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One anastomosis gastric bypass (OAGB) presently constitutes 7.6% of all metabolic and bariatric surgery (MBS) procedures globally. Despite being approved by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) as a standalone MBS procedure and two consensus efforts in the past, multiple areas of controversies remain. This consensus builds upon previous consensus efforts to address unresolved controversies in the field. A modified Delphi consensus exercise was conducted over 4 weeks under the aegis of the MGB-OAGB International Club. A panel of 86 bariatric experts from 25 countries participated in 3 rounds of voting on 29 questions on patient selection, technical standardization, revisional surgeries, and post-operative care. Consensus was defined as at least 70% agreement. Consensus was achieved on 22 out of 29 questions. Key areas of agreement included suitability of OAGB for adolescents above the age of 15 years and patients with class 1 obesity with uncontrolled type 2 diabetes. Patients with severe esophagitis and Barrett's esophagus were not considered as good candidates for OAGB. Crural repair with OAGB was considered as an appropriate procedure in patients with large hiatus hernia. While a bilio-pancreatic limb (BPL) length of 150 – 200 cm was deemed suitable, it was recommended to tailor the BPL length to prevent protein energy malnutrition. It was also agreed to routinely administer ursodeoxycholic acid and proton-pump inhibitors for 6 months post-operatively. This modified Delphi consensus represents a critical step forward in addressing the controversies surrounding OAGB. It also emphasizes on the importance of individualized patient care and the need for ongoing research to refine surgical practices and improve outcomes. [ABSTRACT FROM AUTHOR]

Hiatus hernias (HH) are a common cause of symptoms and complications, with considerable variation in anatomy, function, diagnosis and treatment. We undertook the first systematic review to appraise how HH are diagnosed and classified in the literature, using randomized controlled trials as a sample. A search was performed in July 2021of the PubMed, EMBASE and Cochrane Central Register of Controlled Trials, and 2832 articles were identified and 64 were included. Median Jadad score was 2. Studies demonstrated considerable variation in diagnosis, classification and minimum surgical steps. The commonest classifications before surgery were axial length and the Type I-IV classification, variably assessed by endoscopy and contrast swallow. Intra-operatively, the commonest classification was type I-IV. A minority used more than one classification, or alternatives such as defect size and Hill classification. Most studies reported minimum steps, but these varied. Only a minority reported criteria for diagnosing recurrence. Using randomized controlled trials to appraise the highest quality evidence in the literature, we found considerable variation and inconsistency in the way HH are diagnosed and classified. This lack of a 'common language' has significant impacts for the generalizability of evidence, study synthesis and design. We propose the development of an internationally accepted classification. We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic revisional surgery for recurrent hiatal hernia (HH) is technically demanding. Re-recurrences are common and esophageal hiatus mesh reinforcement might improve durability of the repair, thus minimizing the risk of re-herniation. Purpose: Assess safety and effectiveness of simple suture repair (no mesh group) vs. crural augmentation with a biosynthetic absorbable mesh (mesh group) in patients with recurrent HH. Methods: Observational retrospective study from September 2012 to December 2022. Only patients undergoing redo surgery for previous failures of hiatal hernia repair were enrolled. Surgical failure was defined as symptomatic recurrent HH with > 2 cm of gastric tissue above the diaphragmatic impression at upper gastrointestinal endoscopy and/or swallow study. Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and Short Form-36 (SF-36) questionnaires were used to assess and preoperative and postoperative symptoms and quality of life. Results: One hundred four patients were included. Overall, 60 patients (57.7%) underwent mesh-reinforced cruroplasty, whereas 44 (42.3%) underwent simple suture cruroplasty. Mesh and no mesh groups had similar baseline demographics, symptoms, prevalence of esophagitis and Barrett's esophagus, and HH size. A composite crural repair was most commonly performed in the mesh group (38.3% vs. 20.5%; p = 0.07). In addition to cruroplasty, most patients (91%) underwent a Toupet fundoplication. The 90-day postoperative complication rate was 8.6%, and there was no mortality. Recurrent HH was diagnosed in 21 patients (20.2%) with a clinical trend toward reduced incidence in the mesh group (16.7% vs. 25%; p = 0.06). Compared to baseline, there was a statistically significant improvement of median GERD-HRQL score (p < 0.01) and all SF-36 items (p < 0.01). Conclusions: Laparoscopic revisional surgery for recurrent HH is safe and effective. Selective use of biosynthetic mesh may protect from early recurrence and has the potential to reduce re-herniation in the long-term. [ABSTRACT FROM AUTHOR]

Background: Hiatal mesh repair remains a controversial topic among anti-reflux surgeons. Biosynthetic mesh cruroplasty may prevent early recurrence while avoiding late esophageal erosion and strictures associated with non-resorbable materials. So far, medium-term results on hiatal PH4B (Poly-4-Hydroxybutyrate) mesh repair from high-volume centers are lacking. Methods: We analyzed the medium-term efficacy and safety of PH4B mesh cruroplasty in 176 consecutive patients (≥ 18 years) with symptomatic hiatal hernias. Treatment failure was defined as the clinical recurrence of reflux symptoms. Patients could choose between mesh augmented hiatal repair (combined with a modified anterior hemifundoplication and fundophrenicopexy), Nissen fundoplication, and magnetic sphincter augmentation at their discretion. We also describe the surgical approach to mesh augmented hiatal repair used at our center. Results: On average, patients were 55 (± 14) years old and followed up for 22 (± 7; sum: 3931) months. Treatment failed in 6/176 (3%, 95% CI: 2–7%) patients. The 24-month Kaplan–Meier failure estimate was 2.8% (95% CI: 0.4–5%). Each centimeter in hernia size increased the risk of failure by 52% (p = 0.02). Heavier patients (BMI > 27) had an 11% higher probability of clinical symptom recurrence (p = 0.03). The dysphagia and bloating/gas rate were 13/176 (7%), each. 8 (5%) patients required endoscopy due to dysphagia but without intervention. No serious complications, including mesh infection and erosion, or fatalities, occurred. Conclusion: Augmented PH4B mesh cruroplasty without conventional fundoplication shows excellent intermediate-term results in patients with reflux disease due to hiatal hernia. Around one in thirty patients experience treatment failure within 2 years of surgery. Hernia size and overweight are key determinants of treatment failure. [ABSTRACT FROM AUTHOR]

