Hiatal Hernia Patients Research Articles

Patients Engaged in Losing Weight Preoperatively Experience Improved Outcomes After Hiatal Hernia Repair.

Adherence to preoperative weight loss recommendations may serve as a surrogate for the level of engagement in hiatal hernia (HH) patients. This study aims to evaluate the relationship between achieving preoperative weight loss goals and outcomes after HH repair. A retrospective review of 235 patients undergoing laparoscopic HH repair at a single institution was performed. Patients were grouped based on the percentage of weight loss goal achieved. Low achievement was defined as the bottom quartile of goal achievement (≤75%); high achievement was defined as the top quartile (≥140%). Baseline characteristics, clinical outcomes, and patient reported outcomes (PROMs) were compared between groups. 131/235 (55.7%) achieved their weight loss goal. No differences in baseline characteristics or clinical outcomes were observed between the low and high achievement groups. While both groups experienced improvements in PROMs postoperatively, patients in the high achievement group demonstrated significantly lower symptom burden at one-month postoperatively. Further, high-achievement patients were more likely to experience complete resolution of common HH symptoms at one-month postoperatively, including no difficulty swallowing food, no breathing difficulties or choking episodes, no choking when eating food, no choking when drinking liquid, and no regurgitation of food or liquid. In patients undergoing laparoscopic HH repair, patients achieving their preoperative weight loss goals experienced less overall symptom burden and lower prevalence of common symptoms one-month postoperatively than those with low levels of goal achievement. These results demonstrate that patients can take an active role in improving their own surgical outcomes and health status.

No Association between Helicobacter pylori and Gastroesophageal Reflux Disease: A Comprehensive Risk Factor Analysis in North Indian Patients

Abstract Background: The relationship between gastroesophageal reflux disease (GERD) and Helicobacter pylori infection is a complicated topic. This study aimed to evaluate the association between H. pylori infection and GERD and identify the associated risk factors in North India. Methods: All individuals who were referred for an endoscopy because they had dyspepsia were included in a cross-sectional study. Using endoscopic assessment, GERD was diagnosed. As a comparison group, patients with normal esophageal function were chosen. H. pylori was cultured and genotyped to assess the virulent genes such as cagA, vacA, and iceA. The relationship of H. pylori infection with GERD and its associated risk factors were estimated with Chi-square analysis, odds ratios, and 95% confidence intervals using multiple logistic regression analysis. Results: In total, 420 patients were included in this study, of whom 335 (79.8%) had GERD. The mean age was 44.01 ± 16.52 years. Overall, 143 (34%) patients were positive for H. pylori infection. cagA-negative H. pylori isolates were significantly associated with the GERD group. Variables such as gender, age, alcohol, smoking, body mass index (BMI), smoking, and hiatus hernia in patients had no significant association with H. pylori infection. However, increased age, gender, Frequency Scale for the Symptoms of GERD (FSSG) score, BMI, and presence of hiatus hernia were significantly associated with the GERD group. Conclusion: In our results, there was no association between H. pylori infection and GERD. The risk factors for GERD were age, gender, FSSG score, BMI, and hiatus hernia. Further studies are recommended.

The role of anterior gastropexy in elderly Japanese hiatal hernia patients.

As Japanese society ages, the number of surgeries performed in elderly patients with hiatal hernia (HH) is increasing. In this study, we examined the feasibility, safety, and potential effectiveness of the addition of anterior gastropexy to hiatoplasty with or without mesh repair and/or fundoplication in elderly Japanese HH patients. We retrospectively evaluated 39 patients who underwent laparoscopic HH repair between 2010 and 2021. We divided them into 2 groups according to age: the "younger" group (< 75years old, n = 21), and the "older" group (≥ 75years old, n = 18). The patient characteristics, intraoperative data, and postoperative results were collected. The median ages were 68 and 82years old in the younger and older groups, respectively, and the female ratio was similar between the groups (younger vs. older: 67% vs. 78%, p = 0.44). The older group had more type III/IV HH cases than the younger group (19% vs. 83%, p < 0.001). The operation time was longer in the older group than in the younger group, but there was no significant difference in blood loss, perioperative complications, or postoperative length of stay between the groups. The older group had significantly more cases of anterior gastropexy (0% vs. 78%, p < 0.001) and less fundoplication (100% vs. 67%, p = 0.004) than the younger group. There was no significant difference in HH recurrence between the groups (5% vs. 11%, p = 0.46). The addition of anterior gastropexy to other procedures is feasible, safe, and potentially effective in elderly Japanese patients with HH.

