Clinical surgery—International
Laparoscopic mesh-augmented hiatoplasty as a treatment of gastroesophageal reflux disease and hiatal hernias–preliminary clinical and functional results of a prospective case series

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Abstract

Background

Because fundoplication-related side effects are frequent, we evaluated laparoscopic mesh-augemented hiatoplasty (LMAH) as a potential treatment option for gastroesophageal reflux disease and/or symptomatic hiatal herania. LMAH aims to prevent reflux solely by mesh-reinforced narrowing of the hiatus and lengthening of the intra-abdominal esophagus.

Methods

Twenty-two consecutive patients with LMAH were evaluated prospectively using a modified Gastrointestinal Symptom Rating Scale questionnaire, pH measurement, manometry, and endoscopy. Follow-up was scheduled at 3 and 12 months after surgery.

Results

Total reflux decreased from 16.3% before surgery to 3.5% 3 months after surgery (P = .001). The reflux score decreased from 3.8 before surgery to 2.1 1 year after surgery (P = .001). The respective values of the indigestion score were 3.4 and 2.0 (P < .001). After surgery, all patients were able to belch. Vomiting was impossible only for 2 patients, and 90% of patients assessed their results as good to excellent.

Conclusions

LMAH seems to be feasible, safe, and has no significant side effects.

Section snippets

Patients

Twenty-two consecutive patients who underwent LMAH at the Surgical Department of the Kantonsspital of St. Gallen were prospectively evaluated. Indications for surgery were either objectively proven GERD or symptomatic HH. Consequent therapy with proton-pump inhibitors (PPIs) for at least 3 months was required before surgery to give the patient the opportunity to make a decision for surgery in the context of adequate conservative therapy. Informed consent was obtained from every patient.

Preoperative data

The present patient series consisted of 9 male and 13 female patients with a mean age of 52 ± 18 years (range 20 to 82) and mean body mass index of 26 ± 4 kg/m2 (range 22 to 32). Characteristics did not significantly differ among patients with type I and those with types II and III HH except for age and American Society of Anesthesiologists score (Table 1).

Perioperative course

Mean surgcal time was 112 ± 25 minutes (range 70 to 160). It was shorter for patients with type I HH (97 ± 22.5 minutes) than for those with

Comments

When evaluating a potential surgical option for the treatment of GERD and symptomatic HH, besides feasibility and safety, the treatment option must be focused on symptomatic and objectified outcomes, which are represented by reflux scores, need for PPI treatment, side effects, normalization of esophageal pH, and healing of mucosal reflux lesions. Of course, success should be durable, meaning that recurrence is prevented. In our series, relief or improvement was achieved by LMAH for

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