Background: An increasing number of reflux patients opt for magnetic sphincter augmentation (MSA) instead of fundoplication. However, few studies compare the medium-term efficacy and safety of the procedures. Methods: We conducted a retrospective single-center analysis of consecutive MSA and Nissen fundoplication cases between 01/2015 and 06/2020. Patients underwent surgery, including hiatoplasty, for medical treatment-resistant reflux due to hiatal hernia. Surgical revision and proton pump inhibitor (PPI) reuptake rates were the primary outcomes. We also compared adverse event rates. Patients with severe preoperative dysphagia/motility disorders were assigned different treatment pathways and excluded from the analysis. We used propensity-score matching to reduce confounding between treatments. Results: Out of 411 eligible patients, 141 patients who underwent MSA and 141 with fundoplication had similar propensity scores and were analyzed. On average, patients were 55 ± 12 years old and overweight (BMI: 28 ± 5). At 3.9 years of mean follow-up, MSA was associated with lower surgical revision risk as compared to fundoplication (1.2% vs 3.0% per year, respectively; HR: 0.38; 95% CI 0.15–0.96; p = 0.04), and similar PPI-reuptake risk (2.6% vs 4.2% per year; HR: 0.59; 95% CI 0.30–1.16; p = 0.12). Adverse event rates during primary stay were similar (MSA vs. fundoplication: 1% vs. 3%, p = 0.68). Fewer patients experienced adverse events in the MSA group after discharge (24% vs. 33%, p = 0.11), driven by higher rates of self-limiting dysphagia (1% vs. 9%, p < 0.01) and gas/bloating (10% vs. 18%, p = 0.06) after fundoplication. Differences between MSA and fundoplication in dysphagia requiring diagnostic endoscopy (11% vs. 8%, p = 0.54) or surgical revision (2% vs. 1%, p = 1.0) were non-significant. The device explantation rate was 4% (5/141). Conclusion: MSA reduces the re-operation risk compared to fundoplication and may decrease adverse event rates after discharge. Randomized head-to-head studies between available surgical options are needed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This article discusses the impact of hiatus hernia (HH) in patients with hypersensitivity pneumonitis (HP). The study found that about one-third of HP patients had HH, which is higher than the general population. However, the causal relationship between HH and lung fibrosis has not been established. The study also found that the presence and size of HH were not associated with body mass index (BMI) or the extent of fibrosis on CT scans. Additionally, there was no relationship between HH and baseline lung function. In patients with a usual interstitial pneumonia (UIP) pattern on CT, there was a trend towards poorer survival and lung function decline in those with HH. Consolidation, a CT marker of aspiration, was more prevalent in HP patients with larger HH. Further research is needed to understand the potential role of HH in the development of HP. [Extracted from the article]

Background: Globus pharyngeus is a clinical condition, wherein, a patient senses a lump or a foreign body in the throat with a tightening or choking feeling. A strong association between globus pharyngeus and gastroesophageal reflux disease (GERD) was reported. Therefore, we sought to investigate the predictive factors of globus pharyngeus in patients with established GERD and fit a predictive scoring model for globus pharyngeus. Methods: In this case-control study, 143 patients having globus pharyngeus along with GERD (case) and 109 patients having globus pharyngeus without GERD (control) were enrolled. Data comprising demographics, comorbidities, and psychosocial stress levels were recorded. The predictive factors of globus pharyngeus in patients with GERD were unraveled, and a predictive scoring model was fit for globus pharyngeus. Results: Proton pump inhibitor usage in the case group was significantly higher compared to controls (63.63% vs 24.78%, P < 0.001), and differences in Hiatus Hernia and Stress levels were highly significant between the two groups (P < 0.001). Multivariate logistic regression revealed that variates, Hiatus Hernia, psychosocial stress, and age were highly significant (P < 0.001) independent predictors of globus pharyngeus. Using the regression coefficients of all the independent predictor variables, a predictive scoring model was fitted, which yielded an area under receiver operating characteristic (AUROC) curve of 78.9. Conclusion: Hiatus hernia, psychosocial stress, and age are significant independent predictors of globus pharyngeus in GERD, and our predictive scoring model may help in identifying patients at higher odds of experiencing globus pharyngeus and modulate treatment accordingly. [ABSTRACT FROM AUTHOR]

Objective: Using a comprehensive Australian cohort, we quantified the incidence and determined the independent predictors of intraoperative and postoperative complications associated with antireflux and hiatus hernia surgeries. In addition, we performed an in-depth analysis to understand the complication profiles associated with each independent risk factor. Background: Predicting perioperative risks for fundoplication and hiatus hernia repair will inform treatment decision-making, hospital resource allocation, and benchmarking. However, available risk calculators do not account for hernia anatomy or technical aspects of surgery in estimating perioperative risk. Methods: Retrospective analysis of all elective antireflux and hiatus hernia surgeries in 36 Australian hospitals over 10 years. Hierarchical multivariate logistic regression analyses were performed to determine the independent predictors of intraoperative and postoperative complications accounting for patient, surgical, anatomic, and perioperative factors. Results: A total of 4301 surgeries were analyzed. Of these, 1569 (36.5%) were large/giant hernias and 292 (6.8%) were revisional procedures. The incidence rates of intraoperative and postoperative complications were 12.6% and 13.3%, respectively. The Charlson Comorbidity Index, hernia size, revisional surgery, and baseline anticoagulant usage independently predicted both intraoperative and postoperative complications. These risk factors were associated with their own complication profiles. Finally, using risk matrices, we visualized the cumulative impact of these 4 risk factors on the development of intraoperative, overall postoperative, and major postoperative complications. Conclusions: This study has improved our understanding of perioperative morbidity associated with antireflux and hiatus hernia surgery. Our findings group patients along a spectrum of perioperative risks that inform care at an individual and institutional level. [ABSTRACT FROM AUTHOR]

Background: Gastro-esophageal reflux disease (GERD/GORD) is a chronic condition in which gastric acid flows backwards up into the esophagus, causing heart burn and a higher disposition to esophageal cancer. The reflux is caused by impairment of the lower esophageal sphincter (LES). Over the past century gastro-esophageal reflux has become the principal gastrointestinal condition of our time. The proton pump inhibitor class of drugs is effective in ameliorating the symptoms of reflux. The cost of investigation of patients in Europe is €100 billion per annum. The cost in days lost from work is €100 billion per annum in Europe. The global cost is 3 times this amount. Methodology: The proposed device for treating gastro-esophageal reflux is a biodegradable valve that is placed non surgically in the esophago-gastric junction to prevent reflux from the stomach to the esophagus. Experiment Results: 50 simulator studies were performed with the patented device to elucidate the most consistent method of insertion and fixation in a human like simulator. The simulator was designed to replicate the normal human gastro-esophageal anatomy and characteristics. Four animal insertions were performed under ethical regulation at Amsterdam Medical Centre, Netherlands. Three cadaveric experiments were performed at Hackensack University Hospital, New Jersey, USA, to verify the positive outcomes of the simulator studies. Conclusion: Successful outcomes of simulator studies and cadaveric experiments allowed the design freeze of a NoReflux device for treating gastro-esophageal reflux disease. [ABSTRACT FROM AUTHOR]

