Crural tension measurement in laparoscopic anti-reflux surgery
Research type
Research Study
Full title
Crural tension measurement in laparoscopic hiatal hernia and anti-reflux surgery: A prospective observational pilot study
IRAS ID
222971
Contact name
A Martinez-Isla
Contact email
Sponsor organisation
London North West Healthcare NHS Trust
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Laparoscopic hiatal hernia repair is a tried and tested management option for the treatment of symptomatic hiatal hernia. When repairing a hiatal hernia the surgeon must close the hiatal defect (also called cruroplasty) and broadly speaking this can be done by two ways: suture cruroplasty (stitches alone) or mesh cruroplasty (mesh and stitches). One of the tenets of hiatal hernia repair is tension-free hiatal closure. Difficulty achieving tension-free closure with suture cruroplasty and unacceptable high recurrence rates with a laparoscopic approach prompted exploration of mesh reinforcement to improve hiatal closure durability. An important question exists: does mesh cruroplasty reduce recurrence rates when compared to standard suture cruroplasty and does it bring with it other major complications? The most recent evidence suggests that routine use of mesh for hiatal hernia surgery is not advocated and the decision for placement of mesh needs to individualised based on intra-operative findings and the surgeon’s recommendation. Being able to quantify crural tension intra-operatively may provide the surgeon with more information enabling them to further shape the surgical management for individual patients. This could provide the surgeon with an objective rather than purely subjective assessment which could provide more evidence to support a particular hiatal closure (with or without mesh). This study aims to describe a technique for measuring the tension required to close the edges of the hiatal hernia using a stitch through the crural muscle (which is placed as part of the surgical procedure and tension measured prior to tying the knot) and a digital Newton meter. In summary, the benefits for measuring the tension required to close the hernia defect may provide important information relating to the optimal method for crural closure and may also predict recurrence of hiatal hernia or other post-operative complications.
REC name
London - Hampstead Research Ethics Committee
REC reference
17/LO/0567
Date of REC Opinion
13 Apr 2017
REC opinion
Further Information Favourable Opinion