title: Distal antral gastropexy - a novel technique to prevent recurrence of giant hiatus hernia in selected cases - a cohort study.
abstract: BACKGROUND
  The recurrence rate of giant hiatus hernias (GHH) following repair is high (30%) and increases with the hernia size and previous revision surgery. The mechanism of recurrence is poorly understood.
  
  
  METHODS
  This is a retrospective cohort study of all consecutive patients who underwent repair of giant hiatus hernia in a tertiary upper GI referral centre from November 2000 to November 2014. Patients who underwent redo surgery were identified and data on intra-operative findings and procedure performed at primary and redo surgery from their operation notes were collected.
  
  
  RESULTS
  A total of 81 patients underwent primary repair of GHH over the 14 year study period. 10 (12.3%) had symptomatic/radiological recurrence of which 4 were found to have the distal stomach herniating into the chest despite having an intact intra-abdominal wrap/gastropexy. To prevent migration of the distal stomach into the chest, distal gastropexy - fixing the antrum to the anterior abdominal wall, was added to 'conventional' gastropexy in 5 subsequent cases, in whom the antrum was in the chest preoperatively. These cases have no evidence of recurrence at the end of 6 months follow up.
  
  
  CONCLUSIONS
  Securing the antrum of stomach to the anterior abdominal wall may prevent migration of the distal stomach and other infracolic organs into the chest and thus reduce recurrence of some GHH where antrum had been in chest previously.
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors: Y L
authors: YL
authors: Goh
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors: V
authors: V
authors: Chu
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors: A
authors: A
authors: Tokala
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors: V D
authors: VD
authors: Shetty
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom.
authors: J B
authors: JB
authors: Ward
authors: Department of Upper GI Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom. Electronic address: ravidate@hotmail.com.
authors: R S
authors: RS
authors: Date
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D059485:Gastropexy / Q000379:methods*; D006551:Hernia, Hiatal / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011706:Pyloric Antrum / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Novel technique; Recurrent giant hiatus hernia