Laparoscopic Hiatal Hernia Repair with Falciform Ligament Buttress

Abstract

BackgroundUsing 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. MethodsThis 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. ResultsOne 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. ConclusionsLaparoscopic 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.