The new method for hiatal hernia laparoscopic alloplasty

Abstract

The aim — to analyze the immediate results of the first experience of a new laparoscopic mesh repair method for the hiatal hernia.Materials and methods. Five patients with an age ranging from 38 to 70 years, and a body mass index ranging from 28 to 35 kg/m2, undergone laparoscopic mesh repair and Nissen fundoplication using new method called «internal buttress of posterior crural repair». The average area of the hernia was 9.8 cm2 (from 8 to 16 cm2). In all cases, there was a thinning of the cruras and the upper part of the border of the hiatal. Two pieces of rectangular mesh Parietene ProGrip (Covidien, USA), measuring from 0.8 ´ 2.5 cm to 1.0 ´ 3.0 cm, were fixed by their hooks to the inner surface of the crura. Then, cruroraphy together with the both pieces of the mesh was done using a self­gripping non­absorbable continuous suture with V­loc 2­0 (Covidien, USA).Results and discussion. The mean duration of repair was 20 minutes (range 15 to 35 minutes). The mesh implants were not shifted when flashing and at the same time their position could be corrected. The rupture of the crura and the bleeding from the bite points were not observed. When tightening the thread, cruras approached to each other well. There were no cases of dysphagia.Conclusions. The new method of the internal buttres of posterior crural repair using self­gripping lightweight polyester mesh (Parietene ProGrip, Covidien, USA) demonstrated its technical feasibility and safety. The new method combines the advantages of positioning of a mesh posteriorly to the crura and the comfortability of posterior crural repair. More cases collection with assessment of long­term results and comparing with other methods is needed.