World Journal of Laparoscopic Surgery

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VOLUME 14 , ISSUE 3 ( September-December, 2021 ) > List of Articles

RESEARCH ARTICLE

Laparoscopic Management of Hiatus Hernia

Mela Ram Attri, Irfan N Mir, Irshad Ahmad Kumar

Citation Information : Attri MR, Mir IN, Kumar IA. Laparoscopic Management of Hiatus Hernia. World J Lap Surg 2021; 14 (3):208-211.

DOI: 10.5005/jp-journals-10033-1474

License: CC BY-NC 4.0

Published Online: 05-03-2022

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

Introduction: Hiatus hernia is axial type of hernia occurring at the esophageal opening of diaphragm. Large hiatal hernias have increased risk for severe complications that can include gastric strangulation, bleeding, and perforation. This study presents our technique and results of laparoscopic management of hiatus hernia. Materials and methods: This study was done retrospectively on 42 patients from data over a period of last 10 years (April 2010–March 2020) in a tertiary care hospital. Results: Total number of patients included in our study were 42. The range of age and the mean age of patients were 22–60 years and 38.36 (SD 8.018), respectively. Heartburn (32, 76.19%) was the most common symptom. Nissen's fundoplication was our primary choice performed in 37 (88.1%) patients. Few of our patients were comorbid and frail to whom Toupet's repair (4, 9.52%) and gastropexy (1, 2.3%) were performed, optimum to their conditions. Out of 42, mesh was placed in 17 (40.48%) patients including all the type IV and few of the type III patients. The mean operative time, mean blood loss, and hospital stay were126.90 (SD 12.781 minutes), 62.14 (SD 17.605 mL), and 4.60 (SD 1.127 days), respectively. Two patients were converted to open procedure. Recurrence occurred in three (7.1%) patients of type III hernia in whom only fundoplication was done without mesh placement. Conclusion: This study concluded that laparoscopic management of hiatus hernia is a feasible and safe option, with a very low morbidity and mortality rate.


