Society for Surgery of the Alimentary Tract
SSAT Home SSAT Home Past & Future Meetings Past & Future Meetings

Back to 2023 Posters

Alec Bigness*, Abdul-Rahman F. Diab, Salvatore Docimo, Joseph Sujka, Christopher DuCoin
USF Health, Tampa, FL

Introduction: Surgeons utilize varying surgical tools and techniques when completing hiatal hernia repairs. The purpose of this study is to gauge what aspects of hiatal hernia repair are considered by most practicing surgeons, to establish the "critical view of safety" in hiatal hernia repairs.

Methods: With the cooperation of the American Foregut Society (AFS), a 23-question survey was circulated to the surgeons of the AFS between July and August 2022. Twenty-two responses were received and analyzed. Questions were related to 1. Necessity of complete reduction of the hernia sac to the abdomen while preserving the integrity of muscular and peritoneal lining of the crura. 2. Necessity of complete and aggressive mobilization of the esophagus to the level of the inferior pulmonary vein. 3. Necessity of clear endoscopic visualization of the gastroesophageal junction intraoperatively. 4. Depth of mobilization of the esophagus into the stomach (1-3 cm, 3 cm, or 3-5 cm). 5. Necessity of visualization of the right and left crura to a point over there prevertebral attachment. 6. Necessity of full visualization of the aorta intraoperatively. 7. Necessity of both dissection of phrenoesophageal ligament and clear visualization of a retro-esophageal window. 8. Necessity of visualization of and preservation of the anterior and posterior branches of the vagus nerve. 9. Necessity of having no tension or preference for the stomach to enter the chest after full dissection. 10. Kinds of sutures used in hiatal closure (barbed, filament or braided). 11. The use pledgets 12. The use of mesh. 13. Types of mesh used. 14. Configuration employed. 15. Location of sutures (anterior, posterior or both). 16. Method of hiatal closure. 17. Method of evaluation at the conclusion of reconstruction. 18. Management of insufficient intraabdominal esophageal length. 19. Frequency of performing colis gastroplasty. 20. Frequency of performing gastropexy. 21. Physicians' indications when performing gastropexy. 22. Fundoplication wrap method in case of normal manometry (Nissen or Toupet). 23. Fundoplication wrap method most utilized (Nissen, Toupet, or Watson).

Results: Significant heterogeneity was observed in responses to questions 2-4, 6, 8, 10-17, 19-23. Most important of which is that 78.95% of responders close the hiatus without a bougie. Minimal or no heterogeneity was observed in responses to questions 1, 5, 7, 9, 18. Nature and percentages of all responses to each question are summarized in tables 1 and 2.

Conclusion: Our survey revealed that while there is some agreement in hiatal hernia repair, differences in practice remain. Larger surveys should be performed to better characterize differences in practice in hiatal hernia repair. This would help researchers to identify where comparative studies are needed, and hopefully lead to an evidence-based consensus for best practice.

Back to 2023 Posters