Page 22 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Clinical Profile and Laparoscopic Management

of Hiatus Hernia: In a Tertiary Care Center

2
1
3
Akanksha Talwar , Sunil Krishna , Pavan Madhukar Bhat , Vivek Ramesh Udupi 4
Received on: 04 April 2023; Accepted on: 12 July 2023; Published on: 05 September 2023
AbstrAct
Aim: This study will be useful in evaluating the clinical profile of patients and to assess the outcome of laparoscopic and medical management
of gastroesophageal reflux disease (GERD) with hiatus hernia.
Materials and methods: We retrospectively analyzed patients who were diagnosed with GERD and hiatus hernia over a period of 4 years and
looked for outcomes of laparoscopic fundoplication.
Results: A total number of 30 cases between January 2018 and December 2021 were included in this retrospective study with male-to-female
ratio of 2:1. Most patients with GERD present with abdominal pain which is localized to the epigastric region. About 72.1% (p-value = < 0.005)
of patients had mainly reflux symptoms such as epigastric pain, heartburn, or regurgitation, of which, epigastric pain was the most common
(68%). In our study, the most common investigation performed was upper gastrointestinal endoscopy which was able to highlight an underlying
pathology in terms of hiatal hernia in 38.5% (p-value = 0.019) patients. Proton pump inhibitors were used more frequently in patients and outcome
of medical management varied. Laparoscopic fundoplication is the standard surgical treatment for GERD and has very low complication rates.
On routine follow-up of all patients treated surgically for GERD, 67% (p-value = 0.007) had complete symptomatic relief in contrast to medical
management, wherein only 22% of patients had long-term symptomatic relief.
Conclusion: Laparoscopic total fundoplication is fast being adopted as the surgical gold standard for the treatment of GERD after appropriate
trial of medical management among the population presenting in an Indian tertiary care hospital.
Clinical significance: The study results would improve treatment outcomes in patients with hiatus hernia.
Keywords: Gastroesophageal reflux disease, Hiatus hernia, Laparoscopic fundoplication, Proton pump inhibitors, Retrospective comparative
study, Upper gastrointestinal endoscopy.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1560

IntroductIon 1–4 Department of General Surgery, Kasturba Medical College, Manipal
Hiatal hernia refers to the displacement of abdominal organs, University, MAHE, Udupi, Karnataka, India
most commonly the stomach, through the esophageal hiatus of Corresponding Author: Akanksha Talwar, Department of General
the diaphragm into the mediastinum. The prevalence of hiatal Surgery, Kasturba Medical College, Manipal University, MAHE, Udupi,
hernia increases with age and is present in over 50% of the aged Karnataka, India, Phone: +91 9810049040, e-mail: akankshatalwar97@
1
population. Gastroesophageal reflux disease (GERD) is a motility gmail.com
disorder characterized primarily by heartburn and caused by the How to cite this article: Talwar A, Krishna S, Bhat PM, et al. Clinical
reflux of gastric contents into the esophagus. Most cases can be Profile and Laparoscopic Management of Hiatus Hernia: In a Tertiary
diagnosed on the basis of clinical history; diagnosis can generally Care Center. World J Lap Surg 2023;16(1):21–24.

be made with reasonable certainty if the patient complains of Source of support: Nil
2
heartburn and regurgitation of gastric contents. Clinicians should Conflict of interest: None
develop a care plan for the investigation of symptoms suggestive
of GERD, selection of therapy (with an explanation of potential
risks and benefits), and long-term management, including possible • Assess the outcome of laparoscopic management of GERD with
3
de-escalation, in a shared decision-making model with the patient. hiatus hernia.
Total fundoplication (TF) is an effective treatment for patients with • Know the outcome of medical management of GERD with hiatus
GERD symptoms, particularly in those with persistent regurgitation hernia.
despite proton pump inhibitor (PPI) therapy, based on evaluation
6 months after the procedure. 4 MAterIAls And Methods
This study was a hospital-based retrospective study wherein we
objectIves compiled data from all the patients who were diagnosed with
GERD and hiatus hernia between January 1, 2018 and December 31,
This study will be immensely useful in evaluating further the 2021. The data consisted of the patient demographics, their clinical
outcome of laparoscopic surgery in tertiary care centers. In this symptoms, investigations for diagnosis, treatment, and follow-up
context, our goal is to:
records until 6 months after their surgical/medical management.
• Evaluate the clinical profile of patients with GERD with hiatus These data entries were obtained from the patient records using
hernia. electronic medical record and collected using Microsoft Excel.

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.