| Laparoscopic management of giant hiatal hernia: factors influencing long-term outcome. | |
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MedLine Citation:
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PMID: 16763927 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The laparoscopic management of large hiatal hernias still is controversial. Recent studies have presented a high recurrence rate. METHODS: In this study, 65 patients underwent elective laparoscopic repair of large hiatal hernia. A short esophagus was diagnosed in 13 cases. A primary closure of the hiatal defect was performed in 14 cases. "Tension-free" repair using a mesh was performed in 37 cases, and 14 patients underwent a Collis-Nissen gastroplasty. For the last 38 patients in the series, an intraoperative endoscopy was performed to identify the esophagogastric junction. RESULTS: There was no mortality, no conversions to open surgery, and no intraoperative complications. A recurrent hernia was present in 23 of the 77 patients (30%). The recurrence rate was 77% when a direct suture was used and 35% when a mesh was used (p < 0.05). No recurrences were observed in the patients treated with the Collis-Nissen technique, but in one case, perforation of the distal esophagus developed 3 weeks after surgery. The multivariate analysis showed that recurrences are statistically correlated with the type of hiatal hernia and surgical technique. CONCLUSIONS: To reduce recurrences after laparoscopic management of large hiatal hernias, it is essential to identify all cases of short esophagus using intraoperative endoscopy and to perform a Collis-Nissen procedure in such cases. |
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Authors:
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M Morino; C Giaccone; L Pellegrino; F Rebecchi |
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Publication Detail:
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Type: Journal Article Date: 2006-06-08 |
Journal Detail:
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Title: Surgical endoscopy Volume: 20 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2006 Jul |
Date Detail:
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Created Date: 2006-07-14 Completed Date: 2006-08-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 1011-6 Citation Subset: IM |
Affiliation:
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Department of Surgery, Minimally Invasive Surgery Center, University of Turin, C.so A.M. Dogliotti, 14, 10126 Torino, Italy. mario.morino@unito.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Female Hernia, Hiatal / pathology, surgery* Humans Laparoscopy* Male Middle Aged Retrospective Studies Time Factors Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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