Anne-Sophie S Studer, MD, Teodoros Thomopoulos, MD, Michele Podetta, MD, Henri Atlas, MD, Ronald Denis, MD, Pierre Garneau, MD, Radu Pescarus, MD. Hopital Sacré Coeur de Montréal
Introduction: Surgical management of large paraesophageal hernias (PEH) remains challenging and may be associated with high morbidity. As an alternative to Nissen fundoplication, an anterior 180 degrees wrap has been described in the treatment of hiatal and PEH.
Materiel & Methods: Retrospective analysis of patients operated for PEH that included an anterior 180 degrees fundoplication, between October 2014 and May 2018, was performed. Pre- and post-operative clinical and objective findings (EGD, UGI study, CT abdomen or gastric emptying test) were recorded. Following laparoscopic hernia reduction and hiatal closure, the anterior gastric fundus was sutured as an anterior valve to the top of the left crus and at various locations on the right crus.
Results: Overall, 26 patients (20 Female; 6 Male), with a mean age of 70 years, underwent PEH repair with an anterior fundoplication. 12/26 (46%) patients were obese (BMI over 30 kg/m2). Pre-operative dysphagia, heartburns, epigastric pain, and regurgitations and nausea were respectively present in 65%, 65%, 58% and 35% of cases. All patients underwent primary laparoscopic PEH repair with partial anterior fundoplication, 17 patients (65%) had biological mesh reinforcement and 1 patient underwent a Collis gastroplasty. Four patients (15%) had an incarcerated PEH and underwent emergency surgery. Early post-operative morbidity rate and 30-day post-operative mortality rate were respectively 15,4% (1 post-operative confusion, 1 pneumonia, 1 angina pectoris and 1 myocardial infarction) and 0%. Median length of stay was 2 days (1-9). Median follow-up was 13 months (1-32). Anatomic hiatal hernia recurrences were diagnosed in 7 cases (27%), based on barium study (in 1 patient) or EGD (in 6 patients). Mean time of recurrence diagnosis occurred at 18,5 months. Only one patient was asymptomatic, three others complained bloating, 2 others regurgitations and nausea, and the last one, dysphagia and epigastric pain. There were 7 late complications with a mean time of occurrence of 20 months (4 oesophagitis, 2 gastroparesis, and 1 gastric ulcer). Four of those happened in a context of hiatal hernia recurrence. One patient with gastroparesis underwent a laparoscopic pyloroplasty 5 months post-op. No surgical revision was needed for the PEH recurrences.
Conclusion: Laparoscopic anterior partial fundoplication appears to be a safe option in the armamentarium of the PEH surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94802
Program Number: P442
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster