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METANALYSIS OF RECURRENCE AFTER LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA
Author(s) -
Rathore M. A.,
Najfi S. M.,
Mc Muray A. H.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04122_28.x
Subject(s) - medicine , incidence (geometry) , odds ratio , surgery , odds , hernia repair , retrospective cohort study , general surgery , hernia , logistic regression , physics , optics
Recurrence & reflux are two most important remote complications of lap‐PEH repair (concluded by us at a previous USG meeting UK). However the extent of recurrence remains unknown. Aim To determine the true incidence of recurrence of recurrence after lap‐PEH repair. Material & methods A metanalysis was performed. PubMed, Embase, hand search and personal communication were used to access and appraise studies. Inclusion criteria were full‐text papers from 1991 to date describing lap‐PEH repair on >25 pts, at least 6 m follow up and addressing recurrence. ‘Wrap migration’ papers were excluded. Papers were appraised and data was isolated on summary sheets. MS Office Excel 2005 was used to plot results and represented in graphs. Statistics involved calculating odds, 95 ci and alternative scenario. Results 15 studies were eligible (all retrospective). A total of 1132 pts with 100 recurrences were noted. Overall rec rate (in all pts) was 8.8% and was 10.4% if only followed‐up patients (n = 748/1132) were considered. When patients with objective evidence (follow‐up Ba esophagogram) were used (301/1132), ‘true’ rec rate was 25.5% (i.e. 1 in 4 repairs recurred). Learning curve did not appear to be an issue. The studies revealed broad 95 ci and touching the line‐of‐no‐effect thereby increasing the ‘chance factor’. When alternative model was applied, esophageal lengthening (by Collis‐Nissen gastroplasty) revealed a significant protective influence. Conclusion The true incidence of lap‐PEH recurrence is 25.5%. Mandatory (protocol) follow‐up esophagograms at 1 y are essential. Subconsciously, two emphasis points in the repair have emerged – hiatoplasty and (superadded) esophageal lengthening.