Comparison of Early Outcomes of Laparoscopic Floppy Nissen Fundoplication and Laparoscopic Toupet Fundoplication in the Treatment of Type III and IV Hiatal Hernia

Öz

Objective: This study aims to compare the laparoscopic Floppy Nissen fundoplication technique (LFNFT) and the laparoscopic Toupet fundoplication technique (LTFT) used in treating Type III and IV hiatal hernias (HHs). Materials and Methods: This retrospective analysis was conducted after ethical approval. Patients who underwent Type III and IV hiatal hernia surgery were searched between January 2020 and May 2022. Patients who underwent LFNFT and LTFT for hiatal hernia repair were selected. Patients under 18 and patients who were followed up in our clinic after surgery were excluded from the study. The clinical and follow-up differences between the groups were evaluated statistically. Results: Of the 38 patients who met the study criteria, 27 (71.1%) were female. The mean age of all patients was 41.39±14.03 years (21-77). 10 (26.3%) patients had Type 3 HH, and the remaining patients (73.7%) had Type 4 HH. LFNFT was performed on 27 (71.1%) patients, and LTFT on 11 (28.9%). Complications developed in 14 (36.8%) patients in the postoperative follow-up, and the most common difficulty was gas bloating, with a rate of 13.1%. In comparing the groups, LTFT was preferred in the male patients (p=0.005) and younger patients (p<0.0001). In addition, LTFT was a procedure that had a shorter operation room time (p=0.038) and length of hospital stay (p=0.004). However, there was no difference between the two surgery groups among the early period outcomes. Conclusion: The early period outcomes of both techniques were similar. However, LTFT was the technique with a faster operation time and discharge. Therefore, we recommend the LTFT for hiatal hernia repair.

Anahtar Kelimeler

• Hiatal hernia
• Hospital stay
• Nissen operation.

Tip III ve IV Hiatal Fıtık Tedavisinde Laparoskopik Floppy Nissen Fundoplikasyonu ve Laparoskopik Toupet Fundoplikasyonunun Erken Sonuçlarının Karşılaştırılması

Öz

Giriş ve Amaç: Bu çalışmada Tip III ve IV hiatal hernilerin (HH) tedavisinde kullanılan laparoskopik Floppy Nissen fundoplikasyon tekniği (LFNFT) ile laparoskopik Toupet fundoplikasyon tekniği (LTFT) arasında karşılaştırma yapılması amaçlanmıştır. Gereç ve Yöntemler: Bu retrospektif analiz, etik onay alındıktan sonra yapıldı. Ocak 2020 ile Mayıs 2022 tarihleri arasında Tip III ve IV hiatal herni ameliyatı olan hastalar tarandı. Hiatal herni onarımı için LFNFT ve LTFT uygulanan hastalar seçildi. 18 yaş altı hastalar ve ameliyat sonrası kliniğimizde takip edilen hastalar çalışma dışı bırakıldı. Gruplar arasındaki klinik ve takip farklılıkları istatistiksel olarak değerlendirildi. Bulgular: Çalışma kriterlerine uyan 38 hastanın 27'si (%71,1) kadındı. Tüm hastaların yaş ortalaması 41,39±14,03 yıl (21-77) idi. 10 (%26,3) hastada Tip 3 HH, kalan hastalarda (%73,7) Tip 4 HH vardı. 27 (%71,1) hastaya LFNFT, 11'ine (%28,9) LTFT uygulandı. Postoperatif takiplerinde 14 (%36,8) hastada komplikasyon gelişti ve en sık karşılaşılan güçlük %13,1 ile gaz şişkinliği idi. Gruplar karşılaştırıldığında erkek hastalarda (p=0,005) ve genç hastalarda (p<0,0001) LTFT tercih edildi. Ayrıca LTFT, ameliyathane süresi (p=0,038) ve hastanede kalış süresi (p=0,004) daha kısa olan bir işlemdir. Ancak erken dönem sonuçlarında iki ameliyat grubu arasında fark yoktu. Sonuç: Her iki tekniğin erken dönem sonuçları benzerdi. Ancak LTFT, daha hızlı operasyon süresi ve taburculuk süresi olan teknikti. Bu nedenle hiatal herni onarımı için LTFT'ni öneriyoruz.

Anahtar Kelimeler

• Hiatal herni
• Hastanede kalış
• Nissen operasyonu.

Kaynakça

1. Turgut, A, Kahramanca, Ş, Yıldırım, A.C, Yağmurdur, M.C. Gastro özefageal reflü hastalığı (GÖRH) cerrahisinde yaşam kalitesine etki eden preoperatif faktörler, Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi, 2017, 31(1), 19-24.
2. Bilgi, Z, Batırel, H.F, Hiatal herniler, Bulletin of Thoracic Surgery, 2013, 4(4), 253-8.
3. Smith, R.E, Shahjehan, R.D, Hiatal Hernia, In: StatPearls [Internet], Treasure Island (FL): StatPearls Publishing; 2022 Jan 14 (Access Time: June 6, 2022).
4. Watson, T.J, Moritz, T, Sliding Hernia, 2017, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 2022 May 7 (Access Time: June 6, 2022).
5. Kamolz, T, Granderath, F, Bammer, T, Wykypiel, Jr H, Pointner, R,“Floppy” Nissen vs. Toupet laparoscopic fundoplication: quality of life assessment in a 5-year follow-up (part 2), Endoscopy, 2002, 34(11), 917-22.
6. Danilova, D, Bazaev, A, Gorbunova, L, Current aspects of surgical treatment of gastro-oesophagal reflux disease, Khirurgiia, 2020(2), 89-94.
7. Hu, Y, Ezekian, B, Wells, K.M, Burks, S.G, Jones, D.R, Lau, C.L, et al., Long-term satisfaction and medication dependence after antireflux surgery, Annals of Thoracic Surgery, 2013, 96(4), 1246-51.
8. Broeders, J.A, Mauritz, F.A, Ahmed Ali, U, Draaisma, W.A, Ruurda, J.P, Gooszen, HG, et al., Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease, British Journal of Surgery, 2010, 97(9), 1318-30.

9. Wang, B, Zhang, W, Liu, S, Du, Z, Shan, C, Qiu, M, A Chinese randomized prospective trial of floppy Nissen and Toupet fundoplication for gastroesophageal disease, International Journal of Surgery, 2015, 23, 35-40.
10. Koch, O.O, Kaindlstorfer, A, Antoniou, S.A, Luketina, R.R, Emmanuel, K, Pointner, R, Comparison of results from a randomized trial 1 year after laparoscopic Nissen and Toupet fundoplications, Surgical Endoscopy, 2013, 27(7), 2383-90.
11. Tian, Z.C, Wang, B, Shan, C.X, Zhang, W, Jiang, D.Z, Qiu, M.A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease, PLoS One, 2015 ,10(6), e0127627.
12. Toydemir, T, Tekin, K, Yerdel, M.A, Laparoscopic Nissen versus Toupet fundoplication: Assessment of operative outcomes, Journal of Laparoendoscopic & Advanced Surgical Techniques, 2011, 21(8), 669-76.
13. Erenoğlu, C, Miller, A, Schirmer, B, Laparoscopic Toupet versus Nissen fundoplication for the treatment of gastroesophageal reflux disease, International Surgery, 2003, 88(4), 219-25.
14. Varin, O, Velstra, B, De Sutter, S, Ceelen, W, Total vs partial fundoplication in the treatment of gastroesophageal reflux disease: a meta-analysis, The Archives of Surgery, 2009, 144(3), 273-8.