Mesh-Enforced Repair and Anterior Fundoplication in Large Hiatal Hernias: Few Side-Effects and a High Patient Satisfaction – The Best Way to Go?

Abstract

Abstract Background Nissen and Toupet fundoplication are the predominant procedures in the treatment of large hiatal hernias. Nevertheless, these techniques may cause relevant side-effects such as increased bloating or dysphagia, thus impairing the patient's quality of life. Aims To evaluate the mid-term outcome after mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair. Methods Prospective single-center study investigating the clinical, endoscopic and radiological outcome after laparoscopic, mesh-enforced hiatoplasty and anterior fundoplication in patients with large hiatal hernias. Results Ninety-nine patients were operated between 2012–2022 and met all the inclusion criteria including postoperative computed tomography (CT). 68% were female, mean age was 71 ± 10 years, 72% of the patients needed proton pump inhibitors (PPI) prior to surgery. In all patients, more than 20% of the stomach was located supra diaphragmatic, in 65% more than 50% of the stomach was herniated. Mean operation time was 152 ± 45 minutes, there were no major intraoperative complications and one short-term postoperative complication demanding operative revision due to early recurrence. Mean length of stay was 5.1 ± 1.9 days. Upper endoscopy was performed in 94% after 16 weeks and showed a correct position in all cases. Clinical and CT follow-up were obtained in all patients after 1.6 ± 1 years. 87% had a correct position of the fundoplication in CT, 6% had a slippage and 7% a recurrent hernia. Two patients needed operative revision. 84% of patients reported their clinical outcome as excellent, 10% as good. Mean Gastrointestinal Qualitiy of Life Index was 126 ± 14. 98% of patients would perform the surgery again. Conclusions Mesh-enforced hiatoplasty and anterior fundoplication in large hiatal hernia repair is safe and leads to a high rate of patient satisfaction. The radiological outcome poorly correlates with clinical symptoms or patient reported outcome.