Laparoscopic mesh-augmented hiatoplasty as a treatment of gastroesophageal reflux disease and hiatal hernias–preliminary clinical and functional results of a prospective case series

Müller-Stich, Beat P.; Linke, Georg R.; Borovicka, Jan; Marra, Francesco; Warschkow, René; Lange, Jochen; Mehrabi, Arianeb; Köninger, Jörg; Gutt, Carsten N.; Zerz, Andreas

doi:10.1016/j.amjsurg.2007.06.022

« Previous Next »The American Journal of Surgery
Volume 195, Issue 6 , Pages 749-756, June 2008

Laparoscopic mesh-augmented hiatoplasty as a treatment of gastroesophageal reflux disease and hiatal hernias–preliminary clinical and functional results of a prospective case series

Beat P. Müller-Stich, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
- Corresponding author. Tel.: +49-6221-56 3 8471; fax: +49-6221-56 8645.
Georg R. Linke, M.D.
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
Jan Borovicka, M.D.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
Francesco Marra, M.D.
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
René Warschkow, M.D.
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
Jochen Lange, M.D.
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
Arianeb Mehrabi, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
Jörg Köninger, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
Carsten N. Gutt, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Heidelberg, Germany
Andreas Zerz, M.D.
- Department of Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

Received 5 May 2007; received in revised form 12 June 2007 published online 20 March 2008.

Abstract

Background

Because fundoplication-related side effects are frequent, we evaluated laparoscopic mesh-augemented hiatoplasty (LMAH) as a potential treatment option for gastroesophageal reflux disease and/or symptomatic hiatal herania. LMAH aims to prevent reflux solely by mesh-reinforced narrowing of the hiatus and lengthening of the intra-abdominal esophagus.

Methods

Twenty-two consecutive patients with LMAH were evaluated prospectively using a modified Gastrointestinal Symptom Rating Scale questionnaire, pH measurement, manometry, and endoscopy. Follow-up was scheduled at 3 and 12 months after surgery.

Results

Total reflux decreased from 16.3% before surgery to 3.5% 3 months after surgery (P = .001). The reflux score decreased from 3.8 before surgery to 2.1 1 year after surgery (P = .001). The respective values of the indigestion score were 3.4 and 2.0 (P < .001). After surgery, all patients were able to belch. Vomiting was impossible only for 2 patients, and 90% of patients assessed their results as good to excellent.