Lalin Navaratne1,2, Hutan Ashrafian3, Alberto Martínez-Isla4,3. 1. Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, London, HA1 3UJ, UK. lalin.navaratne@doctors.org.uk. 2. , 3 Auriol Mansions, Edith Road, Kensington, London, W14 0ST, UK. lalin.navaratne@doctors.org.uk. 3. Department of Surgery and Cancer, Imperial College London, QEQM Building, St Mary's Hospital, Praed Street, London, W2 1NY, UK. 4. Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, London, HA1 3UJ, UK.
Abstract
BACKGROUND: A similar technique to measure crural closure tension has not been described before and with this method there is now a possibility to optimise this operation with objective measures, a hundred years after it was first described. The aims of this study were to develop a reliable method for measuring the tension of crural closure during hiatal hernia repair and to describe the tension characteristics of crural closure. METHODS: 50 patients underwent crural tension measurement. Hiatal surface area (HSA) was measured intraoperatively and a Sauter FH 50 Universal Digital Force Gauge was used to measure the tension of crural closure during cruroplasty. Outcome measures included the mean tension of the crural closure and the presence of any muscle splitting during the cruroplasty. RESULTS: A combined total of 148 interrupted cruroplasty sutures were performed in all fifty patients. Each interrupted suture had three tension measurements recorded. The mean standard deviation amongst 148 sets of tension measurements was 0.27. Age, hiatal width and HSA were positively correlated with crural tension with r values of 0.44 (p = 0.0015), 0.81 (p < 0.0001) and 0.78 (p < 0.0001), respectively. Strength of association was low for age (r2 = 0.19) but moderate for hiatal width and HSA (r2 = 0.65 and 0.61, respectively). The presence of muscle splitting occurred at higher crural closure tension (5.3 N vs. 1.62 N, p < 0.0001). The lowest observed mean crural closure tension causing muscle splitting was 3.52 N (IQR 3.93-6.77 N). CONCLUSIONS: We have developed a technique for measuring the tension of crural closure during laparoscopic repair of hiatal hernia which is reproducible, quick, of low cost and requires only minimal additional equipment. Initial findings suggest that crural closure tension up to ~ 4 N could be the permissible tension threshold for suture cruroplasty and higher tension often results in muscle splitting during cruroplasty.
BACKGROUND: A similar technique to measure crural closure tension has not been described before and with this method there is now a possibility to optimise this operation with objective measures, a hundred years after it was first described. The aims of this study were to develop a reliable method for measuring the tension of crural closure during hiatal hernia repair and to describe the tension characteristics of crural closure. METHODS: 50 patients underwent crural tension measurement. Hiatal surface area (HSA) was measured intraoperatively and a Sauter FH 50 Universal Digital Force Gauge was used to measure the tension of crural closure during cruroplasty. Outcome measures included the mean tension of the crural closure and the presence of any muscle splitting during the cruroplasty. RESULTS: A combined total of 148 interrupted cruroplasty sutures were performed in all fifty patients. Each interrupted suture had three tension measurements recorded. The mean standard deviation amongst 148 sets of tension measurements was 0.27. Age, hiatal width and HSA were positively correlated with crural tension with r values of 0.44 (p = 0.0015), 0.81 (p < 0.0001) and 0.78 (p < 0.0001), respectively. Strength of association was low for age (r2 = 0.19) but moderate for hiatal width and HSA (r2 = 0.65 and 0.61, respectively). The presence of muscle splitting occurred at higher crural closure tension (5.3 N vs. 1.62 N, p < 0.0001). The lowest observed mean crural closure tension causing muscle splitting was 3.52 N (IQR 3.93-6.77 N). CONCLUSIONS: We have developed a technique for measuring the tension of crural closure during laparoscopic repair of hiatal hernia which is reproducible, quick, of low cost and requires only minimal additional equipment. Initial findings suggest that crural closure tension up to ~ 4 N could be the permissible tension threshold for suture cruroplasty and higher tension often results in muscle splitting during cruroplasty.
Authors: Brant K Oelschlager; Carlos A Pellegrini; John G Hunter; Michael L Brunt; Nathaniel J Soper; Brett C Sheppard; Nayak L Polissar; Moni B Neradilek; Lee M Mitsumori; Charles A Rohrmann; Lee L Swanstrom Journal: J Am Coll Surg Date: 2011-06-29 Impact factor: 6.113
Authors: T L Trus; T Bax; W S Richardson; G D Branum; S J Mauren; L L Swanstrom; J G Hunter Journal: J Gastrointest Surg Date: 1997 May-Jun Impact factor: 3.452
Authors: Daniel Davila Bradley; Brian E Louie; Alexander S Farivar; Candice L Wilshire; Peter U Baik; Ralph W Aye Journal: Surg Endosc Date: 2014-07-24 Impact factor: 4.584