Additional mechanisms of hiatal hernia recurrence and its prevention

S. K. Mittal, Charles Filipi, P. I. Anderson, S. J. Fenton, J. E. Cummings, D. Cornet, T. H. Quinn, Robert Joseph Fitzgibbons

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

The conventional hiatal hernia repair is a tension repair. Large defects such as those associated with an intrathoracic stomach can have a high rate of recurrence resulting in esophageal symptoms and in some instances gastric strangulation. Numerous additive procedures are used to secure the stomach in the abdominal cavity including mesh buttressing, fundoplication, anterior abdominal wall gastropexy and fundus diaphragmatic suture fixation. The optimal repair is unknown primarily because crura closure failure is poorly understood. A literature review was used to determine the proven causes of hiatal hernia recurrence. Early postoperative vomiting, surgeon inexperience, short esophagus and no crus closure are documented causes. In a series of 19 hiatal hernia recurrence repairs from our institution, additional causes such as suture pull-out and trauma have been established as additional mechanisms of recurrence. Increased intra-abdominal pressure associated with motor vehicle accidents was the precipitating factor in 2/19 patients. Suggested methods for prevention of hiatal disruption and resultant hernia are proposed which include: a postoperative antiemetic regimen, restricted activity in the early postoperative period, an assessment technique for the short esophagus when utilizing a laparoscopic approach, crus closure calibration and inclusion of the diaphragmatic fascia when performing hiatal closure for large paraesophageal hernias and the short esophagus.

Original languageEnglish
Pages (from-to)215-220
Number of pages6
JournalHernia : the journal of hernias and abdominal wall surgery
Volume3
Issue number4
StatePublished - Dec 1999

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Hiatal Hernia
Esophagus
Recurrence
Stomach
Herniorrhaphy
Sutures
Gastropexy
Precipitating Factors
Postoperative Nausea and Vomiting
Fundoplication
Antiemetics
Abdominal Cavity
Fascia
Abdominal Wall
Motor Vehicles
Hernia
Postoperative Period
Calibration
Accidents
Pressure

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Additional mechanisms of hiatal hernia recurrence and its prevention. / Mittal, S. K.; Filipi, Charles; Anderson, P. I.; Fenton, S. J.; Cummings, J. E.; Cornet, D.; Quinn, T. H.; Fitzgibbons, Robert Joseph.

In: Hernia : the journal of hernias and abdominal wall surgery, Vol. 3, No. 4, 12.1999, p. 215-220.

Research output: Contribution to journalArticle

Mittal, SK, Filipi, C, Anderson, PI, Fenton, SJ, Cummings, JE, Cornet, D, Quinn, TH & Fitzgibbons, RJ 1999, 'Additional mechanisms of hiatal hernia recurrence and its prevention', Hernia : the journal of hernias and abdominal wall surgery, vol. 3, no. 4, pp. 215-220.
Mittal, S. K. ; Filipi, Charles ; Anderson, P. I. ; Fenton, S. J. ; Cummings, J. E. ; Cornet, D. ; Quinn, T. H. ; Fitzgibbons, Robert Joseph. / Additional mechanisms of hiatal hernia recurrence and its prevention. In: Hernia : the journal of hernias and abdominal wall surgery. 1999 ; Vol. 3, No. 4. pp. 215-220.
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