Laparoscopic anterior hemifundoplication and hiatoplasty for the treatment of upside-down stomach: mid- and long-term results after 40 patients

• Published in: Surgical endoscopy Vol. 25; no. 7; pp. 2230 - 2235
• Main Authors: Obeidat, Firas W., Lang, Reinhold A., Knauf, Andreas, Thomas, Michael N., Hüttl, Tanija K., Zügel, Nico P., Jauch, Karl-Walter, Hüttl, Thomas P.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.07.2011; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Anemia; Barium; Biological and medical sciences; Blood tests; Digestive system. Abdomen; Dysphagia; Endoscopy; Esophagus; Female; Follow-Up Studies; Fundoplication - methods; Gastroenterology; Gastroesophageal reflux; Gynecology; Hepatology; Hernia, Hiatal - surgery; Hiatal hernias; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - methods; Male; Medical sciences; Medicine; Medicine & Public Health; Mortality; Ostomy; Patient satisfaction; Postoperative Complications; Proctology; Prospective Studies; Quality of Life; Statistics, Nonparametric; Stomach; Stomach - surgery; Surgery; Surveys and Questionnaires; Treatment Outcome; Intrathoracic stomach; Giant hiatal hernia; Hemifundoplication; Laparoscopic antireflux procedure; Upside-down stomach; Human; Endoscopic surgery; Stomach; Treatment; Digestive system; Laparoscopy; Endoscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-010-1537-5

Background Treatment of type 4 hiatal hernia using a minimally invasive approach is challenging and requires good familiarity with this technique. Methods From October 1992 to August 2010, 40 patients with a median age of 68 years underwent laparoscopic anterior hemifundoplication surgery for upside-down stomach and were included in our prospective study. The median symptoms duration was 5 years. The leading clinical symptoms were postprandial, epigastric, or retrosternal pain (80%), heartburn (78%), regurgitation (80%), dysphagia (53%), and anemia (48%). Preoperative evaluation included blood test, chest X-ray, upper endoscopy, and barium swallow. In some patients an esophageal 24-h pH study and esophageal manometry were performed. The median follow-up was 46 months using a standardized questionnaire, including Smiley score, modified Visick score, gastrointestinal quality-of-life index (GQLI), and specific reflux symptoms score. Results Surgery was finished laparoscopically in 39 patients (97%). One patient had to be converted to an open procedure because of severe adhesions. Mesh hiatoplasty had to be performed in one patient due to a large hiatal defect. Median operative time was 160 min (range = 90–275) and median blood loss was 5 ml (range = 0–300). Seven patients (18%) presented with acute symptoms. Intraoperative technical complications occurred in four patients (10%) and nontechnical complications in two cases (5%). Median postoperative hospital stay was 5 days (range = 2–17). Postoperative complications occurred in two patients (5%): one pleural effusion and one surgical emphysema. There was no mortality or symptomatic recurrence. All scores showed significant improvement and patient satisfaction. Conclusion Laparoscopic treatment of type 4 hiatal hernia is safe. With respect to the quality of life, anterior hemifundoplication is highly effective.