International Society For Minimally Invasive Cardiothoracic Surgery

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Laparoscopic Hiatal Hernia Repair With Sphincter Augmentation & Gastropexy is Safe For Patients With High Risk Of Recurrence
Ethan Ledbetter, James Speicher, Anthony Mozer, Luke Hunter, Carlos Anciano.
East Carolina University, Greenville, NC, USA.

Background- Laparoscopic hiatal hernia repair with magnetic sphincter augmentation (MSA) is a relatively new and accepted treatment for GERD. Large crural diameter, "giant" gastric herniation, old age, previous hernia repairs, high body mass index, heavy weight bearing, increased intra-abdominal pressure, emergen repairs, and other factors are recognized to increase failure and recurrence. There is anecdotal evidence of hernia recurrence with MSA systems migration into thoracic cavity. Adjunct fundic gastropexy (PLINX) to the hernia repair has not been studied to minimize recurrence rates and is not validated as safe comparable option in this setting. We seek to validate PLINX as a safe, comparable, and effective method of repair in this high risk of recurrence population, potentially reducing failures.Methods- Retrospective review of prospectively collected data in 95 consecutive patients who underwent laparoscopic hiatal hernia repair with MSA system implantation with or without gastropexy in a 22 month period is performed. Decision to add fundic gastropexy was based on high risk of hernia recurrence (HRHR) factors. Post-operative outcomes are compared with Chi-square and Fisher's Exact test.RESULTS- Resolution of GERD symptoms and postoperative proton pump inhibitor (PPI) use, need for EGD and endoscopic dilations showed no significant difference (p>.05). There were no implant infections. PLINX patients experienced lower rates of dysphagia often associated to MSA (p<.05). There were two recurrences in the non-pexy MSA only group associated to heavy retching episodes.CONCLUSIONS- Laparoscopic hernia repair with MSA and fundic gastropexy PLINX is a safe and effective for treatment of 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 live, imaging, and long term follow up are required.

High Risk for Hiatal Hernia Recurrence (HRHR) Factor Frequency as Indicator for Fundic Gastropexy
Co-Morbid state increasing intra-abdominal pressure64.6%
Gastric herniation >30%41.7%
Maximum transverse crural diameter >4cm35.4%
Age 70 years or older29.2%
Previous hiatal hernia repair27.1%
BMI >3425.0%
Heavy weight bearing job / hobby6.3%
Emergent repair2.1%

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