Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients

Müller-Stich, Beat P.; Köninger, Jörg; Müller-Stich, Bettina H.; Schäfer, Fritz; Warschkow, René; Mehrabi, Arianeb; Gutt, Carsten N.

doi:10.1016/j.amjsurg.2008.07.050

« Previous Next »The American Journal of Surgery
Volume 198, Issue 1 , Pages 17-24, July 2009

Laparoscopic mesh-augmented hiatoplasty as a method to treat gastroesophageal reflux without fundoplication: single-center experience with 306 consecutive patients

Presented at the 15th Annual Congress of the European Association for Endoscopic Surgery, July, 2007, Athens, Greece.

Beat P. Müller-Stich, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- Corresponding author: Tel.: +49-6221-56-38471; fax: +49-6221-56-86-45
Jörg Köninger, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
Bettina H. Müller-Stich
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
Fritz Schäfer, M.D.
- Department of Surgery, Hospital of Bad Saulgau, Bad Saulgau, Germany
René Warschkow, 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, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
Carsten N. Gutt, M.D.
- Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

Received 6 May 2008; received in revised form 11 July 2008 published online 30 January 2009.

Abstract

Background

Laparoscopic fundoplication represents the surgical standard treatment of gastroesophageal reflux disease. However, because of persisting side effects the method is not without controversy. Laparoscopic mesh-augmented hiatoplasty might be an alternative.

Methods

In 306 consecutive patients the perioperative course and symptomatic outcome was analyzed after a mean follow-up period of 52 months.

Results

The mean DeMeester symptom score decreased from 5.3 to 2.0 (P < .001). Acid-suppressive therapy on a regular basis was discontinued in 79% of patients. The gas bloating value decreased from .7 to .5 (P = .031), and the dysphagia value increased from .5 to .9 (P < .001). Belching and vomiting were possible in 93% and 88% of patients, respectively. Mesh-related complications with the need for reoperation occurred in 1% of patients.