PMID- 25294550
OWN - NLM
STAT- MEDLINE
DCOM- 20160217
LR  - 20220321
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 29
IP  - 7
DP  - 2015 Jul
TI  - Laparoscopic repair of paraesophageal hernia with anterior gastropexy: a 
      multicenter study.
PG  - 1856-61
LID - 10.1007/s00464-014-3877-z [doi]
AB  - BACKGROUND: The approach to repair of paraesophageal hernias (PEHs) is 
      controversial. Recent data suggest that mesh repair leads to recurrence rates 
      similar to non-mesh approaches, while subjecting patients to mesh-associated 
      complications. Routine fundoplication during PEH repair has been favored despite 
      significant dysphagia rates. We present our multicenter prospective data on 
      laparoscopic PEH repairs using a modified Boerema anterior gastropexy without 
      fundoplication. METHODS: We prospectively followed patients after modified 
      Boerema PEH repair at three institutions. Patient demographics, perioperative 
      data, and postoperative outcomes were evaluated. Subjective and objective 
      outcomes were assessed via clinical assessment, follow-up questioning, endoscopy, 
      and radiographic swallow studies. RESULTS: A total of 101 patients were followed 
      a mean of 10.8 (median, 12) months. We encountered 9 (8.9%) intraoperative 
      complications and 13 (12.9%) postoperative complications. There was no mortality. 
      Reflux symptoms were absent in 71 patients (70.3%) postoperatively. Of the 
      remaining subjects, 8 (7.9%) had mild intermittent reflux without the need for 
      proton pump inhibitors (PPI), 12 (11.9%) had moderate reflux necessitating PPI as 
      needed, and 10 (9.9%) had reflux requiring daily PPI. Our recurrence rate, 
      assessed at postoperative endoscopy/barium swallow, was 16.8%. Of these, 10 
      (9.9%) were small segmental recurrences and 7 (6.9%) were large recurrences. 
      CONCLUSION: Herein, we demonstrate a favorable recurrence rate while avoiding the 
      potential major complications associated with mesh hiatoplasty. Our data tend to 
      support a tailored approach to incorporation of fundoplication during PEH repair. 
      Postoperative acid reflux was absent in most of our patients, and pharmacotherapy 
      alone was sufficient for those experiencing reflux symptoms.
FAU - Daigle, Christopher R
AU  - Daigle CR
AD  - Division of General Surgery, St. Michael's Hospital, University of Toronto, 30 
      Bond Street, Toronto, ON, M5B 1W8, Canada, daiglec2@ccf.org.
FAU - Funch-Jensen, Peter
AU  - Funch-Jensen P
FAU - Calatayud, Dan
AU  - Calatayud D
FAU - Rask, Peter
AU  - Rask P
FAU - Jacobsen, Bo
AU  - Jacobsen B
FAU - Grantcharov, Teodor P
AU  - Grantcharov TP
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20141008
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Follow-Up Studies
MH  - Gastroesophageal Reflux/drug therapy/etiology
MH  - *Gastropexy
MH  - Hernia, Hiatal/*surgery
MH  - Humans
MH  - Intraoperative Complications
MH  - *Laparoscopy
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/therapeutic use
EDAT- 2014/10/09 06:00
MHDA- 2016/02/18 06:00
CRDT- 2014/10/09 06:00
PHST- 2014/04/29 00:00 [received]
PHST- 2014/09/02 00:00 [accepted]
PHST- 2014/10/09 06:00 [entrez]
PHST- 2014/10/09 06:00 [pubmed]
PHST- 2016/02/18 06:00 [medline]
AID - 10.1007/s00464-014-3877-z [doi]
PST - ppublish
SO  - Surg Endosc. 2015 Jul;29(7):1856-61. doi: 10.1007/s00464-014-3877-z. Epub 2014 
      Oct 8.