Background: Gastroesophageal reflux (GER) is known to be associated with chronic lung diseases. The driving force of GER is the transdiaphragmatic pressure (Pdi) generated mainly by costal and crural diaphragm contraction. The latter also enhances the esophagogastric junction (EGJ) pressure to guard against GER. Methods: The relationship between Pdi and EGJ pressure was determined using high resolution esophageal manometry in patients with interstitial lung disease (ILD, n = 26), obstructive lung disease (OLD, n‐ = 24), and healthy subjects (n = 20). Key Results: The patient groups did not differ with respect to age, gender, BMI, and pulmonary rehabilitation history. Patients with ILD had significantly higher Pdi but lower EGJ pressures as compared to controls and OLD patients (p < 0.001). In control subjects, the increase in EGJ pressure at all‐time points during inspiration was greater than Pdi. In contrast, the EGJ pressure during inspiration was less than Pdi in 14 patients with ILD and 7 patients with OLD. The drop in EGJ pressure was usually seen after the peak Pdi in ILD group (p < 0.0001) and before the peak Pdi in OLD group, (p = 0.08). Nine patients in the ILD group had sliding hiatus hernia, compared to none in control subjects (p = 0.003) and two patients in the OLD, (p = 0.04). Conclusions and Inferences: A higher Pdi and low EGJ pressure, and dissociation between Pdi and EGJ pressure temporal relationship suggests selective dysfunction of the crural diaphragm in patients with chronic lung diseases and may explain the higher prevalence of GERD in ILD as seen in previous studies. [ABSTRACT FROM AUTHOR]

The aim of this report is to describe the management of an iatrogenic diaphragmatic eventration following surgery to relieve neurogenic symptoms of thoracic outlet syndrome in a patient with a prior history of sleeve gastrectomy. We discuss the case of a 46-year-old woman with a 6-month history of gastro-oesophageal reflux and dyspnoea. Imaging demonstrated a left hemidiaphragm eventration and hiatus hernia. The patient underwent laparoscopic plication of the left hemidiaphragm, repair of the hiatus hernia, and an omega loop gastric bypass, with satisfactory resolution of her symptoms. This demonstrates that surgical diaphragmatic plication has good outcomes in cases where the abdominal anatomy is already altered as a result of previous bariatric surgery, and that concurrent hiatus hernia repair, plication of iatrogenic diaphragm eventration, and sleeve to gastric bypass conversion satisfactorily relieve reflux and dyspnoea in a morbidly obese patient. [ABSTRACT FROM AUTHOR]

Background: The adoption of new surgical technologies is inevitably accompanied by a learning curve. With the increasing adoption of robotic techniques in benign foregut surgery, it is imperative to define optimal learning pathways, to ensure a clinically safe introduction of such a technique. The aim of this study was to assess the learning curve for robotic hiatal hernia repair with a pre-defined adoption process and proctoring. Methods: The learning curve was assessed in four surgeons in a high-volume tertiary referral centre, performing over a 100 hiatal hernia repairs annually. The robotic adoption process included simulation-based training and a multi-day wet lab-based course, followed by robotic operations proctored by robotic upper GI experts. CUSUM analysis was performed to assess changes in operating time in sequential cases. Results: Each surgeon (A, B, C and D) performed between 22 and 32 cases, including a total of 109 patients. Overall, 40 cases were identified as 'complex' (36.7%), including 16 revisional cases (16/109, 14.7%). With CUSUM analysis inflection points for operating time were seen after 7 (surgeon B) to 15 cases (surgeon B). Conclusion: The learning curve for robotic laparoscopic fundoplication may be as little as 7–15 cases in the setting of a clearly organized learning pathway with proctoring. By integrating these organized learning pathways learning curves may be shortened, ensuring patient safety, preventing detrimental outcomes due to longer learning curves, and accelerating adoption and integration of novel surgical techniques. [ABSTRACT FROM AUTHOR]

Background: To compare the difference in outcomes in laparoscopic large hiatus hernia (LHH) repair using suture-based and mesh-based repair techniques. Methods: A systematic search of articles was conducted in PubMed, Medline and Embase using the PRISMA guidelines. Studies comparing recurrences and reoperations in those patients with large hiatal hernia repair (> 30% stomach in the chest, > 5 cm hiatal defect, hiatal surface area > 10 cm2) who had mesh vs no mesh were assessed quantitatively. The impact of mesh on significant intraoperative/postoperative surgical complications was qualitatively assessed. Results: Pooled data included six randomized controlled trials and thirteen observational studies with 1670 patients (824 with no mesh, 846 with mesh). There was a significant reduction in the total recurrence rate with mesh (OR 0.44, 95% CI 0.25–0.80, p = 0.007). Mesh use did not cause significant reduction in recurrences > 2 cm (OR 0.94, 95% CI 0.52–1.67, p = 0.83) or in reoperation rates (OR 0.64, 95% CI 0.39–1.07, p = 0.09). None of the specific meshes assessed were found to be superior in the reduction of recurrence or reoperation rates. Cases of mesh erosion with eventual foregut resection were noted and were associated with synthetic meshes only. Conclusion: Mesh reinforcement seemed protective against total recurrence in LHH although this has to be interpreted with caution given the level of heterogeneity introduced by the inclusion of observational studies in the analysis. There was no significant reduction in large recurrences (> 2 cm) or reoperation rate. If the synthetic mesh is to be used patients need to be informed of the risk of mesh erosion. [ABSTRACT FROM AUTHOR]

Background: Mesh augmentation is a highly controversial adjunct of hiatus hernia (HH) surgery. The current scientific evidence remains unclear and even experts disagree on indications and surgical techniques. With an aim to avoid the downsides of both non-resorbable synthetic and biological materials, biosynthetic long-term resorbable meshes (BSM) have recently been developed and are becoming increasingly popular. In this context, we aimed at assessing outcomes after HH repair with this new generation of mesh at our institution. Methods: From a prospective database, we identified all consecutive patients that underwent HH repair with BSM augmentation. Data was extracted from electronic patient charts of our hospital information system. Endpoints of this analysis included perioperative morbidity, functional results and recurrence rates at follow-up. Results: Between December 2017 and July 2022, 97 patients (elective primary cases n = 76, redo cases n = 13, emergency cases n = 8) underwent HH with BSM augmentation. Indications in elective and emergency cases were paraesophageal (Type II–IV) HH in 83%, and large Type I HH in 4%. There was no perioperative mortality, and overall (Clavien–Dindo ≥ 2) and severe (Clavien–Dindo ≥ 3b) postoperative morbidity was 15% and 3%, respectively. An outcome without postoperative complications was achieved in 85% of cases (elective primary surgery 88%, redo cases 100%, emergencies cases 25%). After a median (IQR) postoperative follow-up of 12 months, 69 patients (74%) were asymptomatic, 15 (16%) reported improvement, and 9 (10%) had clinical failure, of which 2 patients (2%) required revisional surgery. Conclusion: Our data suggest that HH repair with BSM augmentation is feasible and safe with low perioperative morbidity and acceptable postoperative failure rates at early to mid-term follow-up. BSM may be a useful alternative to non-resorbable materials in HH surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic hiatal hernia repair (HHR) and fundoplication is a common low risk procedure providing excellent control of gastro-oesophageal reflux disease and restoring of normal anatomy at the hiatus. HHR may fail, however, resulting in hiatus hernia (HH) recurrence, and the use of tension-free mesh-augmented hernioplasty has been proposed to reduce recurrence. Previous research on this topic has been heterogeneous, including study methods, mesh type used and technique performed. A systematic review and network meta-analysis were carried out. An electronic systematic research was carried out using 'PUBMED', 'EMBASE', 'Medline (OVID)' and 'Web of Science', of articles identifying HHR with suture cruroplasty, non-absorbable mesh (NAM) and absorbable mesh (AM) reinforcement. Eight RCTs with 766 patients were evaluated. NAM had significantly (P  < 0.05) lower early recurrence rates (OR: 0.225, 95% CI 0.0342, 0.871) compared with suture repair alone; however, no differences in late recurrences were evident. For AM, no difference in early (0.508, 95% CI 0.0605, 4.81) or late (1.07. 95% CI 0.116, 11.4) recurrence rates were evident compared with the suture only group. Major complication rates were similar in all groups. NAM reinforcement significantly reduced early HH recurrence when compared with sutured cruroplasty alone; however, late recurrence rates were similar with all techniques. Given the limited data in comparing AM with NAM, this study was unable to conclude which composition was significant. We emphasize caution when interpreting small sample size RCTs, and recommend more research with larger randomized studies. [ABSTRACT FROM AUTHOR]

