title: Outcomes of surgical management of symptomatic large recurrent hiatus hernia.
abstract: OBJECTIVE
  Recurrent hiatus hernia is frequently found in patients undergoing reoperative antireflux surgery. The objective of this study is to report perioperative complications and subjective and objective outcomes for patients who underwent reoperative intervention for symptomatic large recurrent hiatus hernia.
  
  
  METHODS
  Retrospective review of a prospectively maintained database was performed to identify patients with large (≥ 5 cm gastric tissue above the crus) recurrent hiatus hernia who underwent reoperation after failed antireflux surgery. Data for preoperative workup, operative procedure, and postoperative 6-month follow-up were reviewed and analyzed.
  
  
  RESULTS
  Two hundred twenty patients underwent reoperation over a 6-year period. Forty-four patients had large recurrent hiatus hernia; 21 underwent redo fundoplication, while 23 underwent Roux-en-Y (RNY) reconstruction as remedial procedure. Short esophagus was found in 16 cases (6 of 21 redo Collis fundoplications, 10 of 23 RNY reconstructions). There was significant symptom improvement and high degree of satisfaction reported in both groups. However, patients with short esophagus did better with RNY reconstruction compared with redo Collis gastroplasty.
  
  
  CONCLUSIONS
  Repair of large recurrent hiatus hernia is a technically challenging procedure; however, there is high degree of symptom resolution and patient satisfaction. RNY reconstruction might be a better alternative in patients with short esophagus compared with redo Collis gastroplasty.
authors.affiliation: Department of Surgery, Esophageal Center, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE 68131, USA.
authors.forename: Arpad
authors.initials: A
authors.lastname: Juhasz
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sundaram
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.forename: Tommy H
authors.initials: TH
authors.lastname: Lee
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome