International Society For Minimally Invasive Cardiothoracic Surgery

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Laparoscopic Hiatal Hernia Repair With Sphincter Augmentation (linx) And Gastropexy Has Safe Operative Outcomes As Without Gastropexy
Ethan Ledbetter, James Speicher, Luke Hunter, Anthony Mozer, Carlos Anciano.
East Carolina University, Greenville, NC, USA.

BACKGROUND- Laparoscopic hiatal hernia repair with magentic sphincter augmentation (MSA) is an accepted treatment for GERD. Large hernias, and other factors present a higher risk of recurrence population. Adjunct fundic gastropexy (PLINX) has not been studied to minimize recurrence rates and is not validates as safe comparable option. We present hypotheis PLINX is a safe, comparable, effective method of repair in this population.METHODS- Review of 95 patients who underwent MSA implantation with or without gastropexy in a 22 month period is performed. Post-operative outcomes are compared with Chi-square and Fisher's Exact test.RESULTS- Resolution of GERD symptoms and postoperative PPI use, need for EGD and dilations, or implant infection rates showed no difference. PLINX patients experienced lower rates of dysphagia. There were two recurrences in the non-pexy MSA only group.CONCLUSIONS- PLINX is safe and effective treatment for hiatal hernias in high risk of recurrence population, and may potentially reduce these. PLINX may improve post-operative dysphagia associated to MSA. Further studies including quality of life and long term follow up are required.

High Risk for Hiatal Hernia Recurrence (HRHR) Factor Frequency as Indicator for Gastropexy
State increasing abdominal pressure64.6%
More than a third of stomach herniated41.7%
Maximum transverse crural diameter larger than 4 cm35.4%
Age 70 or older29.2%
Previous hiatal hernia repair27.1%
BMI 34 or larger25%
Heavy weight bearing job or hobby6.3%
Emergent repair2.1%

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