Collis Gastroplasty and Reinforced Crural Repair: Essential Components of Laparoscopic Giant Hiatal Hernia Repair
Back to 86th Annual Meeting
Back to Program Outline
OBJECTIVE: Laparoscopic repair of a giant hiatal hernia (>50% of stomach above the diaphragm) is associated with an early recurrence rate of 12% to 40%. We hypothesized that increasing intra-abdominal esophagus length via Collis gastroplasty, complete fat-pad dissection, and hernia sac excision with primary reinforced crural repair would minimize early recurrence and provide adequate symptomatic relief.
METHODS: From January 1, 2001 though May 1, 2005, 61 patients underwent giant hiatal hernia repair with laparoscopic Collis-Nissen. Patients completed a validated questionnaire to assess functional outcomes at a median of 199 days postoperatively (range, 53 to 1257). In addition, we obtained a postoperative barium esophogram to objectively evaluate for possible hiatal hernia recurrence at a median of 323 days postoperatively (range, 4 to 1080).
RESULTS: Operating time averaged 308 ± 103 minutes. There were 12 (20%) patients who were referred after previous fundoplication. Median hospital stay was 4 days (range, 1 to 53). Postoperative complications occurred in 6 (9.8%) of the 61 patients, including: 1 death, 1 esophageal leak, and 1 serious pneumonia. Postoperative radiographic data were available for 54 (89%) of the 61 patients. There were no short term (1 month) recurrences and only 1 (1.9%) patient had evidence of a small, asymptomatic radiographic recurrence at longer term (1 year) follow-up. The total recurrence rate was 1.9%. Most of the 52 questionnaire respondents reported excellent results in each of 9 symptoms (Table). The mean postoperative GERD Quality of Life score was 1.15 ± 2.78 (scale 0 to 45; 0=asymptomatic). Overall, 51 (98%) of 52 respondents were satisfied with their surgical outcome.
Postoperative Symptoms and GERD-HRQOL Scores| Symptoms Reported | Excellent | Good | Fair | Poor | Total |
| Heartburn | 88.5% | 7.7 % | 3.9% | 0.0% | 100.0% |
| Dysphagia | 73.1% | 21.2% | 5.8% | 0.0% | 100.0% |
| Regurgitation | 92.3% | 7.7% | 0.0% | 0.0% | 100.0% |
| Abdominal Pain | 78.9% | 17.3% | 1.9% | 1.9% | 100.0% |
| Respiratory Symptoms | 94.2% | 3.9% | 1.9% | 0.0% | 100.0% |
| Bloating | 73.1% | 21.2% | 1.9% | 3.9% | 100.0% |
| Diarrhea | 76.9% | 13.2% | 0.0% | 9.6% | 100.0% |
| Early Satiety | 55.8% | 21.2% | 11.5% | 11.5% | 100.0% |
| GERD-HRQOL | 96.2% | 1.9% | 0.0% | 1.9% | 100.0% |
CONCLUSIONS: Consistent use of a Collis gastroplasty with reinforced crural repair minimizes recurrence following minimally invasive repair of giant hiatal hernia. Functional results are excellent in most patients, translating to high levels of satisfaction with the procedure.
Back to 86th Annual Meeting
Back to Program Outline
