Our Summary

The researchers in this study looked at two different ways of treating a type of health condition called a hiatal hernia, often seen in patients with a digestive disorder called gastroesophageal reflux disease (GERD). GERD is a pricey problem for the United States, costing a total of $12.3 billion each year.

The two treatments compared were a new method called a hybrid repair, which combines a hiatal hernia repair with a procedure called transoral incisionless fundoplication (TIF), versus the conventional repair method which is a hiatal hernia repair with a surgical procedure called fundoplication.

The researchers looked at the medical records of 112 patients who had a robot-assisted laparoscopic hiatal hernia repair performed by the same surgeon at a community hospital. They found that the new hybrid repair method wasn’t better than the conventional method for short-term results or symptom relief.

They also found no significant difference between the two methods when looking at complications within the first 30 days after surgery, emergency room visits, or hospital admissions. There was also no significant difference in symptoms in patients who were checked up on later.

So, the conclusion is, in the short term, the new hybrid repair method doesn’t seem to be better than the conventional repair method. Therefore, the conventional method remains the standard treatment until more data is available on long-term results from the new hybrid approach.

FAQs

  1. What is the difference between hybrid repair and conventional repair for hiatal hernia?
  2. Is the hybrid repair of hiatal hernia superior to conventional repair in terms of short-term functional outcomes and symptom relief?
  3. What is the current standard of care for hiatal hernia repair according to this study?

Doctor’s Tip

A doctor may advise a patient undergoing hiatal hernia repair to follow a post-operative care plan that includes:

  • Avoiding heavy lifting or strenuous activities for a certain period of time
  • Following a diet plan that includes smaller, more frequent meals to prevent acid reflux
  • Taking prescribed medications as directed to manage symptoms and aid in healing
  • Attending follow-up appointments to monitor recovery progress and address any concerns
  • Engaging in light exercise to promote healing and overall health

By following these recommendations, the patient can optimize their recovery and reduce the risk of complications.

Suitable For

Patients who are typically recommended for hiatal hernia repair are those who have symptoms of GERD, such as heartburn, regurgitation, chest pain, and difficulty swallowing. These patients may also have a hiatal hernia that is causing or exacerbating their symptoms. Additionally, patients with complications of hiatal hernias, such as Barrett’s esophagus or esophagitis, may also be recommended for repair. The decision to undergo repair is usually made based on the severity of symptoms and the impact on quality of life.

Timeline

Before hiatal hernia repair:

  1. Patient experiences symptoms of gastroesophageal reflux disease (GERD) such as heartburn, regurgitation, chest pain, and difficulty swallowing.
  2. Patient undergoes diagnostic tests such as endoscopy, pH monitoring, and imaging studies to confirm the presence of a hiatal hernia.
  3. Patient may be prescribed medications to manage GERD symptoms, such as proton pump inhibitors or H2 blockers.

After hiatal hernia repair:

  1. Patient undergoes surgery to repair the hiatal hernia, either through a conventional surgical fundoplication or a transoral incisionless fundoplication (hybrid repair).
  2. Patient experiences postoperative recovery, including pain management, diet modification, and activity restrictions.
  3. Patient may experience symptom relief from GERD, such as reduced heartburn and regurgitation.
  4. Patient follows up with healthcare provider for postoperative care and monitoring of symptoms.
  5. Long-term outcomes of the hiatal hernia repair, such as recurrence of symptoms or need for further interventions, are monitored over time.

What to Ask Your Doctor

  1. What is the difference between hybrid repair (TIF) and conventional repair for hiatal hernia?
  2. What are the potential risks and complications associated with hiatal hernia repair surgery?
  3. How long is the recovery time after hiatal hernia repair surgery?
  4. Will I need to make any lifestyle changes after the surgery to prevent hiatal hernia recurrence?
  5. What is the success rate of hiatal hernia repair surgery in relieving symptoms of GERD?
  6. How long do the results of hiatal hernia repair surgery typically last?
  7. Are there any alternative treatments or procedures for hiatal hernia that I should consider?
  8. Will I need to follow up with the surgeon or a gastroenterologist after the surgery?
  9. How experienced is the surgeon in performing hiatal hernia repair surgeries?
  10. Are there any specific dietary restrictions or recommendations I should follow before or after the surgery?

Reference

Authors: Satoskar S, Kashyap S, Chang A, Ziehm J, Benavides F, Obisesan A, Livert D, Rohondia S, Kashyap M, Singhal V. Journal: J Robot Surg. 2023 Feb;17(1):197-203. doi: 10.1007/s11701-022-01424-7. Epub 2022 May 22. PMID: 35599278