Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene

C. T. Frantzides, C. G. Richards, M. A. Carlson

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence, the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter. Methods: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair with (n = 17) or without (n = 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis, PTFE mesh with a 3-cm 'keyhole' was positioned around the gastroesophageal junction with the esophagus through the keyhole. The PTFE was stapled to the diaphragm and crura with a hernia stapler. Results: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every. 6 months thereafter. Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention) in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE was notable for three (16.7%) recurrences within the first 6 months of surgery. Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence in patients with large hiatal hernia defects.

Original languageEnglish (US)
Pages (from-to)906-908
Number of pages3
JournalSurgical endoscopy
Volume13
Issue number9
DOIs
StatePublished - Sep 1999

Fingerprint

Hiatal Hernia
Polytetrafluoroethylene
Herniorrhaphy
Prostheses and Implants
Recurrence
Hernia
Esophagogastric Junction
Urinary Retention
Pneumothorax
Diaphragm
Esophagus
Length of Stay
Pneumonia
Costs and Cost Analysis

Keywords

  • Gastroesophageal reflux
  • Hiatal hernia
  • Laparoscopic Nissen fundoplication
  • Laparoscopy
  • Polytetrafluoroethylene
  • Prosthetic

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. / Frantzides, C. T.; Richards, C. G.; Carlson, M. A.

In: Surgical endoscopy, Vol. 13, No. 9, 09.1999, p. 906-908.

Research output: Contribution to journalArticle

Frantzides, C. T. ; Richards, C. G. ; Carlson, M. A. / Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. In: Surgical endoscopy. 1999 ; Vol. 13, No. 9. pp. 906-908.
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abstract = "Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence, the technique of hiatal herniorrhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated laparoscopic hiatal hernia repair in individuals with a hernia defect greater than 8 cm in diameter. Methods: A series of 35 patients with sliding or paraesophageal hiatal hernias was prospectively randomized to hiatal hernia repair with (n = 17) or without (n = 18) polytetrafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both repairs were performed by using interrupted stitches to approximate the crurae. In the group randomized to repair with prosthesis, PTFE mesh with a 3-cm 'keyhole' was positioned around the gastroesophageal junction with the esophagus through the keyhole. The PTFE was stapled to the diaphragm and crura with a hernia stapler. Results: Patients were followed with EGD and esophagogram at 3 months postoperatively, and with esophagogram every. 6 months thereafter. Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention) in the group repaired with PTFE and one complication (pneumothorax) in the group without prosthesis. The group without PTFE was notable for three (16.7{\%}) recurrences within the first 6 months of surgery. Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence in patients with large hiatal hernia defects.",
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