Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress
Journal of Gastrointestinal Surgery
Falciform ligament; Hernia recurrence; Hiatal hernia; Laparoscopic paraesophageal hernia repair
© 2015, The Society for Surgery of the Alimentary Tract. Background: Buttressing the crura in paraesophageal hernia (PEH) repairs with synthetic mesh may be associated with erosions and dysphagia, while biologic buttresses are expensive and do not decrease long-term recurrence rates. This study documents outcomes following laparoscopic PEH repairs using the falciform ligament as a buttress. Methods: This is a prospective study of laparoscopic PEH repairs with a falciform ligament buttress. Preoperatively and at 6 months follow-up, medications, radiologic studies and symptom scores were recorded. Patients included had a hiatal defect greater than 5 cm, while recurrent PEH or prior gastric surgery patients were excluded. Results: Thirty-four patients were included with a mean age of 61 years, and 33 patients completed postoperative evaluation with a mean follow-up of 7.1 months. The mean symptom severity decreased from 11.24 ± 1.71 to 3.24 ± 0.84, mean symptom frequency decreased from 11.62 ± 1.70 to 3.45 ± 0.85, and mean total symptom score decreased from 22.85 ± 3.40 to 6.69 ± 1.69 (p < 0.0001). Three patients had recurrences on the upper gastrointestinal (UGI) series. Only one required reoperation. Conclusions: Laparoscopic PEH repair with a falciform ligament buttress is a viable option. Ongoing follow-up will demonstrate the utility of this approach to decrease morbidity and recurrence rates for paraesophageal hernia repairs.
Laird, R., Brody, F., Harr, J., Richards, N., & Zeddun, S. (2015). Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress. Journal of Gastrointestinal Surgery, 19 (7). http://dx.doi.org/10.1007/s11605-015-2796-1