World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 1 ( January-April, 2022 ) > List of Articles

Original Article

Prevention of Mesh-related Complications at the Hiatus: A Novel Technique Using Falciform Ligament

Pranav Mandovra, Vishakha R Kalikar, Roy V Patankar

Keywords : Falciform ligament, Mesh at hiatus, Prevention of mesh complications

Citation Information : Mandovra P, Kalikar VR, Patankar RV. Prevention of Mesh-related Complications at the Hiatus: A Novel Technique Using Falciform Ligament. World J Lap Surg 2022; 15 (1):47-49.

DOI: 10.5005/jp-journals-10033-1497

License: CC BY-NC 4.0

Published Online: 09-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Aim: In this study, a technical modification has been performed by using falciform ligament between the mesh and esophagus thereby preventing mesh to come in direct contact with the hollow viscera so reducing mesh-related complications. Materials and methods: From January 2016 to December 2017, patients requiring the use of prosthetic mesh at the hiatus during laparoscopic antireflux surgery (LARS) surgery were included in the study. Principles of an ideal LARS have adhered. After mesh repair at hiatus and appropriate fundoplication, the falciform ligament was released from its attachment to the ventral abdominal wall and was placed between the mesh and the posterior esophagus avoiding direct contact between the mesh and hollow viscera. Postoperatively patients were followed up for a minimum of 2 years. A retrospective analysis was done of the prospectively collected data. Results: Sixteen patients were included in the study (12 patients had redo surgery and four had large hiatus hernia requiring prosthesis). Average age of the patients was 48.5 years and the average BMI was 24.8. The mean operative time was 128.2 minutes. None of the patients had a recurrence of hiatus hernia, long-term dysphagia, any mesh-related complication, or any unexpected event related to surgery on 2-year follow-up. Conclusion: This innovative technique of using falciform ligament as a bridge between the mesh and the esophagus prevents the mesh-related complication without compromising the strength of hiatal repair. Clinical significance: To prevent the recurrence of hiatus hernia, the use of prosthetic meshes is advocated in patients with large hiatal surface areas. Concern about the safety of mesh at the hiatus has been there. This technique helps in reducing the mesh-related complication at the hiatus.


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  1. Aly A, Munt J, Jamieson GG, et al. Laparoscopic repair of large hiatal hernias. Br J Surg 2005;92(5):648–653. DOI: 10.1002/bjs.4916.
  2. Smith GS, Isaacson JR, Draganic BD, et al. Symptomatic and radiological follow-up after para-esophageal hernia repair. Dis Esophagus 2004;17(4):279–284. DOI: 10.1111/j.1442-2050.2004.00426.x.
  3. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux surgery: tailoring the hiatal closure to the size of hiatal surface area. Surg Endosc 2007;21(4):542–548. DOI: 10.1007/s00464-006-9041-7.
  4. Hazebroek EJ, Leibman S, Smith GS. Erosion of a composite PTFE/ePTFE mesh after hiatal hernia repair. Surg Laparosc Endosc Percutan Tech 2009;19(2):175–177. DOI: 10.1097/SLE.0b013e3181a11926.
  5. Dutta S. Prosthetic esophageal erosion after mesh hiatoplasty in a child, removed by transabdominal endogastric surgery. J Pediatr Surg 2007;42(1):252–256. DOI: 10.1016/j.jpedsurg.2006.09.043.
  6. Tatum RP, Shalhub S, Oelschlager BK, et al. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008;12(5):953–957. DOI: 10.1007/s11605-007-0316-7.
  7. Coluccio G, Ponzio S, Ambu V, et al. Dislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia, a case report. Minerva Chir 2000;55(5):341. PMID: 10953570.
  8. Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 2005;140(1):40–48. DOI: 10.1001/archsurg.140.1.40.
  9. 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.
  10. Gajbhiye R, Quraishi AH, Mahajan P, et al. Dysphagia due to transmural migration of polypropylene mesh into esophagus. Indian J Gastroenterol 2005;24(5):226. PMID: 16361777.
  11. Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 2011;213(4):461–468. DOI: 10.1016/j.jamcollsurg.2011.05.017.
  12. Grossman RA, Brody FJ, Schoolfield CS, et al. Laparoscopic hiatal hernia repair with falciform ligament buttress. J Gastrointest Surg 2018;22(7):1144–1151. DOI: 10.1007/s11605-018-3798-6.
  13. Varga G, Cseke L, Kalmar K, et al. Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias. Surg Endosc Intervent Tech 2004;18(7):1051–1053. DOI: 10.1007/s00464-003-9205-7.
  14. Li XP, Xu DC, Tan HY, et al. Anatomical study on the morphology and blood supply of the falciform ligament and its clinical significance. Surg Radiol Anat 2004;26(2):106–109. DOI: 10.1007/s00276-003-0184-0.
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