Hiatal hernia: only large size predicts recurrence after laparoscopic repair

  • Armijo PR & al.
  • J Gastrointest Surg
  • 7 Jan 2019

  • curated by Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • Having a larger-size hiatal hernia (HH), but not mesh usage, is the only independent factor associated with recurrence in patients with gastroesophageal reflux disease (GERD) or symptomatic HH who undergo laparoscopic antireflux surgery with concomitant HH repair.
  • BMI, age, and other demographic factors have no association with recurrence.

Why this matters

  • This is 1 of the first studies to determine independent predictors of HH recurrence.
  • The usage of mesh for reinforcement in repairing HH has been contentious.

Study design

  • Prospective cohort (n=322) of patients with GERD or symptomatic HH who undergo laparoscopic antireflux surgery with concomitant HH repair (2002-2015).
  • Patients with recurrence (n=50) were compared with patients with nonrecurrence (n=272).
  • Funding: University of Nebraska Medical Center.

Key results

  • Mean follow-up was 19.9 months.
  • Overall rate of HH recurrence was 15.5%.
  • The only factor associated with HH recurrence was large HH size (≥5 cm).
    • Patients with recurrence were almost 3 times more likely than those without recurrence to have large size HH after logistic regression (OR, 2.996; P=.017).
  • No differences between HH recurrence and nonrecurrence groups in age, sex, BMI, race, smoking status, fundoplication time, and mesh usage.

Limitations

  • Observational design.
  • Single-center study.

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