Assessment of hiatus defect size in hiatal hernia patients using computed tomography

Objectives: The aim of this study is to investigate the hiatus defect diameter by measuring on multi-detector computed tomography images in hiatal hernia patients. Methods: The multi-detector computed tomography images of 50 patients and 50 individuals in control group included in this study were investigated. The hiatus surface area (cm²), hiatus antero-posterior and transverse diameters (cm), and the thickness of both diaphragmatic crura (mm) were measured by reformatting contrast-enhanced thoraco-abdomino-pelvic computed tomography images using the region of interest method. Results: In this study, a significant difference was obtained among groups according to hiatus surface area, hiatus antero-posterior, and transverse diameter measurements, and both left and right diaphragmatic crural thickness measurements (P&amp;lt;0.001). In the patient group, the cut-off values were determined by using ROC analysis, and the values above these cut-off values enabled a hernia diagnosis with high sensitivity and specificity. Conclusions: Measuring the hiatus surface area on multi-detector computed tomography images could serve as a supplementary criterion for diagnosing of hiatal hernia.

Comprehensive Assessment of Esophageal Disorders Associated with Hiatus Hernia: Insights from Big Data Analysis.

Hiatus hernia (HH) is a prevalent endoscopic finding in clinical practice, frequently co-occurring with esophageal disorders, yet the prevalence and degree of association remain uncertain. We aim to investigate HH's frequency and its suspected association with esophageal disorders. We reviewed endoscopic reports of over 75,000 consecutive patients who underwent gastroscopy over 12 years in two referral centers. HH was endoscopically diagnosed. We derived data on clinical presentation and a comprehensive assessment of benign and malignant esophageal pathologies. We performed multiple regression models to identify esophageal sequela associated with HH. The overall frequency of HH was (16.8%); the majority (89.5%) had small HHs (<3 cm). Female predominance was documented in HH patients, who were significantly older than controls (61.1±16.5 vs. 52.7±20.0; P < 0.001). The outcome analysis of esophageal pathology revealed an independent association between HH, regardless of its size, and erosive reflux esophagitis (25.7% vs. 6.2%; OR = 3.8; P < 0.001) and Barrett's esophagus (3.8% vs. 0.7%; OR = 4.7, P < 0.001). Furthermore, following rigorous age and sex matching, in conjunction with additional multivariable analyses, large HHs were associated with higher rates of benign esophageal strictures (3.6% vs. 0.3%; P < 0.001), Mallory Weiss syndrome (3.6% vs. 2.1%; P = 0.01), and incidents of food impactions (0.9% vs. 0.2%; P = 0.014). In contrast, a lower rate of achalasia was noted among this cohort (0.55% vs. 0%; P = 0.046). Besides reflux-related esophageal disorders, we outlined an association with multiple benign esophageal disorders, particularly in patients with large HHs.

Evaluation of the frequency of hiatal hernia in patients undergoing upper gastrointestinal system endoscopy

Obesity was identified as an essential and independent risk factor for hiatal hernia. This study focused on the frequency of hiatal hernia detection in patients who underwent upper gastrointestinal system endoscopy in our clinic. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. This study examined the frequency of Hiatal hernia detection in 303 patients who underwent upper gastrointestinal endoscopy at our institution. The relationship between the frequency of hiatal hernia and demographic data and the patient's height-weight-body mass index was evaluated. Patient data were obtained from the hospital's electronic database. Age, gender, and upper gastrointestinal endoscopy reports were examined. The frequency of Hiatal hernia detection in patients who underwent upper gastrointestinal endoscopy was documented. According to the distribution of demographic and clinical findings of the patients, there was a statistically significant difference between the groups in terms of gender, age, waist circumference, and the occurrence of esophagitis (p&lt;0.05). The incidence of hiatal hernia was higher in men than in women, and the ages of patients with hernia were higher than those without. Waist circumferences and esophagitis rates of patients with hiatal hernias were higher than those without. As a result, obesity and body mass index (BMI) carry risks for hiatus hernia. In obese patients, Hiatal hernia should be included in the differential diagnosis of gastrointestinal complaints. The gold standard in the diagnosis of reflux is clinical and endoscopic examination.

Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection.

Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy. Patients who underwent esophagectomy 2012-2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias ≥ 3 cm were included in the HH group. Overall, 66 patients (33%) had HH ≥ 3 cm. The no hernia group included 12 patients (6%) with < 3 cm HH and 106 (53%) without HH. Preoperative variables were comparable among groups. Location of anastomosis was similar among cohorts and predominantly cervical (n = 97, 82.2% vs 61, 92.4%, p = 0.113). Postoperatively, HH patients had higher incidence of atrial dysrhythmia (n = 11, 16.7% vs n = 6, 5.1% p = 0.015). Rates of R0 resections were similar (n = 62, 93.9%, vs n = 113, 95.8%, p = 0.724). HH patients had higher rates of signet ring cell histology (n = 14, 21.2% vs n = 9, 7.6% p = 0.025); this was confirmed on subgroup analysis including only adenocarcinoma patients (n = 14, 28.6% vs n = 8, 12.3%, p = 0.042). On Cox regression analysis, HH was not associated with disease-free or overall survival (HR 1.308, p = 0.274 and HR .905, p = 0.722). Patients with preoperative HH had higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.

480. ANTIREFLUX SURGERY’S LIFESPAN: 20 YEARS AFTER LAPAROSCOPIC FUNDOPLICATION

Abstract Background Laparoscopic Fundoplication (LF) is the surgical technique of choice for treating GERD, but only few studies report a follow-up beyond 15 years. The aim was to evaluate the results at least 20 years after laparoscopic fundoplication at a single national referral center for esophageal diseases. Methods We prospectively collected data on a cohort of consecutive patients who underwent LF between 1992–2001. Patients were divided into two groups: a GERD group (patients with pathological esophageal acid exposure and hiatal hernias &amp;lt;3 cm) and a large hiatal hernia (HH) group (patients having type I &amp;gt; 3 cm and types II-IV hiatal hernias). Patients were followed up for at least 20 years using endoscopy, barium-swallow, esophageal manometry, and pH monitoring. LF was defined failed in case of: GERD symptom recurrence (SS &amp;gt; 10); recurrence of esophagitis; HH recurrence or slipped-fundoplication; pathological pH-monitoring; BE progression or adenocarcinoma onset. Results The study population consisted of 142 patients: 112 in the GERD group and 30 in the HH group. The characteristics of patients are shown on Figure 1. Conversion to open surgery proved necessary in 8 patients (5.6%). At a median follow-up of 22 years, 80.4% of the GERD patients and 63.3% of the HH patients were failure-free. Revisional surgery was necessary in 14 (9.8%) patients (9 GERD and 5 HH patients); indications were dysphagia (5 cases), slipped fundoplication or hernia recurrence (6 cases), abnormal pH-monitoring or esophagitis resistant to medical therapy (2 cases), and telescoping (one case). Two decades after LARS, 87.6% of GERD patients and 76.7% of HH patients were satisfied with the procedure. Conclusions The present study concerns one of the largest populations of patients who had undergone LF to have been followed up for more than 20 years at a single center. The findings showed that laparoscopic antireflux surgery is effective and durable (for &amp;gt;20 years) in patients with uncomplicated GERD and, to a lesser extent, in those with a large hiatal hernia. The satisfaction rate more than 20 years after surgery almost reached 90% in the GERD group.

