Laparoscopic Hiatal Hernia Repair with Falciform Ligament Buttress
Journal of Gastrointestinal Surgery
Falciform; Hiatal hernia; Laparoscopic; Mesh; Paraesophageal hernia
© 2018, The Society for Surgery of the Alimentary Tract (This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply). Background: Using synthetic mesh to buttress the crural repair during laparoscopic hiatal hernia repair may be associated with dysphagia and esophageal erosions, while a biologic mesh is expensive and does not decrease long-term recurrence rates. This study documents outcomes of laparoscopic paraesophageal hernia repairs using the falciform ligament to reinforce the crural repair. Methods: This is a prospective study of laparoscopic paraesophageal hernia repairs with a falciform ligament buttress. Preoperatively and at 6 and 12 months postoperatively, medications, radiologic studies, and symptom severity and frequency scores were recorded. Patients with a hiatal defect greater than 5 cm were included, while patients with recurrent hiatal hernia repairs or prior gastric surgery were excluded. Symptom scores were compared pre- and postoperatively with a p < 0.05 considered significant. Results: One hundred four patients were included with a mean age of 62.4 years, and 57 patients underwent an upper gastrointestinal series at least 12 months from the initial operation with a mean follow-up of 20.6 months. The mean symptom severity score decreased from 14.32 ± 0.93 to 4.75 ± 0.97 (p < 0.001), mean symptom frequency score decreased from 14.99 ± 0.97 to 5.25 ± 0.99 (p < 0.001), and mean total symptom score decreased from 29.31 ± 1.88 to 10.00 ± 1.95 (p < 0.001). Five patients developed recurrent hiatal hernias on upper gastrointestinal series, but only three required operative intervention. Conclusions: Laparoscopic paraesophageal hernia repair with a falciform ligament buttress is a viable option for a durable closure. Ongoing follow-up will continue to illuminate the value of this approach to decrease morbidity and recurrence rates for hiatal hernia repair.
Grossman, R., Brody, F., Schoolfield, C., Biteman, B., & Zeddun, S. (2018). Laparoscopic Hiatal Hernia Repair with Falciform Ligament Buttress. Journal of Gastrointestinal Surgery, 22 (7). http://dx.doi.org/10.1007/s11605-018-3798-6