2005 Abstracts: Esophageal Lenghtening: Does it Influence the Recurrence Rate After Transabdominal Hiatal Hernia Repair?
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Esophageal Lenghtening: Does it Influence the Recurrence Rate After Transabdominal Hiatal Hernia Repair?
Scott G. Houghton, Claude Deschamps, Stephen D. Cassivi, Mayo Clinic College of Medicine, Rochester, MN; Francis C. Nichols, Mayo College of Medicine, Rochester, MN; Mark S. Allen, Peter C. Pairolero, Mayo Clinic College of Medicine, Rochester, MN
Background:A shortened esophagus is thought to contribute to a recurrence rate of 5-42% after transabdominal repair of large hiatal hernias
Patients and Methods: From October 1999 through May 2004, we reviewed and analyzed the records of 63 patients (36 women and 27 men) who had a transabdominal hiatal hernia repair with a concurrent gastroplasty for a shortened esophagus. Results: A type I hiatal hernia was present in six patients, a type II in 10, a Type III in 43, and a type IV in 4. Median age was 68 years. The operative approach was laparoscopic in 44 patients and laparotomy in 19. A Nissen fundoplication was done in 62 patients and a Toupet in 1. Wedge gastroplasty was performed in 47 patients and a modified Collis gastroplasty in 16. Median hospitalization was 3 days. Intraoperative complications occurred in 11 patients (17%) and included pneumothorax in 6, splenic laceration in 2, gastric perforation in 2, and stapled entrapment of the bougie in 1. One laparoscopic approach (2.3%) was converted to laparotomy. Postoperative complications occurred in 12 patients (19%). There were no operative deaths. Median follow-up was 9 months (range, 1 to 49) and was complete in 60 patients (95%). A barium swallow was obtained postoperatively in 56 (89%) patients. Only one patient (1.9%) was found to have a recurrent hiatal hernia and that was diagnosed 14 months postoperatively. Functional results were excellent in 41 (68%) patients, good in 6 (10%), fair in 12 (20%) and poor in 1 (2%). Conclusion: Transabdominal gastroplasty can be performed safely and appears to be effective in reducing the rate of recurrent herniation in the early postoperative period. Functional results were satisfactory in a majority of patients
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