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Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study.
Arch Surg. 2005 Jan; 140(1):40-8.AS

Abstract

BACKGROUND

Postoperative intrathoracic wrap migration is the most frequent morphological complication after laparoscopic antireflux surgery. Previous authors have studied the use of prosthetic materials for hiatal closure to prevent recurrence of hiatal hernia and/or postoperative intrathoracic wrap herniation.

HYPOTHESIS

Patients with prosthetic hiatal closure have a higher rate of short-term dysphagia but a significantly lower rate of postoperative intrathoracic wrap herniation at follow-up.

DESIGN

Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatoplasty with those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure.

SETTING

University-affiliated community hospital.

PATIENTS

One hundred consecutive patients undergoing laparoscopic Nissen fundoplication for gastroesophageal reflux disease and hiatal hernia repair.

INTERVENTION

Laparoscopic Nissen fundoplication with simple sutured crural closure (n = 50 [group 1]) vs laparoscopic Nissen fundoplication with simple sutured cruroplasty and onlay of a polypropylene mesh (n = 50 [group 2]).

MAIN OUTCOME MEASURES

Recurrences; complications; results of esophageal manometry, 24-hour pH monitoring, esophagogastroduodenoscopy, and barium swallow test; and symptomatic outcome.

RESULTS

Patients in both groups had similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring. At the 3-month and 1-year follow-ups, functional outcome variables (lower esophageal sphincter pressure and DeMeester score) improved significantly compared with the preoperative values. A higher postoperative dysphagia rate could be evaluated in group 2. An intrathoracic wrap migration occurred in 13 patients (26%) in group 1 vs 4 (8%) in group 2 (P<.001).

CONCLUSION

Laparoscopic Nissen fundoplication with prosthetic cruroplasty is an effective procedure to reduce the incidence of postoperative hiatal hernia recurrence and intrathoracic wrap herniation.

Authors+Show Affiliations

Granderath FA
Department of General Surgery and Division of Clinical Psychology, Hospital Zell am See, Zell am See, Austria. fagzellamsee@yahoo.com
Schweiger UM
No affiliation info available
Kamolz T
No affiliation info available
Asche KU
No affiliation info available
Pointner R
No affiliation info available

MeSH

FemaleFundoplicationGastroesophageal RefluxHernia, HiatalHumansLaparoscopyMaleMiddle AgedPostoperative ComplicationsProspective StudiesSecondary PreventionSurgical Mesh

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

15655204

Clinical Trial Links

Laparoscopic Lightweight Mesh Repair of Large Hiatal Hernias
Laparoscopic Repair of Giant Hiatal Hernias With Nitinol-framed Lightweight Polytetrafluoroethylene Mesh

Citation

Granderath, Frank Alexander, et al. "Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure Reduces Postoperative Intrathoracic Wrap Herniation: Preliminary Results of a Prospective Randomized Functional and Clinical Study." Archives of Surgery (Chicago, Ill. : 1960), vol. 140, no. 1, 2005, pp. 40-8.
Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg. 2005;140(1):40-8.
Granderath, F. A., Schweiger, U. M., Kamolz, T., Asche, K. U., & Pointner, R. (2005). Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Archives of Surgery (Chicago, Ill. : 1960), 140(1), 40-8.
Granderath FA, et al. Laparoscopic Nissen Fundoplication With Prosthetic Hiatal Closure Reduces Postoperative Intrathoracic Wrap Herniation: Preliminary Results of a Prospective Randomized Functional and Clinical Study. Arch Surg. 2005;140(1):40-8. PubMed PMID: 15655204.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. AU - Granderath,Frank Alexander, AU - Schweiger,Ursula Maria, AU - Kamolz,Thomas, AU - Asche,Kai Uwe, AU - Pointner,Rudolph, PY - 2005/1/19/pubmed PY - 2005/2/25/medline PY - 2005/1/19/entrez SP - 40 EP - 8 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 140 IS - 1 N2 - BACKGROUND: Postoperative intrathoracic wrap migration is the most frequent morphological complication after laparoscopic antireflux surgery. Previous authors have studied the use of prosthetic materials for hiatal closure to prevent recurrence of hiatal hernia and/or postoperative intrathoracic wrap herniation. HYPOTHESIS: Patients with prosthetic hiatal closure have a higher rate of short-term dysphagia but a significantly lower rate of postoperative intrathoracic wrap herniation at follow-up. DESIGN: Prospective randomized trial. We compared patients who underwent laparoscopic Nissen fundoplication with simple sutured hiatoplasty with those who underwent laparoscopic Nissen fundoplication with prosthetic hiatal closure. SETTING: University-affiliated community hospital. PATIENTS: One hundred consecutive patients undergoing laparoscopic Nissen fundoplication for gastroesophageal reflux disease and hiatal hernia repair. INTERVENTION: Laparoscopic Nissen fundoplication with simple sutured crural closure (n = 50 [group 1]) vs laparoscopic Nissen fundoplication with simple sutured cruroplasty and onlay of a polypropylene mesh (n = 50 [group 2]). MAIN OUTCOME MEASURES: Recurrences; complications; results of esophageal manometry, 24-hour pH monitoring, esophagogastroduodenoscopy, and barium swallow test; and symptomatic outcome. RESULTS: Patients in both groups had similar preoperative values in esophageal manometry, 24-hour pH monitoring, and symptom scoring. At the 3-month and 1-year follow-ups, functional outcome variables (lower esophageal sphincter pressure and DeMeester score) improved significantly compared with the preoperative values. A higher postoperative dysphagia rate could be evaluated in group 2. An intrathoracic wrap migration occurred in 13 patients (26%) in group 1 vs 4 (8%) in group 2 (P<.001). CONCLUSION: Laparoscopic Nissen fundoplication with prosthetic cruroplasty is an effective procedure to reduce the incidence of postoperative hiatal hernia recurrence and intrathoracic wrap herniation. SN - 0004-0010 UR - https://www.unboundmedicine.com/medline/citation/15655204/Laparoscopic_Nissen_fundoplication_with_prosthetic_hiatal_closure_reduces_postoperative_intrathoracic_wrap_herniation:_preliminary_results_of_a_prospective_randomized_functional_and_clinical_study_ DB - PRIME DP - Unbound Medicine ER -