HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bryan A. Whitson Peter S. Dahlberg Rafael S. Andrade Michael A. Maddaus Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Whitson, B. A. Articles by Maddaus, M. A. Search for Related Content PubMed PubMed Citation Articles by Whitson, B. A. Articles by Maddaus, M. A. Related Collections Minimally invasive surgery

J Thorac Cardiovasc Surg 2006;132:1196-1202
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Wedge gastroplasty and reinforced crural repair: Important components of laparoscopic giant or recurrent hiatal hernia repair

Department of Surgery, Section of Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minn.

Received for publication May 8, 2006; revisions received June 20, 2006; accepted for publication July 12, 2006.

^_* Address for reprints: Michael A. Maddaus, MD, University of Minnesota Department of Surgery, MMC 207, 420 Delaware St SE, Minneapolis, MN 55455. (Email: madda001{at}umn.edu).

OBJECTIVE: Laparoscopic repair of a giant hiatal hernia (>50% of the stomach above the diaphragm) is associated with short-term recurrence rates of 12% to 42%. Recurrent hiatal hernias often have significantly altered anatomy, making laparoscopic repair challenging. We hypothesized that increasing intra-abdominal esophageal length by means of Collis wedge gastroplasty, complete fat-pad dissection, hernia-sac excision, and primary reinforced crural repair would minimize short-term recurrence and provide adequate symptomatic relief.

METHODS: From January 1, 2001, though May 1, 2005, 61 patients underwent laparoscopic repair of a giant or recurrent hiatal hernia with a Collis wedge gastroplasty and Nissen fundoplication. Symptomatic outcomes were assessed with a validated questionnaire (Gastroesophageal Reflux Disease Health-Related Quality of Life). We obtained postoperative radiographic imaging to objectively assess anatomic results at a median of 1.13 years.

RESULTS: Of the 61 patients, 12 (20%) were referred to our institution after previous repairs. Operating time averaged 308 ± 103 minutes. The median hospital stay was 4 days. Postoperative complications occurred in 5 (8.2%) patients. One (1.6%) patient died of cardiac complications. Postoperatively, 52 (85%) patients completed the questionnaire with mean a Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaire score of 1.15 ± 2.78 (scale, 0-45; 0 = asymptomatic). Overall, 51 (98%) of the 52 respondents were satisfied with their surgical outcome. Postoperative radiographic data were available for 54 (89%) patients. We identified no recurrences at 1-month follow-up, and only 4.7% (2/42) had evidence of radiographic recurrence at 1 year or more.

CONCLUSIONS: Consistent use of a Collis wedge gastroplasty with reinforced crural repair minimizes short-term recurrence after minimally invasive giant hiatal hernia repair. Symptomatic results are excellent in most patients.

This article has been cited by other articles:

				S. S. Groth, B. A. Whitson, J. D'Cunha, R. S. Andrade, and M. A. Maddaus Diaphragmatic hernias after sequential left ventricular assist device explantation and orthotopic heart transplant: Early results of laparoscopic repair with polytetrafluoroethylene J. Thorac. Cardiovasc. Surg., January 1, 2008; 135(1): 38 - 43. [Abstract] [Full Text] [PDF]