Aims: There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology. Methods: We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged). Results: Seventy-two surgeons with a median (IQR) experience of 23 (14–30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15–36) and 40 (28–60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable". Conclusions: This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research. [ABSTRACT FROM AUTHOR]

Das Ligamentum gastrophrenicum (GPL) wird in osteopathischen Lehrbüchern diagnostisch und therapeutisch adressiert. Um zu bewerten, inwieweit das GPL eine Entität ist, die nach den osteopathischen Vorstellungen untersucht und behandelt werden kann, wurden Informationen aus verschiedenen medizinischen Fachrichtungen zum Verlauf, der Festigkeit und der Bedeutung für die Stabilität des Magenfundus zusammengestellt. Es wurde eine Literaturrecherche über die Bibliothek der Westfälischen Wilhelms-Universität Münster sowie in diversen elektronischen Datenbanken nach den unten aufgeführten Schlüsselbegriffen durchgeführt. Zeitlich wurde der Rahmen vom Recherchebeginn bis ins frühe 19. Jahrhundert begrenzt. Das GPL genießt in osteopathischen Betrachtungen eine Aufmerksamkeit, die in anderen Fachrichtungen scheinbar keine Entsprechung findet. In anatomischen Lehrbüchern und Abbildungen wird es weder konstant erwähnt noch einheitlich – und dann sehr vage – beschrieben und dargestellt. Die präparatorische Bestätigung der variablen „gastric bare area", einer serosafreien Fläche an der Hinterwand des Magens, mit direkten Verwachsungen am Zwerchfell bestimmen den Verlauf des GPL mit. Es bildet nicht nur Teil des „Rahmens" dieser Fläche, sondern ist mit seiner Verbindung zum Zwerchfell auch Teil eines dadurch entstehenden dreidimensionalen mit Fett gefüllten Raums. Ob das GPL als alleiniges Band für die Lagestabilität des Fundus verantwortlich ist, muss bezweifelt werden. Die Bedeutung, die dem GPL in der Osteopathie gegeben wird, mit der Konsequenz, dass es gezielte Überlegungen und Anweisungen zur Diagnostik und Therapie dieser Struktur gibt, muss kritisch gesehen werden. Mit Sicherheit besteht eine gewisse Variationsbreite der Strukturen, die als Lig. gastrophrenicum bezeichnet werden. The gastrophrenic ligament (GPL) is addressed diagnostically and therapeutically in osteopathic textbooks. To evaluate the extent to which the GPL is an entity that can be examined and treated according to osteopathic ideas, information from various medical specialties was gathered on the course, strength, and importance to the stability of the gastric fundus. A literature research via the library of the Westfälische Wilhelms-Universität Münster was carried out as well as in various electronic databases according to the key terms listed below. Temporally, the scope was limited from the beginning of the search to the early 19th century. The GPL enjoys a level of attention in osteopathic considerations that seems to have no equivalent in other disciplines. In anatomical textbooks and illustrations, it is neither constantly mentioned nor uniformly – and then very vaguely – described and illustrated. The preparatory confirmation of the variable „gastric bare area", a serosa-free area on the posterior wall of the stomach, with direct adhesions to the diaphragm help determine the course of the GPL. It not only forms part of the „frame" of this area, but with its connection to the diaphragm, it is also part of a resulting three-dimensional fat-filled space. Whether the GPL is the sole ligament responsible for the positional stability of the fundus must be doubted. The importance given to the GPL in osteopathy, with the consequence that there are specific considerations and instructions for the diagnosis and therapy of this structure, must be viewed critically. There is certainly some variation in the structures that are called the gastrophrenic ligament. [ABSTRACT FROM AUTHOR]

Minimally-invasive surgery is the standard of care in many surgical diseases. Robotic surgery has mitigated nearly all limitations of laparoscopic surgery but with a big cost tag. Surgeon-powered robotic instruments were developed with the concept of providing similar advantages to the robotic platforms but with affordable costs. We report three cases of hernia, one hiatus hernia, and two inguinal hernias managed using surgeon-powered robotics platform. It provides additional maneuverability in minimal invasive surgical dissection and suturing. Surgeon powered robotic surgery may be a cost-effective viable alternative to robotic surgery in developing country like Nepal. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The current surgical approach in the treatment of hiatal hernia with gastroesophageal reflux disease is known as hernioplasty together with antireflux surgical procedures. Among the antireflux surgical treatment procedures, the most applied approach is the laparoscopic Nissen fundoplication. In this study, we aimed to examine the results and effectiveness of laparoscopic Nissen fundoplication and to share our clinical experiences. PATIENTS AND METHODS: Patients who underwent laparoscopic Nissen fundoplication operation between January 2017 and January 2022 in the general surgery clinic of a tertiary healthcare center were included in the study. The clinical data, preoperative, operative, and postoperative findings and results of the cases were investigated. RESULTS: The mean age of the patients was 46.2 ± 14.7 years, and the female/male ratio was 1.5/1. According to the Clavien-Dindo classification system, 9.9% of the patients had grade I, and 18.3% grade II complications. The patients were followed up for a mean of 32.6 ± 14.8 months. During the follow-up, reoperation was planned in 5.6% of the patients due to recurrence. CONCLUSIONS: Laparoscopic Nissen fundoplication is a well-defined technique. It is a safe and effective surgical method with appropriate patient selection. [ABSTRACT FROM AUTHOR]

