• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Laparoscopic hiatal hernia repair with anterior or lateral fundoplication

Hitoshi Idani, MD, FACS1, Kent Mishima, MD1, Kanyu Nakano, MD1, Tetsushi Kubota, MD1, Masao Harano, MD1, Shinya Asami, MD2, Norihisa Takakura, MD2. 1Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 2Department of Surgery, Fukuyama City Hospital

Background: Tailored fundoplication according to the esophageal motility is not indicated in recent guideline during laparoscopic hiatal hernia repair, however, dysphagia after surgery is still a crucial matter which might cause aspiration pneumonia especially in elderly patients. We have introduced laparoscopic hiatal hernia repair with anterior or lateral fundoplication for elderly patients with hiatal hernia to minimize dysphagia and evaluated the outcome.

Surgical technique: After the crus was approximated posteriorly +/- anteriorly, anterior 90-180 degree fundoplication or lateral fundoplication was performed according to the age and the symptom of the patient. Onlay mesh was used only for patients with vulnerable hiatus.

Patients and methods: From May 1997 to August 2017, a total of 182 patients with GERD and/or hiatal hernia underwent laparoscopic repair in our hospitals. Preoperative work up included esophagogastrogram, endoscopy, CT, 24h pH and impedance and manometry (selected patients). Nissen or Toupet was indicated for patients aged < 75 and/or with severe to moderate reflux symptom. Anterior fundoplication was indicated for patients aged 70 to 85 years with mild reflux and /or dysphagia. Lateral fundoplication was indicated for patients aged over 80 with dysphagia and/or had a history of aspiration pneumonia. Symptom score and clinical outcome were  evaluated.

Results: The type of fundoplication was as follows; Nissen:70, Toupet:69, Anterior:28, lateral:15. Operation time was 141+/-44.3min and hospital stay was 9.1 days. There was no mortality. Conversion to open surgery was required on one patient. Symprom scores of heart burn, dysphagia and regurgitation were significantly improved both after anterior and lateral fundoplication.  LES pressure (from 1.0 to 14.8mmHg, p=0.0032), LES length (from 1.1 to 2.9, p=0.0021) and DeMeester score (from 27.2 to 2.4, p=0.0018) were significantly increase or improved after anterior fundoplicastion. In 88 patients with paraesophageal hernia, dysphagia (2/40 vs 6/48, p=0.283), esophagitis (4/48 vs 2/40, p=0.448), hernia recurrence (5/48 vs 4/40, p=1.00) and reoperation (6/40, vs 1/40, p=0.121) after anterior or lateral fundoplication  were comparable to those after Nissen or Toupet fundoplication. There was no pneumonia after surgery. Anterior fundoplication showed excellent antireflux effect in 24 h pH and impedance monitoring although the number of patients was small.

Conclusion: Laparoscopic hiatal hernia repair with anterior or lateral fundoplication has feasible outcome and can be a option of fundoplicstion for elderly patients with dysphagia.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87238

Program Number: P446

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

50

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2018 abstract archive

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
sagesweb@sages.org
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons