World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

Laparoscopic Approach to Repair Hiatal Hernias: Our Experience in a Tertiary Care Hospital

Manzoor Ahmad, Ajay Thakral, Divya Prasad, Musharraf Husain

Keywords : Esophagogastroduodenoscopy, Gastroesophageal junction, Gastroesophageal reflux disease, Hiatus hernia, Laparoscopy

Citation Information : Ahmad M, Thakral A, Prasad D, Husain M. Laparoscopic Approach to Repair Hiatal Hernias: Our Experience in a Tertiary Care Hospital. World J Lap Surg 2022; 15 (3):199-201.

DOI: 10.5005/jp-journals-10033-1533

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Hiatal hernia is commonly associated with the symptomatic gastroesophageal reflux disease (GERD). Protrusion of any abdominal structure other than the esophagus into the thoracic cavity through the hiatus of the diaphragm. The relationship between hiatal hernia and gastroesophageal reflux and proposed surgical options to correct the defect as established by the Allison, namely returning the stomach to the abdomen and repairing the diaphragmatic hiatus. Proton pump inhibitors are a preferred treatment option for symptomatic relief. Surgical treatment usually follows medical treatment. Depending on the severity of symptoms and type of hernia involved, surgical treatment is decided. Laparoscopic repair is a good approach nowadays. It offers various benefits to both the patient and the surgeon. It is generally performed by a general abdominal surgeon because it usually involves an abdominal approach. Laparoscopic repair significantly decreases postoperative complications and is the procedure of choice in most centers. Materials and methods: The present study protocol was reviewed and approved by the Institutional Review Board of Hospital, which waived the requirement for informed patient consent based on the retrospective nature of the work. A single team of surgeon performed all the procedures. Eighteen patients with primary hiatal hernia who underwent laparoscopic surgery from 2016 to 2018 were examined. Results: The follow-up period was between 12 months and 24 months. The average follow-up period was around 18 months. • Thirty-nine patients underwent laparoscopic hernia repair with fundoplication, of which 26 were females and 13 males. • Most of the patients present with symptoms of heartburn or epigastric pain. Some of the patients presented with dyspepsia. Few patients were diagnosed incidentally. • The average age was 42 years (25–75). • Operative time was 150–250 minutes with a mean time of 194 minutes. No patient needed conversion from laparoscopic procedure to open technique. • The hospital stay was 4–7 days with an average stay of 4.5 days. These included one-day preoperative admission. • There were no deaths during or after the procedure. • Pain: A total of 15 patients complained of pain on post-op day 1 who needed round-the-clock analgesia. This number fell to 5 by day 3. At the time of discharge (maximum interval being 7 days and median being 5.5 days), none of the patients had complaints of pain. • Two patients had symptoms of dysphagia at the outpatient follow-up. These patients showed no notable findings on imaging examination and no difficulties with feeding, the symptoms were well-controlled with medication. Conclusion: We conclude that laparoscopic repair of hiatal hernia is a feasible technique with satisfactory surgical outcomes. Although it is a complex operation with a substantial learning curve, thoracic surgeons who have adequate experience with laparoscopy would be capable of performing the operation.


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