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Surg Endosc. 2017 Dec;31(12):5327-5341. doi: 10.1007/s00464-017-5612-z. Epub 2017 Jun 8.

What are the differences in the outcome of laparoscopic axial (I) versus paraesophageal (II-IV) hiatal hernia repair?

Author information

1
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
2
Department of General, Visceral and Minimally Invasive Surgery, Helios Hospital, Campus 6, 38518, Gifhorn, Germany.
3
Department of Visceral, Minimally Invasive and Oncologic Surgery, Marien Hospital, Rochusstrasse 2, 40479, Düsseldorf, Germany.
4
StatConsult GmbH, Halberstädter Strasse 40 A, 39112, Magdeburg, Germany.
5
Department of General and Visceral Surgery, Diakonie Hospital, Rosenbergstrasse 38, 70176, Stuttgart, Germany.
6
Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany.
7
Department of General, Visceral and Oncologic Surgery, Wilhelminenhospital, Montleartstrasse 37, 1160, Vienna, Austria.
8
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.

Abstract

INTRODUCTION:

Comparison of elective laparoscopic repair of axial vs paraesophageal hiatal hernias reveals relevant differences in both the patient collectives and the complexity of the procedures.

MATERIALS AND METHODS:

The present uni- and multivariable analysis of data from the Herniamed Registry compares the outcome for 2047 (67.3%) (type I) axial with 996 (32.7%) (types II-IV) paraesophageal primary hiatal hernias following laparoscopic repair.

RESULTS:

Compared with the patients with axial hiatal hernias, patients with paraesophageal hiatal hernia were nine years older, had a higher ASA score (ASA III/IV: 34.8 vs 13.7%; p < 0.001), and more often at least one risk factor (38.8 vs 21.4%; p < 0.001). This led in the univariable analysis to significantly more general postoperative complications (6.0 vs 3.0%; p < 0.001). Reflecting the greater complexity of the procedures used for laparoscopic repair of paraesophageal hiatal hernias, significantly higher intraoperative organ injury rates (3.7 vs 2.3%; p = 0.033) and higher postoperative complication-related reoperation rates (2.1 vs 1.1%; p = 0.032) were identified. Univariable analysis did not reveal any significant differences in the recurrence and pain rates on one-year follow-up. Multivariable analysis did not find any evidence that the use of a mesh had a significant influence on the recurrence rate.

CONCLUSION:

Surgical repair of paraesophageal hiatal hernia calls for an experienced surgeon as well as for corresponding intensive medicine competence because of the higher risks of general and surgical postoperative complications.

KEYWORDS:

Axial hiatal hernia; Fundoplication; Hiatal hernia; Hiatoplasty; Paraesophageal hiatal hernia

PMID:
28597286
PMCID:
PMC5715051
DOI:
10.1007/s00464-017-5612-z
[Indexed for MEDLINE]
Free PMC Article

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