Laparoscopic repair of giant hiatal hernia: A clinical analysis of 96 patients

doi:10.19538/j.cjps.issn1005-2208.2017.11.19

Abstract：Objective To estimate the effectiveness and safety of laparoscopic repair of giant hiatal hernia.Methods The clinical data of 96 patients with giant hiatal hernia performed laparoscopic repair between January 2006 and July 2016 in Department of Mini-invasive Surgery,Tianjin Nankai Hospital were analyzed retrospectively.Primary hiatal closure was performed in 33 patients,and the hiatus was reinforced with mesh strips in 63 patients.A total or partial fundoplication was added in 84 patients.Results All the 96 patients were treated by laparoscopy successfully.No conversion occurred.The mean operative time was (95.8± 13.1)min for primary hiatal closure patients and (101.4± 15.6) for mesh repair patients (P=0.0814).The average operative blood loss was (77.5±21.3)mL for primary hiatal closure patients and (79.6±24.5)mL for mesh repair patients (P=0.6769).The mean postoperative hospital stay was (5.4±4.3)d for primary hiatal closure patients and (5.5±3.7)d for mesh repair patients (P=0.9151).Early postoperative complications occurred in 6.1％ (2/33)for primary hiatal closure patients and 9.5％ (6/63)for mesh repair patients (P=0.71).Eighty-five of the 96 patients (88.5％) were available for following-up,among which there were 28 patients in primary hiatal closure group and 57 in the mash repair group,and the mean follow-up time was 56.3 months(range 6-120 months).Altogether,recurrence symptoms and developed new symptoms were demonstrated in 16 patients.Sour regurgitation recurrence occurred in 17.9％ (5/28) of primary hiatal closure patients and 3.5％ (2/57) of mesh repair patients (P=0.0364),dysphagia occurred in 0 (0/28) of primary hiatal closure patients and 15.8％ (9/57) of mesh repair patients (P=0.0269).85.7％ (24/28) of primary hiatal closure patients and 82.5％ (47/57) of mesh repair patients satisfied with the outcome of operation (P=1).Among 63 mesh repair patients,"O" shape mesh was performed in 29 patients and"U"shape mesh in 34 patients.Early postoperative complications occurred in10.3％ (3/29)of"O" shape mesh group and 8.8％ (3/34)of "U"shape mesh group (P=l).Also,25 cases repaired with "O"shape mesh and 32 cases with "U" shape mesh were followed up for 97 (71-120)months and 29 (6-68)months.Sour regurgitation recurrence occurred in 4.0％(1/25)of"O"shape mesh group and 3.1％(1/32)of"U"shape mesh group(P=1).Dysphagia occurred in 24.0％ (6/25)of"O" shape mesh group and 9.4％ (3/32)of"U" shape mesh group (P=0.1606).Six cases of esophageal stenosis confirmed by endoscopy in 4 cases with "O"shape mesh and 2 cases with "U"shape mesh.The difference was not statistically significant (P=0.3883) Conclusion Laparoscopic repair for giant hiatal hernia is safe and reliable.Mesh repair can reduce the recurrence rate but accompanied with risk of complication of dysphagia and mesh migration.Mesh should be used at surgeon discretion of indication,suitable description and optimized mesh placement to reduce the complication related.Appropriate fundoplication and esophageal lengthening could improve the outcome.