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Fundoplication provides additional benefit in repair of paraesophageal hiatal hernias
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The addition of fundoplication to a laparoscopic mesh-augmented hiatoplasty procedure in patients with symptomatic paraesophageal hiatal hernias led to lower rates of postoperative gastroesophageal reflux and consecutive esophagitis, according to recent study findings.
For the patient and assessor blinded randomized controlled pilot trial, Beat Müller-Stich, MD, of the department of general, visceral and transplantation surgery at the University of Heidelberg in Germany, and colleagues randomly assigned 40 patients with symptomatic paraesophageal hiatal hernias to laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy compared with laparoscopic mesh-augmented hiatoplasty with fundoplication. Primary outcome measures were postoperative gastro-esophageal reflux, complications and quality of life (QOL) at 1 year postoperatively.
“The need for fundoplication during the repair of paraesophageal hiatal hernias remains unclear,” Müller-Stich and colleagues wrote. “Prevention of gastro-esophageal reflux represents a trade-off against the risk for fundoplication related side effects.”
According to study results, when compared with a DeMeester-score of 40.9 at 3 months with laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy, the score was 9.6 with laparoscopic mesh-augmented hiatoplasty with fundoplication (P = .048).
The 1-year reflux syndrome score was 1.9 with laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy vs. 1.1 with laparoscopic mesh-augmented hiatoplasty with fundoplication (P = .02).
Moreover, postoperative esophagitis was present in 53% of patients who underwent laparoscopic mesh-augmented hiatoplasty with simple cardiophrenicopexy compared with 17% of those who underwent laparoscopic mesh-augmented hiatoplasty with fundoplication (P = .026).
Similarities were observed between the two groups for dysphagia (2.1 vs. 1.9; P = .737), gas bloating (2.6 vs. 2.8; P = .782) and QOL (116 vs. 115.9; P = .992). Four patients experienced postoperative complications, which did not differ between the two arms.
“Fundoplication related side effects do not appear to be clinically relevant,” Müller-Stich and colleagues wrote. “Multi-center randomized trials are required to confirm these findings.” – by Jennifer Southall
Disclosure: The researchers report no relevant financial disclosures.
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