Esophageal Motility Patterns in Paraesophageal Hernia Patients Compared to Sliding Hiatal Hernia: Bigger Is Not Better

BackgroundIn patients with paraesophageal hernias (PEH), the course of the esophagus is often altered, which may affect esophageal motility. High-resolution manometry (HRM) is frequently used to evaluate esophageal motor function prior to PEH repair. This study was performed to characterize esophageal motility disorders in patients with PEH as compared to sliding hiatal hernia and to determine how these findings affect operative decision-making. MethodsPatients referred for HRM to a single institution from 2015 to 2019 were included in a prospectively maintained database. HRM studies were analyzed for the appearance of any esophageal motility disorder using the Chicago classification. PEH patients had confirmation of their diagnosis at the time of surgery, and the type of fundoplication performed was recorded. They were case-matched based on sex, age, and BMI to patients with sliding hiatal hernia who were referred for HRM in the same period. ResultsThere were 306 patients diagnosed with a PEH who underwent repair. When compared to case-matched sliding hiatal hernia patients, PEH patients had higher rates of ineffective esophageal motility (IEM) (p<.001) and lower rates of absent peristalsis (p=.048). Of those with ineffective motility (n=70), 41 (59%) had a partial or no fundoplication performed during PEH repair. ConclusionPEH patients had higher rates of IEM compared to controls, possibly due to a chronically distorted esophageal lumen. Offering the appropriate operation hinges on understanding the involved anatomy and esophageal function of each individual. HRM is important to obtain preoperatively for optimizing patient and procedure selection in PEH repair.

Hiatal hernia recurrences after laparoscopic surgery: exploring the optimal technique.

The recurrence rate of hiatal hernia (HH) after laparoscopic surgery with crural repair and Nissen or Toupet fundoplication is high (< 25-42%). HH repair can be reinforced with additional anterior sutures, vertical mesh strips (VMS) or mesh placement but the effect in the long-term (> 1year) is still unclear. We determined the recurrence rate of HH after surgery and established whether the use of reinforcement techniques could reduce long-term recurrence rates. In this retrospective cohort study patients were included if they underwent a laparoscopic fundoplication in this hospital between 2012 and 2019. HH was measured with computed tomography and baseline patient characteristics and surgical details were collected. Primary outcomes were recurrence of symptoms and re-intervention, secondary outcome was effect of surgical reinforcement techniques. Statistical analyses comprised chi-square tests, Mann-Whitney U tests and uni- and multivariable logistic regression analyses. In total, 307 patients were included, 206 women and 101 men. During primary surgery, 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of anterior sutures in 132 patients, VMS in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Use of VMS during primary surgery was significantly associated with fewer recurrences (OR = 0.34, p = 0.048), corrected for confounding factors. Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in five patients (1.6%). Mesh and VMS were used more during secondary and tertiary surgery. The recurrence rate among HH patients in this cohort study was 20.8% with a mean follow-up time of 6years. Secondary surgery was performed in 17.6% of the patients. In future, the use of VMS might lead to fewer recurrences after primary laparoscopic repair of HH.

The role of cardioesophageal lipoma in the formation of hiatal hernia in patients after bariatric surgery

The purpose of this study was to determine the role of cardioesophageal lipoma in the development of hiatal hernia in patients after bariatric surgery.Material and methods. The research involved three groups of patients: patients with obesity without a hiatal hernia, who subsequently underwent a sleeve gastrectomy (1st group, 54 people); patients with normal body mass index (BMI) and diagnosed hiatal hernia (2nd group, 56 people); patients with normal BMI without hiatal hernia (3nd group, 60 people). The assessment of the area of visceral fat and cardioesophageal lipoma was determined according to the MSCT data of the abdomen. Patients completed a questionnaire using the GERD-HRQL, patients of 1st group (after bariatric surgery) completed a questionnaire using the BAROS.Results and discussion. We noted a higher incidence of cardioesophageal lipoma in obese patients (70.4%). In obese patients after a bariatric procedure, along with a decrease in BMI, not only the area of internal visceral fat, but also the area of cardioesophageal lipoma significantly decreases, which led to the formation of hiatal hernia in 68.75% of patients.Conclusion. The data obtained indicate a high incidence of cardioesophageal lipoma in obese patients. Cardioesophageal lipoma is an important pathogenetic link in the development of hiatal hernia, and, as a result of gastroesophageal reflux, in bariatric patients in the late postoperative period.

