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Author Spotlight: Recent Advancements in Reoperative Foregut Surgery
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A retrospective multicenter analysis on redo-laparoscopic anti-reflux surgery: conservative or conversion
Al-Warith Al Hashmi1, Guillaume Pineton de Chambrun2, Regis Souche3
1Division of HBP Surgery and Transplantation (A), Department of Surgery, Hôpital Saint Eloi, CHU-Montpellier, 80 Av. Augustin Fliche, 34295, Montpellier, France.
Surgical Endoscopy
|June 27, 2018
Summary
Redo anti-reflux surgery (ARS) for recurrent hiatal hernia (HH) is feasible with minimally invasive techniques. Toupet fundoplication and mesh repair show better outcomes in reducing symptoms compared to Nissen fundoplication for redo hiatal hernia repair.
Area of Science:
- Gastroenterology and Surgical Innovation
- Minimally Invasive Surgical Techniques
- Hiatal Hernia and GERD Management
Background:
- Recurrent hiatal hernia (HH) after initial repair affects nearly 20% of patients, necessitating redo anti-reflux surgery (ARS).
- Existing literature on redo-ARS is limited by small sample sizes and single-center data, highlighting the need for multicenter studies.
- Redo-ARS presents unique challenges, including the risk of severe complications and ongoing debate regarding the optimal surgical technique.
Purpose of the Study:
- To review the outcomes of redo-fundoplication procedures for recurrent hiatal hernia (HH).
- To identify the most effective anti-reflux surgery (ARS) repair technique for recurrent HH and gastroesophageal reflux disease (GERD).
- To compare the efficacy of different surgical approaches, including Toupet and Nissen fundoplications, in redo procedures.
Main Methods:
- Retrospective analysis of 975 patients undergoing hiatal hernia and GERD repair across five high-volume European centers.
- Detailed collection of patient demographics, BMI, surgical techniques (mesh use, ARS type), and perioperative outcomes.
- Statistical analysis using GraphPad Prism and R software to identify risk factors for recurrence and complications.
Main Results:
- Out of 975 patients, 73 (7.49%) underwent redo-ARS, predominantly via minimally invasive approaches (98%).
- Toupet fundoplication resulted in fewer postoperative symptoms compared to Nissen fundoplication (p=0.005).
- Mesh repair during redo-fundoplication was associated with reduced postoperative symptoms (p=0.020); overall complication rate was 11%.
Conclusions:
- Redo-ARS is a feasible and effective option when performed using minimally invasive techniques by experienced surgeons.
- Toupet fundoplication appears superior to Nissen fundoplication for redo procedures, particularly for patients with prior Nissen repair.
- Incorporating mesh repair during reoperations may positively impact symptom recurrence rates postoperatively.
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