A comparison between Belsey Mark IV and laparoscopic Nissen fundoplication in patients with large paraesophageal hernia

Danuel V. Laan, John Agzarian, William S. Harmsen, K. Robert Shen, Shanda H. Blackmon, Francis C. Nichols, Stephen D. Cassivi, Dennis A Wigle, Mark S. Allen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: Laparoscopic Nissen fundoplication is the most commonly performed operation for the repair of large hiatal hernias. We compared outcomes between the Belsey Mark IV fundoplication and the laparoscopic Nissen fundoplication. Methods: A retrospective review was performed over a 10-year period on patients who had repair of large paraesophageal hernia. Patients who received the Belsey Mark IV (n = 118) were matched 1 to 1, by year of surgery, gender, and age, with patients who received laparoscopic Nissen fundoplication. We compared these 2 groups, examining recurrence, need for reoperation, perioperative outcomes, and symptomatic follow-up as defined by the Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire. Results: Recurrence rates were similar between patients who had a Belsey Mark IV and laparoscopic Nissen fundoplication (8.4% vs 16.1%, P = .11). However, the esophageal leak rate was higher in patients who received a laparoscopic Nissen fundoplication compared with the Belsey Mark IV (6.8% vs 0%, respectively, P = .006), and patients who received a laparoscopic Nissen fundoplication had higher rates of reoperation (9.3% vs 2.5%, respectively, P = .05). Gastroesophageal Reflux Disease-Health Related Quality of Life symptom scores were similar between groups with symptoms in laparoscopic Nissen fundoplication and Belsey Mark IV, being excellent (74.4% vs 81.4%), good (9.3% vs 7.0%), fair (9.3% vs 0), and poor (7.0% vs 11.6%), respectively (P = .52). Conclusions: Laparoscopic Nissen fundoplication for large paraesophageal hernias was associated with an increased incidence of leak and reoperation when compared with Belsey fundoplication. Belsey Mark IV fundoplication should be considered when deciding on what operation to perform in patients with large paraesophageal hernias.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Fundoplication
Hiatal Hernia
Reoperation
Gastroesophageal Reflux
Quality of Life
Recurrence

Keywords

  • Belsey Mark IV
  • Laparoscopic Nissen fundoplication
  • Paraesophageal hernia

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

A comparison between Belsey Mark IV and laparoscopic Nissen fundoplication in patients with large paraesophageal hernia. / Laan, Danuel V.; Agzarian, John; Harmsen, William S.; Shen, K. Robert; Blackmon, Shanda H.; Nichols, Francis C.; Cassivi, Stephen D.; Wigle, Dennis A; Allen, Mark S.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Laan, Danuel V. ; Agzarian, John ; Harmsen, William S. ; Shen, K. Robert ; Blackmon, Shanda H. ; Nichols, Francis C. ; Cassivi, Stephen D. ; Wigle, Dennis A ; Allen, Mark S. / A comparison between Belsey Mark IV and laparoscopic Nissen fundoplication in patients with large paraesophageal hernia. In: Journal of Thoracic and Cardiovascular Surgery. 2018.
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abstract = "Objectives: Laparoscopic Nissen fundoplication is the most commonly performed operation for the repair of large hiatal hernias. We compared outcomes between the Belsey Mark IV fundoplication and the laparoscopic Nissen fundoplication. Methods: A retrospective review was performed over a 10-year period on patients who had repair of large paraesophageal hernia. Patients who received the Belsey Mark IV (n = 118) were matched 1 to 1, by year of surgery, gender, and age, with patients who received laparoscopic Nissen fundoplication. We compared these 2 groups, examining recurrence, need for reoperation, perioperative outcomes, and symptomatic follow-up as defined by the Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire. Results: Recurrence rates were similar between patients who had a Belsey Mark IV and laparoscopic Nissen fundoplication (8.4{\%} vs 16.1{\%}, P = .11). However, the esophageal leak rate was higher in patients who received a laparoscopic Nissen fundoplication compared with the Belsey Mark IV (6.8{\%} vs 0{\%}, respectively, P = .006), and patients who received a laparoscopic Nissen fundoplication had higher rates of reoperation (9.3{\%} vs 2.5{\%}, respectively, P = .05). Gastroesophageal Reflux Disease-Health Related Quality of Life symptom scores were similar between groups with symptoms in laparoscopic Nissen fundoplication and Belsey Mark IV, being excellent (74.4{\%} vs 81.4{\%}), good (9.3{\%} vs 7.0{\%}), fair (9.3{\%} vs 0), and poor (7.0{\%} vs 11.6{\%}), respectively (P = .52). Conclusions: Laparoscopic Nissen fundoplication for large paraesophageal hernias was associated with an increased incidence of leak and reoperation when compared with Belsey fundoplication. Belsey Mark IV fundoplication should be considered when deciding on what operation to perform in patients with large paraesophageal hernias.",
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AU - Agzarian, John

AU - Harmsen, William S.

AU - Shen, K. Robert

AU - Blackmon, Shanda H.

AU - Nichols, Francis C.

AU - Cassivi, Stephen D.

AU - Wigle, Dennis A

AU - Allen, Mark S.

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N2 - Objectives: Laparoscopic Nissen fundoplication is the most commonly performed operation for the repair of large hiatal hernias. We compared outcomes between the Belsey Mark IV fundoplication and the laparoscopic Nissen fundoplication. Methods: A retrospective review was performed over a 10-year period on patients who had repair of large paraesophageal hernia. Patients who received the Belsey Mark IV (n = 118) were matched 1 to 1, by year of surgery, gender, and age, with patients who received laparoscopic Nissen fundoplication. We compared these 2 groups, examining recurrence, need for reoperation, perioperative outcomes, and symptomatic follow-up as defined by the Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire. Results: Recurrence rates were similar between patients who had a Belsey Mark IV and laparoscopic Nissen fundoplication (8.4% vs 16.1%, P = .11). However, the esophageal leak rate was higher in patients who received a laparoscopic Nissen fundoplication compared with the Belsey Mark IV (6.8% vs 0%, respectively, P = .006), and patients who received a laparoscopic Nissen fundoplication had higher rates of reoperation (9.3% vs 2.5%, respectively, P = .05). Gastroesophageal Reflux Disease-Health Related Quality of Life symptom scores were similar between groups with symptoms in laparoscopic Nissen fundoplication and Belsey Mark IV, being excellent (74.4% vs 81.4%), good (9.3% vs 7.0%), fair (9.3% vs 0), and poor (7.0% vs 11.6%), respectively (P = .52). Conclusions: Laparoscopic Nissen fundoplication for large paraesophageal hernias was associated with an increased incidence of leak and reoperation when compared with Belsey fundoplication. Belsey Mark IV fundoplication should be considered when deciding on what operation to perform in patients with large paraesophageal hernias.

AB - Objectives: Laparoscopic Nissen fundoplication is the most commonly performed operation for the repair of large hiatal hernias. We compared outcomes between the Belsey Mark IV fundoplication and the laparoscopic Nissen fundoplication. Methods: A retrospective review was performed over a 10-year period on patients who had repair of large paraesophageal hernia. Patients who received the Belsey Mark IV (n = 118) were matched 1 to 1, by year of surgery, gender, and age, with patients who received laparoscopic Nissen fundoplication. We compared these 2 groups, examining recurrence, need for reoperation, perioperative outcomes, and symptomatic follow-up as defined by the Gastroesophageal Reflux Disease-Health Related Quality of Life questionnaire. Results: Recurrence rates were similar between patients who had a Belsey Mark IV and laparoscopic Nissen fundoplication (8.4% vs 16.1%, P = .11). However, the esophageal leak rate was higher in patients who received a laparoscopic Nissen fundoplication compared with the Belsey Mark IV (6.8% vs 0%, respectively, P = .006), and patients who received a laparoscopic Nissen fundoplication had higher rates of reoperation (9.3% vs 2.5%, respectively, P = .05). Gastroesophageal Reflux Disease-Health Related Quality of Life symptom scores were similar between groups with symptoms in laparoscopic Nissen fundoplication and Belsey Mark IV, being excellent (74.4% vs 81.4%), good (9.3% vs 7.0%), fair (9.3% vs 0), and poor (7.0% vs 11.6%), respectively (P = .52). Conclusions: Laparoscopic Nissen fundoplication for large paraesophageal hernias was associated with an increased incidence of leak and reoperation when compared with Belsey fundoplication. Belsey Mark IV fundoplication should be considered when deciding on what operation to perform in patients with large paraesophageal hernias.

KW - Belsey Mark IV

KW - Laparoscopic Nissen fundoplication

KW - Paraesophageal hernia

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