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Patrzyk M, Hummel R, Kersting S. [Surgical strategy for hiatal hernias]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:336-344. [PMID: 38372742 DOI: 10.1007/s00104-024-02054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
The indications for surgical treatment of hiatus hernias differentiate between type I and types II, III and IV hernias. The indications for a type I hernia should include a proven reflux disease but the indications for surgical treatment of types II, III and IV hernias are mandatory due to the symptoms with problems in the passage of food and due to the sometimes very severe possible complications. The primary aims of surgery are the repositioning of the herniated contents and a hiatoplasty, which includes a surgical narrowing of the esophageal hiatus by suture implantation. In addition, depending on the clinical situation other procedures, such as hernia sac removal, mesh implantation, gastropexy and fundoplication can be considered. There are various approaches to the repair, all of which have individual advantages and disadvantages. An adaptation to the specific needs situation of the patient and the expertise of the surgeon is therefore essential.
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Affiliation(s)
| | | | - Stephan Kersting
- Klinik für Allgemeine Chirurgie, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland.
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2
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Liu T, Saber A. Utility of Falciform Ligament in Abdominal Surgery: A Systematic Review. Am Surg 2023; 89:2705-2712. [PMID: 36444692 DOI: 10.1177/00031348221142577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE The aim of the present systematic review was to assess current trends in use of falciform ligament in abdominal surgery. BACKGROUND The falciform ligament has been proposed in surgical literature as a suitable pedicle or flap with acceptable surgical outcomes; however, it is underutilized in abdominal surgery. METHODS We performed a literature search and meta-analysis. All English studies describing use of a falciform ligament were eligible for inclusion. RESULTS Of the 547 articles mentioning use of falciform ligament, 32 full text articles were included in this review. The majority were case reports (n = 14). The mremaining papers included retrospective analysis (n = 10), randomized control trials (n = 2), reviews (n = 3), and technique descriptions (n = 6). CONCLUSION The falciform ligament appears to be a safe and easily accessible natural tissue with a variety of surgical applications. It is most useful as a pedicle flap and could have benefit in foregut surgery including hepatic, pancreatic, biliary, gastric, and esophageal operations.
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Affiliation(s)
- Tom Liu
- Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, USA
| | - Alan Saber
- Department of Surgery, Rutgers - New Jersey Medical School, Newark, NJ, USA
- Department of Surgery, Newark Beth Israel Medical Center, Newark, NJ, USA
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Runkel M, Kuvendjiska J, Marjanovic G, Fichtner-Feigl S, Diener MK. Ligamentum teres augmentation (LTA) for hiatal hernia repair after minimally invasive esophageal resection: a new use for an old structure. Langenbecks Arch Surg 2021; 406:2521-2525. [PMID: 34611750 PMCID: PMC8578099 DOI: 10.1007/s00423-021-02284-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/18/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Hiatal hernias with intrathoracic migration of the intestines are serious complications after minimally invasive esophageal resection with gastric sleeve conduit. High recurrence rates have been reported for standard suture hiatoplasties. Additional mesh reinforcement is not generally recommended due to the serious risk of endangering the gastric sleeve. We propose a safe, simple, and effective method to close the hiatal defect with the ligamentum teres. METHODS After laparoscopic repositioning the migrated intestines, the ligamentum teres is dissected from the ligamentum falciforme and the anterior abdominal wall. It is then positioned behind the left lobe of the liver and swung toward the hiatal orifice. Across the anterior aspect of the hiatal defect it is semi-circularly fixated with non-absorbable sutures. Care should be taken not to endanger the blood supply of the gastric sleeve. RESULTS We have used this technique for a total of 6 patients with hiatal hernias after hybrid minimally invasive esophageal resection in the elective (n = 4) and emergency setting (n = 2). No intraoperative or postoperative complications have been observed. No recurrence has been reported for 3 patients after 3 months. CONCLUSION Primary suture hiatoplasties for hiatal hernias after minimally invasive esophageal resection can be technically challenging, and high postoperative recurrence rates are reported. An alternative, safe method is needed to close the hiatal defect. Our promising preliminary experience should stimulate further studies regarding the durability and efficacy of using the ligamentum teres hepatis to cover the hiatal defect.