Preoperative hiatal hernia in esophageal adenocarcinoma; does it have an impact on patient outcomes?

BackgroundThe impact of hiatal hernia (HH) on oncologic outcomes of patients with esophageal adenocarcinoma (AC) remains unclear. The aim of this study was to assess the effect of pre-existing HH (≥3 cm) on histologic response after neoadjuvant treatment (NAT), overall (OS) and disease-free survival (DFS). MethodsAll consecutive patients with oncological esophagectomy for AC from 2012 to 2018 in our center were eligible for assessment. Categorical variables were compared with the X2 or Fisher's test, continuous ones with the Mann-Whitney-U test, and survival with the Kaplan-Meier and log-rank test. ResultsOverall, 101 patients were included; 33 (32.7%) had a pre-existing HH. There were no baseline differences between HH and non-HH patients. NAT was used in 81.8% HH and 80.9% non-HH patients (p = 0.910), most often chemoradiation (63.6% and 57.4% respectively, p = 0.423). Good response to NAT (TRG 1–2) was observed in 36.4% of HH versus 32.4% of non-HH patients (p = 0.297), whereas R0 resection was achieved in 90.9% versus 94.1% respectively (p = 0.551). Three-year OS was comparable for the two groups (52.4% in HH, 56.5% in non-HH patients, p = 0.765), as was 3-year DFS (32.7% for HH versus 45.6% for non-HH patients, p = 0.283). ConclusionHH ≥ 3 cm are common in patients with esophageal AC, concerning 32.7% of all patients in this series. However, its presence was neither associated with more advanced disease upon diagnosis, worse response to NAT, nor overall and disease-free survival. Therefore, such HH should not be considered as risk factor that negatively affects oncological outcome after multimodal treatment of esophageal AC.

Severe Intermittent Dysphagia is not a Contraindication for Total Nissen Fundoplication

Aim: To study the effect of total Nissen fundoplication on severe intermittent esophageal dysphagia according to a hiatal hernia. Methods: Twenty-three consecutive patients (12 men, 11 women, median age 43 yrs) with severe intermittent dysphagia and with hiatal hernia verified by endoscopy were included in the study. They were investigated with esophageal high-resolution manometry (HRM)-, and 24-hr pH- monitoring prior to hiatal hernia repair and at follow-up 6 months after surgery. On both test occasions, the patients were asked to fill in a questionnaire comprising 17 questions on esophageal and chest symptoms (severity grades 0-3). Results: A hiatal hernia was recorded via HRM in all 23 patients prior to surgery and in no one at follow-up. Prior to surgery, all patients had either severe no stenotic dysphagia or frequent retention symptoms in the chest while eating. These two mechanical problems were relieved by surgery (p&lt; 0.0001). Motility disturbances in the distal esophagus were recorded in 35 % of patients prior to surgery, but in no one at follow-up. The median total reflux time prior to surgery was 2.2 % (range 0.2 – 36.5 %) and at follow-up 0 % (0 – 0.3 %). Five patients had no pathological gastro-esophageal reflux prior to surgery. Conclusion: Severe intermittent esophageal dysphagia in hiatal hernia patients can be successfully treated with total Nissen fundoplication, and this should be a strong indication for hiatal hernia surgery even in the absence of pathological gastro-esophageal reflux.

Preoperatif Aneminin Hiatal Herni Cerrahisi ve Postoperatif Komplikasyonlara Etkisi

