Laparoscopic Hiatal Hernia Repair with or without Fundoplication. Is There Any Difference?

Abstract

Background: A hiatal hernia is a type of hernia in which abdominal organs (typically the stomach) slip through the diaphragm into the middle compartment of the chest. This may result in gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) with symptoms such as a taste of acid in the back of the mouth or heartburn. Other symptoms may include swallowing trouble and chest pains. Objectives: This study aimed to compare laparoscopic hiatal hernia repair (HHR) cruroplasty (the effect of hernia reduction and only repair of diaphragmatic crura) versus HHR with concomitant fundoplication in terms of relative frequency and severity of symptoms before laparoscopic antireflux surgery, and DeMeester scores (DMS), relative symptom improvement, patients’ satisfaction, and complications after antireflux surgery. Patients and methods: This prospective randomized study was conducted in GIT Unit of General Surgery Department, Faculty of Medicine, Zagazig University, on 18 patients with hiatal hernia underwent laparoscopic hiatal hernia repair. They were divided into two equal groups; 1st group was laparoscopic hiatal hernia repair (HHR) without fundoplication and 2nd group was with Nissen Fundoplication (HHR – LNF). Results: We found that there was complete absence of hernia among HHE-LNF group (0.0 %) versus 2 patients (22.2 %) had persistent hernia after HHR group with no significance difference between both groups pre- and post-operatively. There was not a statistically significance difference between the two studied groups regarding success rate with 100.0% versus 77.8% among HHR_LNF and HHR respectively. Conclusion: Laparoscopic hiatal hernia repair with Nissen Fundoplication had better short-term outcome than without Nissen fundoplication.