Background: Hiatal hernias are a common finding in patients who undergo bariatric surgery with an incidence of about 20% of all bariatric patients. Controversy exists on the utility of a biosynthetic tissue matrix (BTM) usage in combination with crural repair. This study was designed to explore the safety and benefits of the use of a BTM during concomitant hiatal hernia repair with bariatric surgical procedures. Methods: This was a retrospective chart review of bariatric surgical patients who underwent a concomitant hiatal hernia repair at a single practice at a tertiary academic medical center from January 2014 to February 2019. Results: A total of 420 patients were reviewed. Hiatal BTM reinforcement, recurrence, and postoperative proton pump inhibitor use were reported by type of operation. Recurrence was higher in gastric bypass patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs. 3.7%, P =.52) and significantly higher in gastric sleeve patients who underwent hiatal hernia repair with suture cruroplasty alone vs. those who also underwent hiatal BTM reinforcement (7.1% vs..5%, P =.01). No patient required reoperation for hiatal hernia recurrence. Discussion: Performing Roux-en-Y gastric bypass or vertical sleeve gastrectomy with concomitant hiatal hernia repair is safe and durable. Employing crural reinforcement with BTM may be of benefit in reducing recurrence rates of hiatal hernia, particularly in sleeve gastrectomy patients. [ABSTRACT FROM AUTHOR]

Background/Aim: 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. Material and Methods: 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. Results: 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). Conclusions: 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. [ABSTRACT FROM AUTHOR]

Objective: Determine the utility of routine esophagograms after hiatus hernia repair and its impact on patient outcomes. Background: Hiatus hernia repairs are common. Early complications such as re-herniation, esophageal obstruction and perforation, although infrequent, incur significant morbidity. Whether routine postoperative esophagograms enable early recognition of these complications, expedite surgical management, reduce reoperative morbidity, and improve functional outcomes are unclear. Methods: Analysis of a prospectively-maintained database of hiatus hernia repairs in 14 hospitals, and review of esophagograms in this cohort. Results: A total of 1829 hiatus hernias were repaired. Of these, 1571 (85.9%) patients underwent a postoperative esophagogram. Overall, 1 in 48 esophagograms resulted in an early (<14 days) reoperation, which was undertaken in 44 (2.4%) patients. Compared to those without an esophagogram, patients who received this test before reoperation (n = 37) had a shorter time to diagnosis (2.4 vs 3.9 days, P = 0.041) and treatment (2.4 vs 4.3 days, P = 0.037) of their complications. This was associated with lower rates of open surgery (10.8% vs 42.9%, P = 0.034), gastric resection (0.0% vs 28.6%, P = 0.022), postoperative morbidity (13.5% vs 85.7%, P < 0.001), unplanned intensive care admission (16.2% vs 85.7%, P < 0.001), and decreased length-of-stay (7.3 vs 18.3 days, P = 0.009). Furthermore, we identified less intraoperative and postoperative complications, and superior functional outcomes at 1-year follow-up in patients who underwent early reoperations for an esophagogram-detected asymptomatic re-herniation than those who needed surgery for late symptomatic recurrences. Conclusions: Postoperative esophagograms decrease the morbidity associated with early and late reoperations, and should be considered for routine use after hiatus hernia surgery. [ABSTRACT FROM AUTHOR]

A 63-year-old male presented to us with upper abdominal pain and odynophagia for 3 months. Contrast-enhanced computed tomography of the abdomen revealed hiatus hernia with ulceroproliferative growth involving the gastro-oesophageal (GE) junction and cardia of the stomach with no obvious transserosal extension. Upper gastrointestinal (GI) endoscopy was suggestive of a tumour of size 3 cm × 3 cm near the GE junction and sliding hiatus hernia. Although there are various ways described in the literature for managing GI stromal tumour (GIST), we opted for laparo-endoscopic transgastric resection with hiatus hernia repair due to obvious advantages in terms of safety and efficacy. Just a handful of cases have been described in the literature being treated in this fashion. The procedure was successfully performed as evidenced by an uneventful recovery of the patient. His histopathology report was suggestive of GIST of size 3.5 cm × 3.0 cm × 2.0 cm. The resected margins were free of the tumour.

Background: Hiatus hernia (HH) contributes to development of gastroesophageal reflux disease, Barrett's esophagus and esophageal adenocarcinoma. This study was aimed to investigate the influence of HH on reflux patterns and distal esophageal mucosal integrity in non‐erosive reflux disease (NERD). Methods: We retrospectively analyzed PPI‐refractory NERD patients referred to three tertiary referral centers who underwent high‐resolution manometry and off‐PPI 24‐h impedance‐pH monitoring (with or without bile spectrophotometry). Patients with HH ≥2 cm (HH group, n = 42) or no HH (non‐HH group, n = 40) with similar esophageal acid exposure time (AET 6%–12%) were included. Key Results: Age, gender, BMI, esophageal motility, AET, and esophageal clearance were similar between the two groups. The HH group had higher numbers of total reflux episodes (p = 0.015) with similar proportion of acid/non‐acid reflux compared with the non‐HH group. Mean nocturnal baseline impedance (MNBI) in the distal esophagus was significantly lower in the HH group than the non‐HH group at both 5 cm (p = 0.002) and 3 cm (p = 0.015) above the lower esophageal sphincter. Multivariable regression analysis showed that HH, less non‐acid reflux and lower post‐reflux swallow‐induced peristaltic wave index (PSPWI) were independently associated with lower MNBI. Among 31 patients tested with bile spectrophotometry, the HH group had significantly longer bile exposure time than the non‐HH group (p = 0.011), and bile reflux inversely and significantly correlated with MNBI (rho = −0.75, p < 0.001). Conclusions and Inferences: Hiatus hernia, less non‐acid reflux and lower PSPWI were associated with lower MNBI. HH impairs distal esophageal mucosal integrity, the mechanism of which we speculate to be through excessive bile reflux. [ABSTRACT FROM AUTHOR]

Background: Pertussis is an infectious disease of the respiratory tract with a changing epidemiology. An increasing incidence has been found in the adult population with recurrent infections possibly related to changes in the current vaccine. Is there an association between pertussis infection, refractory cough and atypical gastro-oesophageal reflux (GORD)? Does this magnify and compound respiratory complications? Methods: Observational study which compares post-pertussis (n=103) with non-pertussis patients (n=105) with established GORD. Patients were assessed for laryngopharyngeal reflux and aspiration of refluxate by a novel scintigraphic study. Results: Both groups showed severe GORD in association with high rates of laryngopharyngeal reflux (LPR) and pulmonary aspiration and lung disease. High rates of hiatus hernia and clinical diagnosis of "atypical" asthma showed correlations with pulmonary aspiration. Conclusions: A high level of new onset LPR and lung aspiration has been shown in patients with chronic cough after recent pertussis infection by a novel scintigraphic technique with fused hybrid x-ray computed tomography (SPECT/CT). [ABSTRACT FROM AUTHOR]