Aim: Anemia is associated with increased mortality and morbidity in all patients undergoing surgery. This study aimed to reveal to what extent anemia caused postoperative complications before hiatal hernia surgery. Material and Methods: One hundred and ninety-two patients operated for hiatal hernia in our clinic between 2015 and 2019 were analyzed retrospectively. Patients were compared according to demographics, preoperative laboratory values, preoperative Charlson comorbidity index score, hiatal hernia type, postoperative intensive care requirement, presence of postoperative complications, Clavien-Dindo score, blood transfusion need, and length of hospital stay. Results: Of the patients, 109 were female and 83 were male. The mean age was 50.1±9.1 years. Fifty-four (28.2%) of the patients were in the anemic group, and 138 (71.8%) were in the non-anemic group. There was no statistically significant difference between the groups in terms of gender distribution (p=0.663). When the groups were compared in terms of age distribution, it was found that the anemic group was older than the non-anemic group and the difference was statistically significant (p&amp;lt;0.001). There was a significant difference between the groups in terms of the postoperative complications rate and it was more common in the anemic group (p&amp;lt;0.001). There was a significant difference between the groups in terms of the need for intensive care and blood transfusion in the postoperative period (p=0.020, p&amp;lt;0.001, respectively). Conclusion: Preoperative anemia increases postoperative complications in hiatal hernia surgery. Therefore, the presence of anemia should be investigated before hiatal hernia surgery and patients with anemia should be followed up closely postoperatively.

Does the use of bioabsorbable mesh for hiatal hernia repair at the time of bariatric surgery reduce recurrence rates? A meta-analysis.

Anywhere from 16% to 37% of patients undergoing bariatric and metabolic surgery are estimated to have a hiatal hernia. To address the lack of long-term data showing the efficacy of bioabsorbable mesh in reducing the recurrence of hiatal hernia in patients who undergo bariatric surgery, we evaluated the world literature and performed a meta-analysis. To evaluate hiatal hernia recurrence rates after placement of bioabsorbable mesh in bariatric patients. Meta-analysis of world literature. We performed a literature search using PubMed and MEDLINE with search terms including "hiatal hernia recurrence," "bariatric surgery," "bioabsorbable mesh," "Gore BIO-A," and "trimethylene carbonate." Analysis was conducted to compare surgical time, length of stay, recurrence rate, hernia size, and changes in body mass index before and after surgery between mesh-group (MG) and nonmesh (NM) patients. The meta-analysis was described using standardized mean difference, weighted mean difference, effect size, and 95% confidence interval (CI). An I2 statistic was computed to assess heterogeneity. Twelve studies with 1351 patients were included in our meta-analysis. Four studies had both an MG and an NM group. There were 668 patients in the MG and 683 patients in the NM group. Hernia size noted in the NM group (7 cm2) was compared with that in the MG (6.5 cm2) (95% CI: 3.89-9.14; P = .86). The MG had fewer recurrences than the NM group (effect size, 2% versus 14%; 95% CI: -.26 to -.02; P = .027). The average follow-up was 28.8 months for the MG and 32.8 months for the NM group. Repair with bioabsorbable mesh at the time of the index bariatric surgery is more effective at reducing the recurrence rate of hiatal hernia than suture cruroplasty. Further studies investigating the long-term outcomes of bioabsorbable mesh placed at the time of bariatric surgery are needed.

Identification of Sliding Hiatus Hernia by High-Resolution Manometry and Upper Gastrointestinal Endoscopy in Patients with Gastro-Oesophageal Reflux Disease

The aim of this study was to compare high-resolution manometry (HRM) and upper gastrointestinal (GI) endoscopy as diagnostic utilities in detecting a sliding hiatus hernia in patients with gastro-oesophageal reflux disease (GORD) symptoms. For both diagnostic modalities, the data obtained from 31 patients (20 females; mean age 48.2) who qualified for Nissen fundoplication were analysed using oesophageal pressure topography in line with the Chicago Classification. Confirmation of hiatus hernia during the surgery was considered the gold standard. HRM protocol involved 10 consecutive boluses of 10 mL of water. Sliding hiatus hernia was confirmed intraoperatively in 29 out of 31 patients. In 14 patients, hiatus hernia was detected in HRM, while 19 patients were found to have hiatus hernia by upper GI endoscopy before surgery. No false positive results were obtained in HRM, while 15 false negative results were shown. In upper GI endoscopy, false positive data were observed in 1 patient, while false negative results were found in 10 patients. Thus, the sensitivity of HRM in detecting hiatus hernia was 48% (95%CIs: 29-67%), and sensitivity of upper GI endoscopy was 66% (95%CIs: 46-82%). It was not possible to assess the specificity of HRM or upper GI endoscopy because only 2 of 31 patients had no hiatus hernia during fundoplication (gold standard). False negative results (sensitivity) were not significantly different between compared diagnostic modalities HRM and upper GI endoscopy (52% vs. 34%, respectively, p = 0.29). Due to poor sensitivity, both modalities, i.e., HRM and upper GI endoscopy, are not reliable tools to diagnose sliding hiatus hernia in patients with GORD symptoms.

