C T Huerta, BS, Margaret A Plymale, DNP, RN, Peter Barrett, Daniel L Davenport, PhD, John S Roth, MD. University of Kentucky
INTRODUCTION: Laparoscopic hiatal hernia repair via partial (Toupet) or complete (Nissen) fundoplication remain the most commonly performed procedures for management of large hiatal hernia. Few studies have compared the procedures’ long-term effectiveness with none looking beyond 5 years. This study sought to characterize the efficacy of laparoscopic Toupet versus Nissen fundoplication for types III and IV hiatal hernia using a telephone survey.
METHODS AND PROCEDURES: With IRB approval, a review of all laparoscopic hiatal hernia repairs with mesh reinforcement performed over seven years at a single center by one surgeon was conducted. Patient demographics and perioperative characteristics were recorded. Hiatal hernia was classified per published SAGES guidelines as type III or IV using operative reports and preoperative imaging. Patients with type I or II or recurrent hiatal hernia and patients receiving concomitant procedures were excluded. The GERD-Health Related Quality of Life Survey was administered by telephone no earlier than 18 months postoperatively. Patients responded to items concerning symptom severity using a 5-point scale (0= no symptoms to 5 = symptoms are incapacitating to do daily activities). Symptoms surveyed included heartburn (6 items), difficulty swallowing (1 item) and regurgitation (6 items) and reported degree of satisfaction with present condition.
RESULTS: A total of 473 patients underwent laparoscopic fundoplication with 179 having type III or IV hiatal hernia that met inclusion criteria; 62 patients underwent Toupet and 117 underwent Nissen fundoplication. Average patient age was 64 years and 63% of patients were female. Cohorts were similar in demographics, comorbidities, and intraoperative factors except an increased number of patients that smoked in the Toupet cohort. Survey was completed by 77 patients (43%): 50 having had Nissen and 27 Toupet. Reasons for survey nonparticipation included inability to contact (90) or declined participation (12). Median time of survey completion after surgery was 54 months in the Nissen cohort and 25 months for the Toupet patients. Median survey responses across all items for both groups was 0 (no symptoms) with no variation between groups. Of patients that had Nissen, 26% reported current PPI use vs. 31% of Toupet patients (p =0.486). Patient-reported satisfaction with current condition was similar between groups (67% Toupet, 72% Nissen, p = 0.351).
CONCLUSIONS: Surveyed symptoms did not vary between patients receiving laparoscopic Nissen vs. Toupet fundoplication, which may indicate that patients with large type III and IV hiatal hernia undergoing either procedure have similar long term postoperative symptom control.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86528
Program Number: P432
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster