesh was used (15.2% vs 7.3%,p=0.049). The patients with a history of previous uppergastrointestinal surgery had similar recurrence, reoperation, and complication rates than those who did not have previous surgery history (p=0.563 ,p=0.563, and p=0.318). There was mortality due to AFib after exploratory reoperation for small bowel obstruction.
Conclusions: Laparoscopic HH repair can be performed with acceptable surgical outcomes and overall lower recurrence, reoperation, and complication rates. Continuous barbed sutures for cruroplasty had better outcomes compared with interrupt sutures. Although mesh usage was related with higher perioperative complication rate, it did not increase the reoperation rate. However, mesh did not provide benefit for recurrence. Previous surgery had no negative impact on the surgical outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79315
Program Number: P614
Presentation Session: Poster (Non CME)
Presentation Type: Poster
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