Laparoscopic paraesophageal hernia mesh repair

Abstract

Operative repair of paraesophageal hernia has become more popular and widely used with the development of the minimally invasive surgery. 1 Gangopadhyay N. Perrone J.M. Soper N.J. Matthews B.D. Eagon J.C. Klingensmith M.E. et al. Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery. 2006; 140: 491-498 Abstract Full Text Full Text PDF PubMed Scopus (73) Google Scholar There are reports, however, of high recurrence rates after laparoscopic paraesophageal hernia (PEH) repair. 2 Hashemi M. Peters J.H. DeMeester T.R. Huprich J.E. Quek M. Hagen J.A. et al. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg. 2000; 190: 553-560 Abstract Full Text Full Text PDF PubMed Google Scholar , 3 Granderath F.A. Carlson M.A. Champion J.K. Szold A. Basso N. Pointner R. et al. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc. 2006; 20: 367-379 Crossref PubMed Scopus (127) Google Scholar Some authors believe that one of the reasons for the failure of the technique is the tension in the hiatoplasty. The recurrence is related to the diameter of the hiatus and excessive tension in the crura after the hiatus is approximated. Because of the recurrences in the PEH repair with simple suture in hiatoplasty, the use of mesh has been advocated. 3 Granderath F.A. Carlson M.A. Champion J.K. Szold A. Basso N. Pointner R. et al. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc. 2006; 20: 367-379 Crossref PubMed Scopus (127) Google Scholar In this study, anatomic failure was 18.7% overall, possibly more if the follow-up were longer.