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Controversies in Complex Hiatal Hernia A. Daniel Guerrón MD Assistant Professor of Surgery Department of Surgery Division of Metabolic and Weight Loss Surgery Duke University Health System @danguerron

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Page 1: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

ControversiesinComplexHiatalHernia

A.DanielGuerrón MD

AssistantProfessorofSurgeryDepartmentofSurgery

DivisionofMetabolicandWeightLossSurgeryDukeUniversityHealthSystem

@danguerron

Page 2: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

Disclosure

• Gore• Levita• Medtronic

Page 3: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

ControversyAs always, when data are scarce, opinions are strongly held!

Page 4: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,
Page 5: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,
Page 6: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,
Page 7: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

n=108at4Institutions

57primaryrepair:51biologicmesh

PrimaryOutcomerecurrence(>2cm)byUGIat6months

93%followupand90%had6monthUGI

Page 8: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

operativetime- 183minprimary:202biologic

6monthrecurrence- 12primary:4biologic

Page 9: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,
Page 10: Controversies in Complex Hiatal Hernia PEH_Guerron.… · (GPEH) repair in patients with persistent shortened esophagus after laparoscopic mobilization. Concerns remain, however,

NoQualityoflifeDifference

RecurranceRate- 59%primary:54%biologicnostatisticdifference

Nostrictureserosions,dysphagiarelatedtobiologic


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