The Newfound Impact of a Shortened Esophagus for Hiatal Hernia Patients

The Newfound Impact of a Shortened Esophagus for Hiatal Hernia Patients

Hiatal hernias recur after surgery 15% to 50% of the time, says Miguel Burch, MD, chief of Minimally Invasive and GI Surgery at Cedars-Sinai. Though some patients are asymptomatic upon recurrence, others experience a return in symptoms such as reflux, regurgitation or the sensation of waking up during the night choking. To figure out what

Hiatal hernias recur after surgery 15% to 50% of the time, says Miguel Burch, MD, chief of Minimally Invasive and GI Surgery at Cedars-Sinai. Though some patients are asymptomatic upon recurrence, others experience a return in symptoms such as reflux, regurgitation or the sensation of waking up during the night choking.

To figure out what might cause or prevent a recurrence, Burch and a team of researchers launched a study to review the short- and long-term outcomes in patients who have undergone a Collis gastroplasty with fundoplication and hiatal hernia repair. The study included 183 patients who had undergone these procedures and were cared for by four surgeons at Cedars-Sinai between 2002 and 2018.

“We looked at a database of patients who had these procedures and interviewed those who had a Collis gastroplasty,” says Burch. “Then we presented them with a validated questionnaire to determine the impact of their treatment.”

Esophageal length is key to the success of hiatal hernia repair, because when too short, it can act as a rubber band—pulling the stomach back up into the chest, promoting recurrence. The team’s research helped them identify factors that can cause a shortened esophagus, illuminating a path toward longer-term success after repairs.

“The difference between hiatal hernias and others is that it’s an opening in the diaphragm, and we can’t close the hole completely because the esophagus still needs to pass through it,” says Burch. “As the opening widens, the stomach rises through it. To repair it, we pull the stomach back into the abdominal cavity and narrow the opening, but hiatal hernias come back because you use that muscle all the time. You’re using it when you laugh, cry or even just breathe, so there’s a constant strain.”

For years, surgeons have made various attempts to minimize recurrence, primarily through the insertion of mesh. “The problem is that mesh can cause different and more adverse issues for patients over time,” says Burch. “We needed to find a better way to reinforce the closure that avoided introducing foreign bodies.”

Source: https://www.cedars-sinai.org/blog/newfound-impact-for-hiatal-hernia-patients.html

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