OC-067 HIATAL HERNIA RECURRENCES AFTER LAPAROSCOPIC SURGERY: EXPLORING CONTRIBUTING SURGICAL FACTORS

Abstract Aim The recurrence rate of hiatus hernia (HH) is high after laparascopic surgery (25–42%). HH repair can be reinforced by means of additional ventral sutures, pledgets or mesh placement. We determined the recurrence rate of HH after surgery and established whether lower long-term recurrence rates can be achieved with reinforcement techniques. Methods Patients were included in this retrospective cohort study if they underwent a laparoscopic fundoplication in our hospital between 2012–2019. HH was measured on CT scans and patient files were reviewed. Results In total, 307 patients were included, 206 women and 101 men. Pre-operatively, 102 patients were diagnosed with type III HH and 68 patients with type IV HH. The median transverse diameter of the HH was 3.2 cm. 208 patients underwent a Toupet fundoplication and 97 patients underwent a Nissen fundoplication. Reinforcements consisted of ventral sutures in 132 patients, pledgets in 89 patients and mesh in 17 patients. After primary surgery, recurrence of HH was diagnostically confirmed in 64 patients (20.8%). Secondary surgery was performed in 54 patients (17.6%) and tertiary surgery in 5 patients (1.6%). Use of pledgets during primary surgery (OR=0.34, p=0.048) was significantly associated with fewer recurrences, corrected for confounding factors. Use of ventral sutures and mesh were not significantly associated with reduced recurrence rates. Conclusions The recurrence rate among HH patients in our hospital was 20.8% with a mean follow-up time of 6 years. In future, the use of pledgets might lead to fewer recurrences after primary laparoscopic repair of HH.

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Comment on "Sutured Versus Mesh-augmented Hiatus Hernia Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials".

Hiatal hernia in patients with dyspepsia undergoing esophagogastroscopy.

Objective: To find out the frequency of hiatal hernia among patients with dyspepsia undergoing esophagogastroscopy. Study Design: Descriptive, Cross-sectional study. Setting: Departments of Medicine and Gastroenterology, Services Hospital Lahore. Period: December 2018 to June 2019. Material &amp; Methods: A total of 195 patients with dyspepsia aged 20 to 60 years of both sexes were enrolled. Patients with history of gastric or duodenal ulcer, pregnant women, Chronic Renal Failure and Chronic Liver Disease were excluded. After taking informed consent, esophagogastroscopy was done in each patient and presence or absence of hiatal hernia was noted. Results: Out of 195 patients enrolled 104 (53.3%) were male. Mean age was 41.3±8.8 years and mean duration of disease 6.3±2.0 months. Mean BMI was 27.5±3.0 kg/m2 and 101 (51.7%) had BMI &lt;27 kg/m2. Thirty-seven (19.8%) were smokers while sedentary lifestyle was reported in 93 (47.6%). Hiatal hernia among patients with dyspepsia undergoing esophagogastroscopy was found in 16 (8.21%) patients. Conclusion: We conclude that hiatal hernia was not uncommon in patients with dyspepsia undergoing esophagogastroscopy. Age and smoking status had a significant association with hiatal hernia while no association with sex, duration of disease, BMI, occupation or lifestyle.

Insights from a magnetic resonance imaging-based evaluation of five hiatal hernia patients pre- and postoperatively on heart-mediated peristaltic action for reflux control and clearance: a case report

Insights from a magnetic resonance imaging-based evaluation of five hiatal hernia patients pre- and postoperatively on heart-mediated peristaltic action for reflux control and clearance: a case report