Outcomes of Redo Hiatal Hernia repair: A single institution experience

Nisha Dhanabalsamy, MD, Lisandro Montorfano, MD, Federico Perez Quirante, MD, Rajmohan Rammohan, MD, Alex Ordonez, MD, Abhiman Cheeyandira, MD, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS. Cleveland Clinic Florida

Background: Redo laparoscopic repair of hiatal hernias is a technically challenging procedure with potential significant perioperative morbidity. The aim of this study is to evaluate the safety and efficacy of laparoscopic re-operative hiatal hernia repair. 

Methods: A retrospective review of a prospectively collected database was performed. Al the redo hiatal hernia repairs were identified. Morbidity, mortality, perioperative and functional outcomes of the second procedure were analyzed. 

Results: Between 2010 and 2015, a total of 74 patients that underwent re-operative laparoscopic hiatal hernia repair were analyzed. All hiatal hernia repairs were done in a laparoscopic fashion (100%). The median length of the surgery was 105.3 min (33-252 min). The mean blood loss was 54.7 mL. The average length of stay was 4 days (2-15 days). The most common complaint before re-operations was dysphagia (46%) followed by gastro esophageal reflux (39%). The majority of the initial repairs also had a Nissen fundoplication. (39%). Regarding the technique of the hiatal redo repair there was no difference between hernia repairs using barbed sutures only and using barbed suture and mesh reinforcement. At the 6 months follow up visit 5 patients (6.7%) presented de novo GERD, 8 patients (10.8%) dysphagia, 2 patients (2.7%) recurrent GERD, and 2 patients (2.7%) achalasia. We had no mortality and no clinical evidence of hernia recurrence in our population. 

Conclusions: Re-operative laparoscopic hiatal hernia repair appears to be a safe and effective procedure. We had no clinical evidence of  hernia recurrence and no mortality in our population. The level of patient satisfaction after the procedure was high in this series. Further studies are needed in order to confirm our findings.

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