Kurzfristiges Ergebnis einer neuartigen Doppeltrakt-Rekonstruktion für das fehlgeschlagenes Repair einer Redo-Hiatus-Hernie

Einleitung Recurrence of hiatal hernia is seen in up to 70 % of patients who undergo repeat operative antireflux procedure.

Aim To demonstrate the early results of a novel double tract reconstruction in treating failed re-do fundoplication.

Material und Methoden Retrospective review of prospectively obtained data (from “Herniamed Registry”) on patients who had undergone salvage operation of failed re-do fundoplication. Data pertaining to demographics, operative details, and perioperative outcomes, symptomatic outcomes and patient satisfication were reviewed.

Ergebnisse Overall: Three patients underwent double tract reconstruction in the last 6 months. All patients in this study had previously undergone a re-do fundoplication with concurrent hiatal hernia repair: - Study subjects: * The 1st patient is a 60-years old female (BMI, 18.6 kg/m²) experienced the 3rd recurrence episode after 3 previously failed laparoscopic hiatus hernia repairs.* The 2nd patient is a 50-years old female (BMI, 22.3 kg/m²) with the 2nd recurrence after 2 previously failed laparoscopic and open repairs.

* The 3rd patient is a 50-years old female (BMI, 42 kg/m²) with the 3rd recurrence after 2 previously failed laparoscopic fundoplications with mesh.

- In detail: All patients underwent laparoscopic transhiatal distal esophagus resection including proximal gastric resection with laparoscopic double-tract reconstruction (Roux-en-Y esophagojejunostomy with gastrojejunostomy). Mean operating time was 308 min. Mean hospital stay was 13 d.

- Outcome There were no 30-d reoperation and no 30-d readmission. One patient reported repeated abdominal pain and vomiting with weight loss. The control investigation showed no organic causes for her complain. She had psychotherapy with additional jejunal feeding. The other two patients showed substantial clinical and endoscopic improvement.

Schlussfolgerung Double tract reconstruction appears a suitable option in treating symptomatic recurrently failed re-do hiatus hernia repair especially after the second or third recurrence episode with disruption of the anatomy and scarring of gastroesophageal junction by previous multiple surgery.

Publication History

Article published online:
07 September 2021