Type III/Type IV Giant Para-Oesophageal Herniae: Our Technique of Gastropexy with Biological Prosthesis

Kassem Alubaidi,Meera Joshi,Ashish Kiran Shrestha,Sanjoy Basu

doi:10.4236/ss.2016.75031

Kassem Alubaidi, Meera Joshi + Show 2 more

Open Access

https://doi.org/10.4236/ss.2016.75031

Copy DOI

Journal: Surgical science	Publication Date: Jan 1, 2016
Citations: 7	License type: CC BY 4.0

Affiliation: William Harvey Hospital

Abstract

Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port placement for anti-reflux surgery, mediastinal sac dissection and excision, crura-plasty, tension free placement of the biological prosthesis for hiatal reinforcement, fundoplication and gastropexy. Conclusion: Our technique of laparoscopic repair of giant paraoesophageal hernia with biological mesh is feasible and safe with acceptable morbidity and outcome.

Highlights

Giant paraoesophageal hernia that accounts for 5% of all hiatus hernia is defined as 30% - 50% displacement of the stomach above the diaphragm (Figure 1) [1]-[6]
The two loose ends of the mesh are kept apart on the left crus preventing full encircleage of the oesophagus and fixed to the diaphragm and crura with 5 interrupted, 0 polyester, braided sutures (Figure 4). This is followed by a 360o loose fundoplication achieved with three interrupted 0 polyester, braided sutures and the gastropexy is completed by securing the wrap to the diaphragm, mesh and the right crus with another five interrupted 0 polyester, braided sutures (Figure 5)
We believe our technique of laparoscopic repair and the use of porcine dermis for hiatal reconstruction for patients with GPEH is a safe technique that reduces recurrence and improves quality of life with acceptable morbidity

Summary

Introduction

Giant paraoesophageal hernia that accounts for 5% of all hiatus hernia is defined as 30% - 50% displacement of the stomach above the diaphragm (Figure 1) [1]-[6]. Various techniques from endoscopic reduction to percutaneous gastrostomy have been advocated but the gold standard intervention remains either an open or a laparoscopic surgical repair [6] through either a primary suture repair or a tension free hiatal mesh reinforcement [1]-[3] [6]. We have an 8-year experience at repairing GPEH (Type III-IV) laparoscopically with biological prosthesis (non-cross linked porcine dermis) and describe here our technique of hiatal reconstruction for these patients. (2016) Type III/Type IV Giant Para-Oesophageal Herniae: Our Technique of Gastropexy with Biological Prosthesis.

Surgical Technique

Discussion

Findings

Conclusion