Repair of paraesophageal hiatal Hernias-is a fundoplication needed?

• Verfasst von: Müller, Beat P. [VerfasserIn]
• Verfasst von: Achtstätter, Lena Verena [VerfasserIn]
• Verfasst von: Diener, Markus K. [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Linke, Georg R. [VerfasserIn]
• Titel: Repair of paraesophageal hiatal Hernias-is a fundoplication needed?
• Titelzusatz: a randomized controlled pilot trial
• Verf.angabe: Beat P. Müller-Stich, Verena Achtstätter, Markus K. Diener, Matthias Gondan, René Warschkow, Francesco Marra, Andreas Zerz, Carsten N. Gutt, Markus W. Büchler, Georg R. Linke
• E-Jahr: 2015
• Jahr: 14 March 2015
• Umfang: 9 S.
• Fussnoten: Gesehen am 03.08.2020
• Titel Quelle: Enthalten in: American College of SurgeonsJournal of the American College of Surgeons
• Ort Quelle: [Philadelphia, Pa.] : Wolters Kluwer Health, 1997
• Jahr Quelle: 2015
• Band/Heft Quelle: 221(2015), 2, Seite 602-610
• ISSN Quelle: 1879-1190
• DOI: doi:10.1016/j.jamcollsurg.2015.03.003
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1726091716

Abstract

Background - The need for a fundoplication during repair of paraesophageal hiatal hernias (PEH) remains unclear. Prevention of gastroesophageal reflux represents a trade-off against the risk of fundoplication-related side effects. The aim of this trial was to compare laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy (LMAH-C) with laparoscopic mesh-augmented hiatoplasty with fundoplication (LMAH-F) in patients with PEH. - Study Design - The study was designed as a patient- and assessor-blinded randomized controlled pilot trial, registration number: DRKS00004492 (www.germanctr.de/). Patients with symptomatic PEH were eligible and assigned by central randomization to LMAH-C or LMAH-F. Endpoints were postoperative gastroesophageal reflux, complications, and quality of life 12 months postoperatively. - Results - Forty patients (9 male, 31 female) were randomized. Patients were well matched for baseline characteristics. At 3 months, the DeMeester score was higher after LMAH-C compared with LMAH-F (40.9 ± 39.9 vs. 9.6 ± 17; p = 0.048). At 12 months, the reflux syndrome score was higher after LMAH-C compared with LMAH-F (1.9 ± 1.2 vs. 1.1 ± 0.4; p = 0.020). In 53% of LMAH-C patients and 17% of LMAH-F patients, postoperative esophagitis was present (p = 0.026). Values of dysphagia (2.1 ± 1.6 vs 1.9 ± 1.4; p = 0.737), gas bloating (2.6 ± 1.4 vs 2.8 ± 1.4; p = 0.782), and quality of life (116.0 ± 16.2 vs 115.9 ± 15.8; p = 0.992) were similar. Relevant postoperative complications occurred in 4 (10%) patients and did not differ between the groups. - Conclusions - Laparoscopic repair of PEH should be combined with a fundoplication to avoid postoperative gastroesophageal reflux and resulting esophagitis. Fundoplication-related side effects do not appear to be clinically relevant. Multicenter randomized trials are required to confirm these findings.