Clinical and computed tomography outcomes after mesh-enforced hiatoplasty and anterior hemi-fundoplication in large hiatal hernia repair.

Background: The surgical technique in large hiatal hernia (HH) repair is controversially discussed and the outcome measures and follow-up schemes are highly heterogeneous. The aim of this study is to assess the true recurrence rate using computed tomography (CT) in patients with standardized large HH repair.

Methods: Prospective single-center study investigating the outcome after dorsal, mesh-enforced large HH repair with anterior fundoplication. Endoscopy was performed after 3 months and clinical follow-up and CT after 12 months.

Results: Between 2012 and 2021, 100 consecutive patients with large HH were operated in the same technique. There were two reoperations within the first 90 days for cephalad migration of the fundoplication. Endoscopic follow-up showed a correct position of the fundoplication and no relevant other pathologies in 99% of patients. Follow-up CT was performed in 100% of patients and revealed 6% of patients with a cephalad slippage, defined as migration of less than 3 cm of the wrap, and 7% of patients with a recurrent hernia. One patient of each group underwent subsequent reoperation due to symptoms. There was no statistical correlation between abnormal radiological findings and clinical outcomes with 69.2% of patients being asymptomatic. Multivariate logistic regression did not show any prognostic factor for an unfavorable radiologic outcome. Ninety-four percent of patients rated their outcomes as excellent or good.

Conclusion: Radiological follow-up after large HH repair using CT allows to detect slippage of the fundoplication wrap and small recurrences. Patients with unfavorable radiological outcomes rarely require operative revision but should be considered for further follow-up.