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Affiliation(s)
- Mira Runkel
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Jasmina Kuvendjiska
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany
| | - Markus K Diener
- Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetterstrasse 55, 79106, Freiburg, Germany.
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Asti E, Lovece A, Bernardi D, Milito P, Manzo CA, Bonavina L. Falciform Ligament Flap as Crural Buttress in Laparoscopic Hiatal Hernia Repair. J Laparoendosc Adv Surg Tech A 2021; 31:738-742. [PMID: 33970030 DOI: 10.1089/lap.2021.0244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Crural repair is an essential technical component in laparoscopic hiatal hernia surgery, but there is no consensus regarding the optimal method to prevent postoperative hernia recurrence. Mesh augmentation, especially with permanent materials, is associated with dysphagia and complications. The rotational falciform ligament flap (FLF) has been reported to be effective in reinforcing standard suture closure of the hiatus. Materials and Methods: Patients with primary or secondary hiatal hernia in whom FLF was used to buttress the hiatus repair were included. The FLF was dissected from the anterior abdominal wall, detached from the umbilical area, and transposed below the left lateral liver segment to buttress the cruroplasty. Indocyanine green fluorescence was used to assess vascularization of the flap before and after mobilization. Results: Eighteen consecutive patients underwent laparoscopic FLF cruroplasty reinforcement between October 2019 and January 2021. Indications were primary hiatal hernia (n = 9), recurrent hiatal hernia (n = 4), postsleeve gastrectomy hernia (n = 1), prophylactic hiatal repair during esophagectomy and gastric conduit reconstruction (n = 2), and postesophagectomy hernia (n = 2). All flaps were well vascularized and covered the entire hiatal area. There was no morbidity. At a median follow-up of 8 months (range 3-15), the symptomatic and quality of life scores significantly improved compared with baseline (P < .001), and no anatomic hernia recurrences were detected. Conclusions: FLF is safe for crural buttress and is a viable alternative to mesh in laparoscopic hiatal hernia surgery.
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Affiliation(s)
- Emanuele Asti
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Andrea Lovece
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Daniele Bernardi
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Pamela Milito
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Carlo Alberto Manzo
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
| | - Luigi Bonavina
- Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese (Milano), Italy
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Baskaran V, Banerjee JK, Ghosh SR, Kumar SS, Anand S, Menon G, Mishra DS, Saranga Bharathi R. Applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery-a review of their utility and efficacy. Langenbecks Arch Surg 2021; 406:1249-1281. [PMID: 33411036 DOI: 10.1007/s00423-020-02031-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Despite their ubiquitous presence, easy availability and diverse possibilities, falciform ligament and hepatic round ligament have been used less frequently than their potential dictates. This article aims to comprehensively review the applications of hepatic round ligament/falciform ligament flap and graft in abdominal surgery and assess their utility and efficacy. METHODS Medical literature/indexing databases were searched, using internet search engines, for pertinent articles and analysed. RESULTS The studied flap and graft have found utility predominantly in the management of diaphragmatic hernias, gastro-oesophageal reflux disease, peptic perforations, biliary reconstruction, venous reconstruction, post-operative pancreatic fistula, post-pancreatectomy haemorrhage, hepatic cyst cavity obliteration, liver bleed, sternal dehiscence, splenectomy, reinforcement of aortic stump, feeding access, diagnostic/therapeutic access into portal system, composite tissue allo-transplant and ventriculo-peritoneal shunting where they have exhibited the desired efficacy. CONCLUSIONS Hepatic round ligament/falciform ligament flap and graft are versatile and have multifarious applications in abdominal surgery with some novel and unique uses in hepatopancreaticobiliary surgery including liver transplantation. Their evident efficacy needs wider adoption to realise their true potential.
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Affiliation(s)
| | - Jayant Kumar Banerjee
- Department of Gastro-intestinal Surgery, Bharati Vidyapeeth Medical College, Pune, India
| | - Sita Ram Ghosh
- Department of Gastro-intestinal Surgery, Command Hospital (Eastern Command), Kolkata, India
| | - Sukumar Santosh Kumar
- Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India
| | | | - Govind Menon
- Department of Plastic & Reconstructive Surgery, Command Hospital (Central Command), Lucknow, India
| | | | - Ramanathan Saranga Bharathi
- Department of Gastro-intestinal Surgery, Command Hospital (Central Command), Lucknow, Uttar Pradesh, 226002, India.