A 63-year-old male presented to us with upper abdominal pain and odynophagia for 3 months. Contrast-enhanced computed tomography of the abdomen revealed hiatus hernia with ulceroproliferative growth involving the gastro-oesophageal (GE) junction and cardia of the stomach with no obvious transserosal extension. Upper gastrointestinal (GI) endoscopy was suggestive of a tumour of size 3 cm x 3 cm near the GE junction and sliding hiatus hernia. Although there are various ways described in the literature for managing GI stromal tumour (GIST), we opted for laparo-endoscopic transgastric resection with hiatus hernia repair due to obvious advantages in terms of safety and efficacy. Just a handful of cases have been described in the literature being treated in this fashion. The procedure was successfully performed as evidenced by an uneventful recovery of the patient. His histopathology report was suggestive of GIST of size 3.5 cm x 3.0 cm x 2.0 cm. The resected margins were free of the tumour. [ABSTRACT FROM AUTHOR]

Background: Imperfect high‐resolution manometry (HRM) studies can impact clinical management of patients with esophageal symptoms. Methods: Esophageal high‐resolution manometry (HRM) studies attempted and/or performed by trained motility operators at a tertiary care center over a 2‐year period were identified. When studies were attempted but not completed, reasons for an imperfect study (critically imperfect = LES not adequately traversed; non‐critically imperfect = diaphragm not traversed), and point of identification (identified by motility nurse vs. identified on physician review) were recorded. Prevalence and clinical predictors of critically and non‐critically imperfect studies were determined. Key Results: Of 962 HRM studies attempted in 951 patients, 33 (3.4%) were critically imperfect (17 curled catheters), and 125 (13.0%) were non‐critically imperfect. A third of critically imperfect studies, and 64.7% of curled catheters had achalasia, while 99.2% of non‐critically imperfect studies had large hiatus hernias. Motility nurses detected 90.9% of critically imperfect and 55.8% of non‐critically imperfect studies in real‐time (p < 0.001). Achalasia independently predicted curled catheters; large hiatus hernias predicted non‐critically imperfect studies (p < 0.001 for each). Compared to technically perfect studies, catheter curling was encountered more often in older patients, catheter intolerance in younger patients, and non‐critically imperfect studies in females (p < 0.001 for each). No critical motor disorder was identified in intolerant patients. Conclusions and Inferences: Achalasia should be suspected when a curled catheter is encountered especially in older patients, while intolerant patients do not have critical motor disorders. Critically imperfect HRM studies are rare when performed by trained motility operators, which are identified in real time and aborted. [ABSTRACT FROM AUTHOR]

Introduction Hiatal hernia (HH) is a condition which refers to the protrusion of an intraabdominal organ in the thorax cavity throughan oesophageal hiatus of the diaphragm. Sliding HH is usually associated with non-specific symptoms, including heartburn, regurgitation or epigastric pain. Importantly, true paraesophageal hernia may lead to cardiac compression. Knowledge of cardiac manifestations of HH is limited. Objective The main aim of the study is to present the rare case of a patient with gastrothorax due to hiatal hernia which caused cardiac arrest, and to provide a literature-based review of the cardiac aspects of hiatal hernia. Brief description of the state of knowledge Patients with paraesophageal hernia may experience arrhythmia, including sinus tachycardia, atrial flutter, atrial fibrillation, supraventricular extrasystole and ventricular tachycardia, as well as left bundle branch block, atrioventricular conduction block and electrocardiographic changes in the ST-segment and T-wave. In echocardiograph, HH may appear as an extracardiac posterior mass encroaching on the left atrial cavity, mimicking the left atrial mass. Rarel, HH may be manifested as tension gastrothorax leading cardiac arrest. In such a case, timely diagnosis and instant adequate treatment of the underlying condition are crucial. Conclusions Hiatal hernia should be considered as a possible cause of arrhythmia and changes in ST-T pattern, particularly if symptoms occurred after a meal. Differential diagnosis of the posterior mediastinal mass or intracardiac mass should include hiatal hernia. Gastrothorax is a rare condition associated with hiatal hernia which may lead to cardiac arrest. However, even timely recognition and therapy of gastrothorax does not ensure a positive clinical outcome.

Background: Long-term dysphagia is a known complication of laparoscopic anti-reflux surgery (LARS). Of the several factors, inadequate hiatal closure is one of the major reasons for its occurrence. The aim of this study is to develop a technique for the quantitative assessment of crural closure during LARS to reduce dysphagia. Materials and Methods: It is an analysis of prospectively collected data of 109 patients who underwent LARS at a tertiary healthcare centre in India. To identify the adequacy of hiatal closure intraoperatively, a 7 French Fogarty catheter was used, and its balloon was inflated with 1 cc air at the repaired hiatus. This inflated balloon in the repaired hiatus following cruroplasty gives an accurate quantitative assessment of the adequate closure and adequate space for food bolus to pass without causing mechanical obstruction after hiatus repair. Pre- and post-operative 12 months' DeMeester scores and lower oesophageal sphincter (LES) pressures were calculated. Results: The patients had a significant reduction in DeMeester scores postoperatively from a mean of 68.5–12.3 (P < 0.0001). None of the patients had long-term dysphagia or the need for long-term proton-pump inhibitors. The mean LES pressures on post-operative manometry showed increase to 15.1 mmHg from a mean of 6.4 mmHg, which was statistically significant (P = 0.0001). None of the patients had a recurrence of hiatus hernia. Conclusion: Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia.

1 Kaplan-Meier estimated recurrence rates by type of revisional procedure for recurrent hiatal hernia (p = 0.09) Discussion This study confirms the safety and efficacy of laparoscopic revisional surgery for recurrent hiatal hernia. Keywords: Hiatus hernia; Recurrent hiatal hernia; Failed fundoplication; Crural repair; Biosynthetic mesh; Collis gastroplasty; GERD-HRQL score EN Hiatus hernia Recurrent hiatal hernia Failed fundoplication Crural repair Biosynthetic mesh Collis gastroplasty GERD-HRQL score 917 920 4 04/22/22 20220401 NES 220401 Introduction The current standard of care in patients with recurrent symptomatic hiatal hernia is revisional cruroplasty and fundoplication [1]. Hiatus hernia, Recurrent hiatal hernia, Failed fundoplication, Crural repair, Collis gastroplasty, Biosynthetic mesh, GERD-HRQL score. [Extracted from the article]

