Abstract
ABSTRACT Background: Erosion and migration into the esophagogastric lumen after laparoscopic hiatal hernia repair with mesh placement has been published. Aim:To present surgical maneuvers that seek to diminish the risk of this complication. Method:We suggest mobilizing the hernia sac from the mediastinum and taking it down to the abdominal position with its blood supply intact in order to rotate it behind and around the abdominal esophagus. The purpose is to cover the on-lay mesh placed in “U” fashion to reinforce the crus suture. Results:We have performed laparoscopic hiatal hernia repair in 173 patients (total group). Early postoperative complications were observed in 35 patients (27.1%) and one patient died (0.7%) due to a massive lung thromboembolism. One hundred twenty-nine patients were followed-up for a mean of 41+28months. Mesh placement was performed in 79 of these patients. The remnant sac was rotated behind the esophagus in order to cover the mesh surface. In this group, late complications were observed in five patients (2.9%). We have not observed mesh erosion or migration to the esophagogastric lumen. Conclusion:The proposed technique should be useful for preventing erosion and migration into the esophagus.
Highlights
Ahigh recurrence rate after laparoscopic hiatal hernia repair, which can reach up to 66%, ranging from 1.2% to 66%, 1,12,16,17,19,27 has been reported in patients with giant type III or IV hernias
Patients From January 2007 to December 2016, our department operated on 961 patients diagnosed with gastroesophageal reflux and hiatal hernia
One hundred seventy-three of them corresponded to a giant hiatal hernia, with a mean age of 69.5 years (34-84), and they were subjected to hiatal hernia repair
Summary
Ahigh recurrence rate after laparoscopic hiatal hernia repair, which can reach up to 66%, ranging from 1.2% to 66% , 1,12,16,17,19,27 has been reported in patients with giant type III or IV hernias. In order to diminish this recurrence after surgery, different types of mesh have been proposed[5]. A vast variation in mesh configuration and positioning has been employed[11]. Some of these products carry a risk of migration into the esophagogastric lumen. Biomaterial tends to be associated with failure and a high rate of recurrence, but it does not present risk of migration, whereas non-absorbable mesh tends to be associated with stricture and erosion. We present our technique to prevent or diminish the risk of erosion of the esophagogastric wall and migration into the lumen when non-absorbable mesh is used
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