‘Mesh hiatal hernioplasty’ versus ‘suture cruroplasty’ in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis

Summary: In laparoscopic ‘paraoesophageal hernia’ (POH) repair, non-absorbable suture materials have been used to close the crural defects. More recently, various types of prosthetic mesh have been utilized to repair the defect. We conducted a systematic review with meta-analysis of the recent and up to-date studies incorporating 942 POH repairs. We examined the rates of recurrence, reoperation, and complication rates alongside operative time of these two techniques in the management POH. Randomized controlled trials (RCT) and observational studies comparing mesh hiatal hernioplasty versus Suture cruroplasty for Paraoesophageal hernia were selected by searching Medline, Embase, and Cochrane Central database published between January 1995 and December 2016. Predefined inclusion and exclusion criteria were applied to select the studies. The outcome variables analysed are recurrence of hiatal hernia, reoperation, operative time and complications. Nine studies (RCTs = 4 and Observational studies = 5) were analysed totalling 942 patients (Mesh = 517, Suture cruroplasty = 425). The pooled effect size for recurrence favoured mesh repair over suture cruroplasty (OR 0.48, 95% CI 0.32, 0.73, P < 0.05). But the operation time is significantly less in suture cruroplasty (SMD 15.40, 95% CI 7.92, 22.88, P < 0.0001). Comparable effect sizes were noted for both groups which included reoperation (OR 0.35, 95%CI 0.09, 1.31, P = 0.12) and complication rates (OR 1.30, 95%CI 0.74, 2.29, P = 0.36). Our systematic review and meta-analysis demonstrates that mesh hiatoplasty and suture cruroplasty produce comparable results with regards to reoperation rate and complications following the repair of paraoesophageal hernias (POH). Moreover, the study showed significant reduction of recurrence following mesh hiatoplasty. Keywords: Paraoesophageal, Hiatus hernia, Laparoscopy, Mes

The First International Delphi Consensus Statement on Laparoscopic Gastrointestinal Surgery

Abstract Background: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. Methods: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. Results: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient’s body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥ 10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. Conclusion: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

BACKGROUND: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. METHODS: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. RESULTS: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. CONCLUSION: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery: Laparoscopic GI Surgery Consensus

Background: Laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. Methods: A committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. Results: A consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. Conclusion: Thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes

The first international Delphi consensus statement on Laparoscopic Gastrointestinal surgery

Background: laparoscopic surgery has almost replaced open surgery in many areas of Gastro-Intestinal (GI) surgery. There is currently no published expert consensus statement on the principles of laparoscopic GI surgery. This may have affected the training of new surgeons. This exercise aimed to achieve an expert consensus on important principles of laparoscopic GI surgery. Methods: a committee of 38 international experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a strict modified Delphi protocol. Results: a consensus was achieved on 133 statements after two rounds of voting. All experts agreed on tailoring the first port site to the patient, whereas 84.2% advised avoiding the umbilical area for pneumoperitoneum in patients who had a prior midline laparotomy. Moreover, 86.8% agreed on closing all 15 mm ports irrespective of the patient's body mass index. There was a 100% consensus on using cartridges of appropriate height for stapling, checking the doughnuts after using circular staplers, and keeping the vibrating blade of the ultrasonic energy device in view and away from vascular structures. An 84.2% advised avoiding drain insertion through a ≥10 mm port site as it increases the risk of port-site hernia. There was 94.7% consensus on adding laparoscopic retrieval bags to the operating count and ensuring any surgical specimen left inside for later removal is added to the operating count. Conclusion: thirty-eight experts achieved a consensus on 133 statements concerning various aspects of laparoscopic GI Surgery. Increased awareness of these could facilitate training and improve patient outcomes.</p