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Runkel A, Scheffel O, Marjanovic G, Chiappetta S, Runkel N. Augmentation of Hiatal Repair with the Ligamentum Teres Hepatis for Intrathoracic Gastric Migration After Bariatric Surgery. Obes Surg 2021; 31:1422-1430. [PMID: 33409977 DOI: 10.1007/s11695-020-05153-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE The augmentation of hiatoplasty (HP) with the ligamentum teres hepatis (LTA) is a new concept for intrathoracic migration of a gastric sleeve or pouch (ITGM). We retrospectively analyzed all cases of hiatal hernia repair in a single center between 2015 and 2019. METHODS A total of 171 patients underwent 307 hiatal hernia repairs after sleeve gastrectomy (SG) (n = 79), Roux-en-Y gastric bypass (RYGB) (n = 129), and one anastomosis gastric bypass (OAGB) (n = 99). Each hiatal hernia repair was defined as a "case" and assigned to the LTA group or the non-LTA group. The primary outcome was the recurrence of ITGM as detected by endoscopy or CT. RESULTS The basic characteristics in the LTA group (78 cases) and the non-LTA group (229 cases) were comparable with the exception of the rate of revisional HP (72% vs. 21%), the rate of prior conversion to RYGB (33% vs. 17%), the initial BMI (45.9 ± 8.2 kg/m2 vs. 49.0 ± 8.8 kg/m2), and the follow-up (7 months (1-16) vs. 8 months (1-54)). The ITGM recurrence rate was 15% in the LTA group and 72% in non-LTA group (p < 0.001). Multivariate analysis showed that the length of ITGM and the type of surgical repair were independent risk factors. The addition of LTA to HP lowered the probability of ITGM recurrence by a factor of 0.35 (p = 0.015), but the conversion from SG or OAGB to RYGB did not reduce the risk. CONCLUSIONS LTA reduces the risk of early ITGM recurrence. The long-term durability, however, needs to be further investigated.
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Affiliation(s)
- Alexander Runkel
- Department of Plastic and Hand Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - Goran Marjanovic
- Centre for Obesity and Metabolic Surgery, Department of General and Visceral Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sonja Chiappetta
- Obesity and Metabolic Surgery Unit, Ospedale Evangelico Betania, Naples, Italy
| | - Norbert Runkel
- Department of Obesity and Metabolic Surgery, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
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Runkel A, Scheffel O, Marjanovic G, Runkel N. The New Interest of Bariatric Surgeons in the Old Ligamentum Teres Hepatis. Obes Surg 2020; 30:4592-4598. [PMID: 32808167 DOI: 10.1007/s11695-020-04918-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 02/06/2023]
Abstract
The search for an operation that effectively prevents and treats intrathoracic gastric migration (ITGM) after bariatric surgery has revived a long-forgotten technique: ligamentum teres cardiopexy (LTC) by which a vascularized flap of the teres ligament is wrapped around the distal esophagus. The systematic search of publications in the English language revealed 4 studies (total number of patients 53) in the non-bariatric literature with an unsatisfactory resolution of GERD. There were 5 reports from the bariatric literature with small patient numbers (total 64) and a short follow-up (6-36 months). There were no objective signs of gastric remigration in 93% of investigated patients. Acknowledging the limitations of these preliminary reports, bariatric surgeons are encouraged to further investigate the potentials of LTC in their patients.