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  1. Skinner D, Belsey R. Surgical management of esophageal reflux and hiatus hernia. J Thorac Cardiovasc Surg 1967;53(1):33–54. PMID: 5333620.
  2. Treacy PJ, Jamieson GG. An approach to the management of paraoesophageal hiatus hernias. Aust NZ J Surg 1987;57(11):813–817. DOI: 10.1111/j.1445-2197.1987.tb01271.x.
  3. Mercer CD, Velasco N, Hill LD. Paraesophageal hernia. In: Hill L, Kozarek R, McCallum R, Mercer CD, editors. The esophagus: medical and surgical management. Philadelphia: WB Saunders; 1998. p. 148–156.
  4. Pearson FG, Cooper JD, Ilves R, et al. Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg 1983;35(1):45–51. DOI: 10.1016/s0003-4975(10)61430-0.
  5. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg 2005;241(1):185–193. DOI: 10.1097/01.sla.0000149430.83220.7f.
  6. Cuschieri A, Shimi S, Nathanson LK. Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 1992;163(4):425–430. DOI: 10.1016/0002-9610(92)90046-t.
  7. Nissen R. A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr 1956;86(Suppl. 20):590–592. PMID: 13337262.
  8. DeMeester TR, Bonavina L, Albertucci M. Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 1986;204(1):9–20. DOI: 10.1097/00000658-198607000-00002.
  9. Donahue PE, Samelson S, Nyhus LM, et al. The floppy Nissen fundoplication. Effective long-term control of pathologic reflux. Arch Surg 1985;120(6):663–668. DOI: 10.1001/archsurg.1985.01390300013002.
  10. Martin IG, Holdsworth PJ, Asker B, et al. Laparoscopic cholecystectomy as a routine procedure for gallstones: results of an “allcomers” policy. Br J Surg 1992;79:807–810. DOI: 10.1002/bjs.1800790833.
  11. Oleynikov D, Jolley JM. Paraesophageal hernia. Surg Clin North Am 2015;95(3):555–565. DOI: 10.1016/j.suc.2015.02.008.
  12. Vasudevan V, Reusche R, Nelson E, et al. Robotic paraesophageal hernia repair: a single-center experience and systematic review. J Robot Surg 2018;12(1):81–86. DOI: 10.1007/s11701-017-0697-x.
  13. Luketich JD, Nason KS, Christie NA, et al. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 2010;139(2):395–404. DOI: 10.1016/j.jtcvs.2009.10.005.
  14. Jamieson GG. The results of antireflux surgery and reoperative antireflux surgery. Gullet Edinburgh 1993;341–345.
  15. Granderath FA, Granderath UM, Pointner R. Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg 2008;32(6):999–1007. DOI: 10.1007/s00268-008-9558-0.
  16. Frantzides CT, Madan AK, Carlson MA, et al. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 2002;137(6):649–652. DOI: 10.1001/archsurg.137.6.649.
  17. Granderath FA. Measurement of the esophageal hiatus by calculation of the hiatal surface area (HSA). Why, when and how? Surg Endosc 2007;21(12):2224–2225. DOI: 10.1007/s00464-007-9348-z.
  18. Zaman JA, Lidor AO. The optimal approach to symptomatic paraesophageal hernia repair: important technical considerations. Curr Gastroenterol Rep 2016;18(10):53. DOI: 10.1007/s11894-016-0529-6.
  19. Zhang C, Liu D, Li F, et al. Systematic review and meta-analysis of laparoscopic mesh versus suture repair of hiatus hernia: objective and subjective outcomes. Surg Endosc 2017;31(12):4913–4922. DOI: 10.1007/s00464-017-5586-x.
  20. Huddy JR, Markar SR, Ni MZ, et al. Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc 2016;30(12):5209–5221. DOI: 10.1007/s00464-016-4900-3.
  21. Tam V, Winger DG, Nason KS. A systematic review and meta-analysis of mesh vssuture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 2016;211(1):226–238. DOI: 10.1016/j.amjsurg.2015.07.007.
  22. Luketich JD, Raja S, Fernando HC, et al. Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 2000;232(4):608–618. DOI: 10.1097/00000658-200010000-00016.
  23. Morino M, Giaccone C, Pellegrino L, et al. Laparoscopic management of giant hiatal hernia: factors influencing long-term outcome. Surg Endosc 2006;20(7):1011–1016. DOI: 10.1007/s00464-005-0550-6.
  24. Pessaux P, Arnaud JP, Delattre JF, et al. Laparoscopic antireflux surgery: five-year results beyond in 1340 patients. Arch Surg 2005;140(10): 946–951. DOI: 10.1001/archsurg.140.10.946.
  25. Kemppainen E, Kiviluoto T. Fatal cardiac tamponade after emergency tension free repair of a large paraesophageal hernia. Surg Endosc 2000;14(6):593. DOI: 10.1007/s004640000138.
  26. Dallemagne B, Weerts J, Markiewicz S, et al. Clinical results of laparoscopic fundoplication at ten years after surgery. Surg Endosc 2006;20(1):159–165. DOI: 10.1007/s00464-005-0174-x.
  27. Granderath FA, Schweiger UM, Kamolz T, et al. Dysphagia after laparoscopic antireflux surgery: a problem of hiatal closure more than a problem of the wrap. Surg Endosc 2005;19(11):1439–1446. DOI: 10.1007/s00464-005-0034-8.
  28. Stadlhuber RJ, Sherif AE, Mittal SK, et al. Mesh complications after prosthetic reinforcement of hiatal clouse: a 28-case series. Surg Endosc 2009;23(6):1219–1226. DOI: 10.1007/s00464-008-0205-5.
  29. Sorricelli E, Bossa N, Genco A, et al. Long-term results of hiatal hernia mesh repair and antireflux laparoscopic surgery. Surg Endosc 2009;23(11):2499–2504. DOI: 10.1007/s00464-009-0425-3.
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