The new method of tension-free alloplasty for giant hiatal hernia

Abstract

The aim — to analyze first results of a new tension‑free mesh repair method for giant hiatal hernias.Materials and methods. Sіх patients (4 women and 2 men) with giant hiatal hernia underwent laparoscopic repair with new technique. The mean age was 62 years (52 — 70). The mean BMI was 24.8 kg/m2 (16.4 — 30.8). The average area of the hernia was 33.9 cm2 (18 — 60 cm2). Round shaped polyester mesh with collagen coating Symbotex (Covidien) measuring 9 or 12 cm was used. It was cut out of a section in the form of an equilateral triangle with a smaller side cut for the esophagus (creating a heart‑shaped implant).A separate rectangular mesh was cut out. Transverse incisions were made on it, the rectangle was folded along, closing the notch, thus repeating its curvature. The upper edge of the structure was fastened with four knot sutures with Prolene 2 — 0, which was stitched all 3 layers of the grid, creating a «stiffening rib».Results and discussion. There were no conversions. The mean duration of procedure was 3 hours (2.5 — 4). There were no intraoperative complications. The mean duration of hiatoplasty was 35 minutes (25 — 40 min). There were no postoperative complications. There were no symptoms of anatomical and reflux recurrence in a follow‑up period of 1 — 3 months. There were also no complaints of dysphagia. X‑ray image with barium and endoscopy showed no anatomical recurrence or esophageal stenosis.Conclusions. The new method of tension‑free hiatoplasty with lightweight polyester mesh with collagen coating Symbotex (Covidien) showed the basic feasibility and convenience of the esophageal giant hernias. The immediate results of the new method showed no anatomical recurrences and dysphagia. More cases collection with assessment of long‑term results and comparing with other methods are needed.