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Clinical Trial
. 2014 Jan 8:14:1.
doi: 10.1186/1471-2482-14-1.

The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia

Luigi Marano  1 , Michele Schettino, Raffaele Porfidia, Michele Grassia, Marianna Petrillo, Giuseppe Esposito, Bartolomeo Braccio, PierLuigi Gallo, Modestino Pezzella, Angelo Cosenza, Giuseppe Izzo, Natale Di Martino
Affiliations
Clinical Trial

The laparoscopic hiatoplasty with antireflux surgery is a safe and effective procedure to repair giant hiatal hernia

Luigi Marano et al. BMC Surg. .

Abstract

Background: Although minimally invasive repair of giant hiatal hernias is a very surgical challenge which requires advanced laparoscopic learning curve, several reports showed that is a safe and effective procedure, with lower morbidity than open approach. In the present study we show the outcomes of 13 patients who underwent a laparoscopic repair of giant hiatal hernia.

Methods: A total of 13 patients underwent laparoscopic posterior hiatoplasty and Nissen fundoplication. Follow-up evaluation was done clinically at intervals of 3, 6 and 12 months after surgery using the Gastro-oesophageal Reflux Health-Related Quality of Life scale, a barium swallow study, an upper gastrointestinal endoscopy, an oesophageal manometry, a combined ambulatory 24-h multichannel impedance pH and bilirubin monitoring. Anatomic recurrence was defined as any evidence of gastric herniation above the diaphragmatic edge.

Results: There were no intraoperative complications and no conversions to open technique. Symptomatic GORD-HQL outcomes demonstrated a statistical significant decrease of mean value equal to 3.2 compare to 37.4 of preoperative assessment (p < 0.0001). Combined 24-h multichannel impedance pH and bilirubin monitoring after 12 months did not show any evidence of pathological acid or non acid reflux.

Conclusion: All patients were satisfied of procedure and no hernia recurrence was recorded in the study group, treated respecting several crucial surgical principles, e.g., complete sac excision, appropriate crural closure, also with direct hiatal defect where possible, and routine use of antireflux procedure.

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Figures

Figure 1
Figure 1
Laparoscopic view of a giant hiatal hernia with more than 50% of the stomach migrated in the chest throughout a large hiatal defect.
Figure 2
Figure 2
The hiatus is repaired with a series of interrupted sutures.
Figure 3
Figure 3
Analysis of preoperative symptoms questionnaires.
Figure 4
Figure 4
Preoperative endoscopic evaluation.
See this image and copyright information in PMC

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