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Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura.
Surg Endosc. 2002 Apr; 16(4):572-7.SE

Abstract

BACKGROUND

Recurrent hiatal hernia with or without intrathoracic wrap migration ("slipping Nissen") is one of the most common complications after laparoscopic Nissen fundoplication (LNF). Therefore, we decided to reinforce the hiatal crura using a prosthetic mesh prosthesis in an attempt to reduce recurrent hiatal hernia.

METHODS

The current nonrandomized study compares the surgical outcome, including quality of life data [Gastrointestinal Quality of Life Index (GIQLI)] and subjective degree of dysphagia, in a total of 200 patients with (n = 100) or without (n = 100) mesh prosthesis for a follow-up for at least 1 year.

RESULTS

There are no significant differences between groups in postoperative DeMeester score or lower esophageal sphincter pressure. In the group without mesh prosthesis, in 6 cases laparoscopic redo surgery was necessary due to severe and persistent dysphagia (n = 2) or a slipping Nissen (n = 4). Additionally, in 5 patients we found recurrent hiatal hernia, but patients have been without symptoms for at least 1 year. In the group with mesh prosthesis, laparoscopic refund application was performed in only 1 patient due to a slipping Nissen. In this group, recurrent hiatal hernia was not found in endoscopy. After laparoscopic antireflux surgery, GIQLI showed an equal improvement in both groups with an outcome comparable to that for healthy individuals. Postoperative dysphagia was significantly higher in the group with mesh prothesis within the 3 first months after surgery. One year after surgery no differences could be found.

CONCLUSIONS

Our findings suggest that LNF with reinforcement of the hiatal crura reduces the risk of recurrent hiatal hernia with or without wrap migration. In addition, LNF with mesh prosthesis improves patient's quality of life significantly to the same level as that in patients without mesh prosthesis. Postoperative dysphagia is higher in the early period after surgery, but this is only temporary. Long-term results of a randomized trial must be obtained before a general standardization can be discussed.

Authors+Show Affiliations

Department of General Surgery, Hospital of Zell am See, A-5700 Zeil am See, Austria.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

11972190

Citation

Kamolz, T, et al. "Dysphagia and Quality of Life After Laparoscopic Nissen Fundoplication in Patients With and Without Prosthetic Reinforcement of the Hiatal Crura." Surgical Endoscopy, vol. 16, no. 4, 2002, pp. 572-7.
Kamolz T, Granderath FA, Bammer T, et al. Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura. Surg Endosc. 2002;16(4):572-7.
Kamolz, T., Granderath, F. A., Bammer, T., Pasiut, M., & Pointner, R. (2002). Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura. Surgical Endoscopy, 16(4), 572-7.
Kamolz T, et al. Dysphagia and Quality of Life After Laparoscopic Nissen Fundoplication in Patients With and Without Prosthetic Reinforcement of the Hiatal Crura. Surg Endosc. 2002;16(4):572-7. PubMed PMID: 11972190.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura. AU - Kamolz,T, AU - Granderath,F A, AU - Bammer,T, AU - Pasiut,M, AU - Pointner,R, Y1 - 2002/01/09/ PY - 2001/07/16/received PY - 2001/09/27/accepted PY - 2002/4/25/pubmed PY - 2002/8/30/medline PY - 2002/4/25/entrez SP - 572 EP - 7 JF - Surgical endoscopy JO - Surg Endosc VL - 16 IS - 4 N2 - BACKGROUND: Recurrent hiatal hernia with or without intrathoracic wrap migration ("slipping Nissen") is one of the most common complications after laparoscopic Nissen fundoplication (LNF). Therefore, we decided to reinforce the hiatal crura using a prosthetic mesh prosthesis in an attempt to reduce recurrent hiatal hernia. METHODS: The current nonrandomized study compares the surgical outcome, including quality of life data [Gastrointestinal Quality of Life Index (GIQLI)] and subjective degree of dysphagia, in a total of 200 patients with (n = 100) or without (n = 100) mesh prosthesis for a follow-up for at least 1 year. RESULTS: There are no significant differences between groups in postoperative DeMeester score or lower esophageal sphincter pressure. In the group without mesh prosthesis, in 6 cases laparoscopic redo surgery was necessary due to severe and persistent dysphagia (n = 2) or a slipping Nissen (n = 4). Additionally, in 5 patients we found recurrent hiatal hernia, but patients have been without symptoms for at least 1 year. In the group with mesh prosthesis, laparoscopic refund application was performed in only 1 patient due to a slipping Nissen. In this group, recurrent hiatal hernia was not found in endoscopy. After laparoscopic antireflux surgery, GIQLI showed an equal improvement in both groups with an outcome comparable to that for healthy individuals. Postoperative dysphagia was significantly higher in the group with mesh prothesis within the 3 first months after surgery. One year after surgery no differences could be found. CONCLUSIONS: Our findings suggest that LNF with reinforcement of the hiatal crura reduces the risk of recurrent hiatal hernia with or without wrap migration. In addition, LNF with mesh prosthesis improves patient's quality of life significantly to the same level as that in patients without mesh prosthesis. Postoperative dysphagia is higher in the early period after surgery, but this is only temporary. Long-term results of a randomized trial must be obtained before a general standardization can be discussed. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/11972190/Dysphagia_and_quality_of_life_after_laparoscopic_Nissen_fundoplication_in_patients_with_and_without_prosthetic_reinforcement_of_the_hiatal_crura_ L2 - https://doi.org/10.1007/s00464-001-9136-0 DB - PRIME DP - Unbound Medicine ER -