Background: Different surgical variations have been described for laparoscopic crural repair however, the technique is not standardized and left to the surgeons' preference. Objective: The purpose of this study is to describe a standardized "patient tailored" approach for laparoscopic posterior cruroplasty in the setting of elective hiatal hernia repair. Methods: Retrospective single-center study was conducted (November 2015 to November 2019). The technical aspects of a standardized "patient tailored" laparoscopic posterior crural repair are described. Perioperative outcomes and patients' quality of life, measured with the disease specific Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and generic Short Form-36 (SF-36), were analyzed. Results: One hundred and forty-one patients were treated for symptomatic hiatal hernia according to the described "patient tailored" concept. Overall, 102 (72.3%) patients underwent simple suture repair while simple suture repair buttressed with biosynthetic resorbable U shaped mesh [Phasix ST®-Bard] was used in 39 (27.7%) patients. Toupet fundoplication was fashioned in all patients. The median operative time was 131 min (IQR 55–240). No intraoperative complications or conversion to open surgery occurred. The median postoperative stay was 1.8 days (range 1–7). The overall postoperative complication rate was 4.2%. The median follow-up was 21 months (IQR range 1–34) with 102 patients having a minimum follow-up of 6 months. Recurrent hernia was diagnosed in three patients (2.1%), but none required reoperation. No mesh-related complications occurred. Compared to baseline, the median GERD-HRQL (p = 0.003) and all SF-36 items (p < 0.001) were significantly improved. Conclusion: The application of a standardized "patient tailored" concept for laparoscopic posterior cruroplasty seems safe and effective in the medium-term follow-up with promising perioperative outcomes and quality of life improvement. This approach may be valuable to assure procedure reproducibility, standardization, and to uniformly interpret the outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Although upper gastrointestinal series (UGI) series are frequently requested in pediatric radiology department, there are few articles investigating its value in children with vomiting. The purpose of this study was to review imaging findings perceived during UGI series in infants and children presented with vomiting in correlation to their symptoms based on the ACR appropriateness criteria. This was to identify clinical scenarios with higher diagnostic yield. Results A cross-sectional study including UGI series of 76 patients presented with vomiting (1 month–17 years) was performed. Patients were grouped according to their age into 5 groups and stratified according to the type of vomiting into 3 groups (bilious vomiting, new-onset nonbilious vomiting, intermittent nonbilious vomiting since birth). Associated symptoms were described with calculation of a novel clinical score. Radiological abnormalities in different age groups were described in relation to the type of vomiting. All patients with bilious vomiting or nonbilious vomiting associated with melena or dysphagia had abnormal findings. Gastroesophageal reflux was detected in 25% of cases. Patients with normal and abnormal study were compared according to their clinical score. The clinical score was significantly higher in the group of patients with abnormal findings (p < .001). Patients with recurrent chest symptoms and loss of weight had significantly higher rate of abnormal findings. Conclusion UGI series had a higher diagnostic yield in patients with bilious vomiting, children with nonbilious vomiting with higher clinical scores when associated with recurrent chest symptoms, loss of weight, dysphagia, or GIT bleeding especially melena.

The utilization of transthoracic approaches for the repair of large hiatus hernias remains a topic of clinical debate. This study aims to evaluate the efficacy, safety, and recovery metrics for transthoracic hiatal hernia repair. A literature search was conducted using the key terms "hiatus hernia," "thoracotomy," "thoracic approach," and "Belsey Mark IV." The databases searched included MEDLINE, EMBASE, and Web of Science, covering the period from 2000 to June 2024. Extracted data included patient demographics, study design characteristics, length of stay, complication rate, and mortality rate. A total of five citations were selected, comprising a total of 560 patients, of which 164 were male (29.3%), with an overall mean age of 64.9 (pooled SD = 1.93) and a weighted mean follow-up length of 56.4 months (pooled SD = 39.1 months). The weighted overall mean length of stay was 14.5 days (pooled SD = 7.42). The overall rate of minor complications was 19% (95% confidence interval (CI) (6%, 31%)). The overall rate of major complications was 13% (95% CI (6%, 21%)). There were four reported mortalities in total and an overall leak rate of 1% (95% CI (0%, 2%)). Transthoracic approaches have unique benefits and risks in the context of hiatal hernia surgery. Access via thoracotomy is associated with a higher incidence of complications. However, for large or emergent paraesophageal hernias, the transthoracic approach may represent a viable option in select patients., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Abdul et al.)

Background: Gastroesophageal reflux disease (GERD), the most common esophageal disorder worldwide, is a progressive condition that may lead to Barrett's esophagus and adenocarcinoma. Upfront therapy with proton pump inhibitors is ineffective in up to 40% of patients. The scope of surgical therapy is to reconstruct the natural antireflux barrier provided by the diaphragmatic crura, the lower esophageal sphincter, and the gastroesophageal flap valve., Summary: For 70 years, the 360° Nissen fundoplication has dominated the surgical scenario and is still considered the gold-standard treatment. However, over the past two decades, the Toupet and Dor partial fundoplications have emerged as alternative options to decrease the incidence of dysphagia and gas-bloat syndrome. Randomized and observational clinical studies have shown that the outcomes of partial fundoplication compare favorably with those of the Nissen and can provide satisfactory quality of life minimizing the risk of side effects. However, reflux control and anatomical integrity of partial fundoplications may fade away over time. Further research and close scrutiny of new surgical procedures and technologies is in progress to improve clinical outcomes and provide a more personalized and durable antireflux therapy., Key Messages: Laparoscopic antireflux surgery is a safe and effective therapy for GERD. It should be performed in centers offering a comprehensive diagnostic pathway and a spectrum of techniques tailored to the individual GERD phenotype., Competing Interests: The authors have no conflicts of interest to declare., (© 2024 S. Karger AG, Basel.)

In order to extract new inferences to help medical intervention, this paper aims to construct a mathematical model to suitably characterize swallowing in an oesophagus which suffers from sliding hiatus hernia. In such a state of dysfunction of oesophagus, the stomach moves upward through the hiatal orifice; due to which, there is a widening above the hiatus. We make an attempt to mathematical formulate the circumstances created due to herniation, The formulation is in the dimensionless parameters using the long wavelength and low Reynolds number approximations modelling Newtonian flows in tubes, converging and diverging partially, or converging somewhere and diverging somewhere else. The model validates the practical observations and gives some clues of the impact of partial convergence and divergence on pressure distribution. Less pressure is required for flow if the tube diverges but pressure has to be increased if the tube converges. It is further inferred from computer simulation that even if merely the lower part diverges, pressure is affected right from the beginning of flow. In case of sliding hiatal hernia, it is expected, pressure requirement for swallowing will be less due to oesophageal widening near the lower sphincter. It is even an experimental report that hiatus hernia reduces LES pressure. When the oesophagus converges, unlike this, pressure requirement for flow is more. This convergence may be an alarming situation. If hiatus hernia goes unnoticed, it is suspected that the narrowed part is less than the widened part. This inference can also be useful in peristaltically driven engineering applications. [ABSTRACT FROM AUTHOR]

Laparoscopic fundoplication (LF) is considered when medical treatments for gastroesophageal reflux have failed. However, the definition of failure is largely subjective and clinician dependent. Laparoscopy has revolutionized the surgical management of the disease and has become the preferred approach by most surgeons. There are two main laparoscopic anti-reflux fundoplications that are currently performed; the "total wrap" technique, such as a Nissen fundoplication and the modified Nissen-Rossetti fundoplication, and the "partial wrap" technique. However, choosing the optimal fundoplication procedure remains controversial. Laparoscopic Nissen anti-reflux procedure has replaced the open approach to become the standard surgical procedure for the treatment of medical resistant gastro-oesophageal reflux disease (GERD) and hiatus hernia. Complications after laparoscopic fundoplication include hiatal hernia, slipped wrap, recurrent GERD, persistent dysphagia, and gas bloat syndrome. Therefore, this study aimed to review a short term outcomes of laparoscopic Nissen fundoplication as a treatment of GERD and hiatus hernia in children. [ABSTRACT FROM AUTHOR]

