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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