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Forgoing Preoperative Manometry for Minimally Invasive Hiatal Hernia Repair.

Andrew G Marthy1, Patrick Nguyen1, Emily Su2

  • 1Department of Surgery, Albany Medical Center, Albany, New York.

The Journal of Surgical Research
|July 27, 2024
PubMed
Summary

Preoperative manometry is not essential for minimally invasive hiatal hernia repair with partial fundoplication. Omitting this test did not lead to worse outcomes, suggesting it is not mandatory for patient assessment.

Keywords:
Benign esophageal diseaseHiatal herniaRobotic surgery

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Digestive Health

Background:

  • Hiatal hernia is common in adults, often managed with acid suppression or lifestyle changes.
  • Some patients require surgical repair, typically preceded by esophagoscopy, esophagography, and manometry.
  • The necessity of preoperative motility studies for hiatal hernia repair with partial fundoplication warrants investigation.

Purpose of the Study:

  • To evaluate the impact of preoperative manometry on outcomes after minimally invasive hiatal hernia repair with partial fundoplication.
  • To determine if omitting preoperative manometry affects postoperative dysphagia, complications, or need for interventions.

Main Methods:

  • Retrospective review of 185 patients undergoing elective minimally invasive hiatal hernia repair with partial fundoplication (2014-2018).
  • Patients were stratified into two groups: those with and without preoperative manometry.
  • Primary outcomes included postoperative dysphagia, complications, interventions, and proton pump inhibitor use.

Main Results:

  • No significant difference in postoperative morbidity (leak, readmission, mortality) between groups.
  • Postoperative dysphagia rates were similar: 5% with manometry vs. 7% without (P=0.80).
  • Intervention rates for symptom recurrence were comparable: 7% with manometry vs. 12% without (P=0.42).

Conclusions:

  • Forgoing preoperative manometry is not associated with adverse outcomes in minimally invasive hiatal hernia repair.
  • While manometry can be informative, it is not a mandatory preoperative assessment for partial fundoplication.
  • This finding supports a more streamlined approach to preoperative evaluation for select patients.