Introduction: Outcomes of laparoscopic procedures for gastroesophageal reflux disease (GERD) are variable depending on surgical expertise and/or patient-related factors. Some procedures may be inadequate in patients with severe disease. Effectiveness of laparoscopic magnetic sphincter augmentation (MSA) has not been extensively tested in patients with severe disease.Methods: A prospectively collected database was analyzed to identify patients who underwent MSA at a single institution. Individuals who had previous esophago-gastric surgery were excluded. Severe GERD was defined as lower esophageal sphincter pressure 50. Clinical characteristics and outcomes of patients with severe GERD were compared with those of patients with mild to moderate GERD who served as control group.Results: Over the study period, a total of 336 patients met the inclusion criteria, and 102 (30.4%) had severe GERD. The median follow-up was 24 months (IQR = 75) in severe GERD patients and 32 months (IQR = 84) in those with non-severe GERD. Patients with severe GERD had a higher rate of dysphagia and higher GERD-HRQL scores. After the MSA procedure, symptoms, health-related quality of life scores, and proton-pump inhibitors consumption significantly decreased in both groups (p < 0.05). No difference between groups was found in the prevalence of severe post-operative dysphagia, the need for endoscopic dilation or device removal, and the DeMeester score.Conclusion: Laparoscopic MSA is safe and effective in reducing symptoms, PPI use, and esophageal acid exposure also in patients with severe GERD.

Background: Long-term dysphagia is a known complication of laparoscopic anti-reflux surgery (LARS). Of the several factors, inadequate hiatal closure is one of the major reasons for its occurrence. The aim of this study is to develop a technique for the quantitative assessment of crural closure during LARS to reduce dysphagia. Materials and Methods: It is an analysis of prospectively collected data of 109 patients who underwent LARS at a tertiary healthcare centre in India. To identify the adequacy of hiatal closure intraoperatively, a 7 French Fogarty catheter was used, and its balloon was inflated with 1 cc air at the repaired hiatus. This inflated balloon in the repaired hiatus following cruroplasty gives an accurate quantitative assessment of the adequate closure and adequate space for food bolus to pass without causing mechanical obstruction after hiatus repair. Pre- and post-operative 12 months' DeMeester scores and lower oesophageal sphincter (LES) pressures were calculated. Results: The patients had a significant reduction in DeMeester scores postoperatively from a mean of 68.5-12.3 (P < 0.0001). None of the patients had long-term dysphagia or the need for long-term proton-pump inhibitors. The mean LES pressures on post-operative manometry showed increase to 15.1 mmHg from a mean of 6.4 mmHg, which was statistically significant (P = 0.0001). None of the patients had a recurrence of hiatus hernia. Conclusion: Quantitative assessment of adequacy for crural closure during LARS using a 7 French Fogarty catheter balloon is a novel technique which may decrease the incidence of post-operative dysphagia or intrathoracic wrap migration or recurrence of hiatus hernia. [ABSTRACT FROM AUTHOR]

Background Recurrence after primary hiatal hernia repair is common and ranges between 15 and 60%. Symptomatic patients who are actually in need of redosurgery are ∼5%. Resurgery after the primary repair is usually not easy and is challenging. The reputation of mesh migration and erosion into gastroesophageal junction makes most of the surgeons avoid the use of mesh in hiatal hernia repair. Aim This prospective study aims to compare the efficacy of redolaparoscopic Nissen fundoplication with and without mesh repair for treatment of recurrent hiatus hernia after failed primary repair, regarding improvement of recurrent symptoms, rate of recurrence of hernia after secondary repair, and postoperative patients' satisfaction. Patients and methods This prospective randomized study was conducted on 25 patients who underwent redolaparoscopic Nissen fundoplication for the treatment of recurrent hiatus hernia after a failed primary repair between January 2017 and January 2020 with at least 1-year follow-up at Ain Shams University Hospitals. A total of 12 patients underwent redolaparoscopic Nissen fundoplication (group A), whereas 13 patients underwent the same technique with mesh reinforcement (group B). The outcomes of both techniques were compared regarding the postoperative improvement of recurrent symptoms, postoperative recurrence, and postoperative patients' satisfaction. Results Significant differences in postoperative reflux-associated symptoms were observed in both groups than preoperatively, but with a significant higher score for dysphagia noticed in group B than group A. Anatomical recurrence occurred in three (25%) patients in group A after 12 months with relatively higher regurgitation, heartburn scores, and pH monitoring. Overall, 83.3% of patients in group A and 92.3% in group B were satisfied with their postoperative improved symptoms. Conclusion Mesh reinforcement is associated with less recurrence rate in comparison with redolaparoscopic Nissen fundoplication alone during short-term follow-up, but it is associated with higher incidence of postoperative dysphagia. However, some patients had recurrence after redolaparoscopic Nissen fundoplication without mesh, but their postoperative symptoms were much less compared with the preoperative ones. [ABSTRACT FROM AUTHOR]

Introduction: The anatomy of the esophageal hiatus is altered during esophagogastric surgery with an increased risk of postoperative hiatus hernia (HH). The purpose of this article was to examine the current evidence on the surgical management and outcomes associated with HH after esophagogastric surgery for cancer. Materials and methods: Systematic review and meta-analysis. Web of Science, PubMed, and EMBASE data sets were consulted. Results: Twenty-seven studies were included for a total of 404 patients requiring surgical treatment for HH after esophagogastric surgery. The age of the patients ranged from 35 to 85 years, and the majority were males (82.3%). Abdominal pain, nausea/vomiting, and dyspnea were the commonly reported symptoms. An emergency repair was required in 51.5%, while a minimally invasive repair was performed in 48.5%. Simple suture cruroplasty and mesh reinforced repair were performed in 65% and 35% of patients, respectively. The duration between the index procedure and HH repair ranged from 3 to 144 months, with the majority (67%) occurring within 24 months. The estimated pooled prevalence rates of pulmonary complications, anastomotic leak, overall morbidity, and mortality were 14.1% (95% CI = 8.0–22.0%), 1.4% (95% CI = 0.8–2.2%), 35% (95% CI = 20.0–54.0%), and 5.0% (95% CI = 3.0–8.0%), respectively. The postoperative follow-up ranged from 1 to 110 months (mean = 24) and the pooled prevalence of HH recurrence was 16% (95% CI = 13.0–21.6%). Conclusions: Current evidence reporting data for HH after esophagogastric surgery is narrow. The overall postoperative pulmonary complications, overall morbidity, and mortality are 14%, 35%, and 5%, respectively. Additional studies are required to define indications and treatment algorithm and evaluate the best technique for crural repair at the index operation in an attempt to minimize the risk of HH. [ABSTRACT FROM AUTHOR]