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Affiliation(s)
- Alexander Runkel
- Department of Plastic and Hand Surgery, University of Freiburg Medical Centre, Freiburg, Germany
| | - Oliver Scheffel
- Department of Obesity and Metabolic Surgery, German Centre of Excellence, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany
| | - Goran Marjanovic
- Centre for Obesity and Metabolic Surgery, Department of General and Visceral Surgery, University of Freiburg Medical Centre, Freiburg, Germany
| | - Norbert Runkel
- Department of Obesity and Metabolic Surgery, German Centre of Excellence, Sana-Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
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Correa Restrepo J, Morales Uribe CH, Toro Vásquez JP. Reparación laparoscópica de hernia hiatal gigante. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introducción. La reparación laparoscópica es el estándar de tratamiento en hernia hiatal gigante. Sin embargo, a pesar de su baja morbilidad, la tasa de recurrencia sigue siendo alta. Nuestro objetivo fue describir los resultados de la reparación laparoscópica de hernia hiatal gigante, independientemente de la técnica de cruroplastia empleada. Métodos. Se llevó a cabo un estudio retrospectivo de pacientes llevados a reparación laparoscópica de hernia hiatal gigante en el periodo 2009-2017. Se analizaron los datos demográficos, la técnica quirúrgica, las complicaciones y la estancia hospitalaria. Se revisaron los resultados de la endoscopia, la radiografía de vías digestivas altas y la escala de síntomas GERD-HRQOL, obtenidos luego de un año de cirugía. Resultados. Se incluyeron 44 pacientes con un tamaño promedio de la hernia de 7 cm. Se practicó cruroplastia con sutura simple en 36,4 %, sutura más refuerzo con politetrafluoroetileno (PTFE) o dacrón, en 59,1 %, y se usó malla en 4,5 %. Hubo 12 complicaciones, la estancia hospitalaria promedio fue de 3,5 días y no hubo mortalidad. Se encontró recurrencia endoscópica o radiológica en 6/20 pacientes, todas pequeñas y asintomáticas. En 23 pacientes, la escala GERD-HRQOL reportó un valor promedio de 7,7 y 78 % de satisfacción. Solo un paciente requirió cirugía de revisión. Conclusión. El método preferido de reparación laparoscópica de la hernia hiatal gigante es la cruroplastia sin malla, técnica asociada a baja morbilidad y adecuado control de los síntomas. La tasa de recurrencia es similar a la reportada en la literatura. Se requieren estudios prospectivos con seguimiento completo a largo plazo para validar estos resultados.
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Abstract
A hiatus hernia is defined as a transdiaphragmatic protrusion/migration of the intrabdominal contents through the esophageal hiatus of the diaphragm. The classification of hiatus hernias is based on anatomical morphological differentiation (types I-IV). The leading symptoms and psychological stress vary with respect to the symptoms, e. g. reflux and compression symptoms. Gastroscopy and multichannel intraluminal impedance pH measurement are obligatory preoperative functional diagnostics. A distinction is made between frequent type I hernia (antireflux surgery), symptomatic paraesophageal, thoracic and mixed hernia types (II-IV). Surgical indications exist in symptomatic type II-IV hernias. Hiatal mesh augmentation reduces recurrences. The complication potential of synthetic meshes must be taken into account. Biological implants show no advantages.
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Straatman J, Groen LCB, van der Wielen N, Jansma EP, Daams F, Cuesta MA, van der Peet DL. Treatment of paraesophageal hiatal hernia in octogenarians: a systematic review and retrospective cohort study. Dis Esophagus 2018. [PMID: 29538745 DOI: 10.1093/dote/doy010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Over the coming years octogenarians will make up an increasingly large proportion of the population. With the rise in octogenarians more paraesophageal hiatal hernias may be identified. In research for the optimal treatment for paraesophageal hiatal hernias, octogenarians are often omitted and the optimal surgical strategy for this patient group remains unclear. A systematic search in PubMed, Embase, and The Cochrane Library was conducted, including articles compromising 'surgery,' 'paraesophageal hiatal hernia,' and 'octogenarians.' Selection of articles was based on independent review by two authors. Alongside, a retrospective cohort study was conducted including all type II-IV hiatal hernia repairs performed in the VU Medical Center in Amsterdam, The Netherlands, from 2005 to 2015. A total of 486 papers were eligible for selection. After careful selection, a total of eight articles were included. All articles were retrospective cohort studies describing different proportions of octogenarians. The populations and surgical techniques were very heterogeneous. Elective paraesophageal hiatal hernia repair was performed safely in symptomatic octogenarians in all studies. Additional analysis of 84 patients, of which 9.5% octogenarians, was performed at our tertiary referral center. A larger hernia type, more acute interventions and a higher morbidity and mortality rate was observed in octogenarians compared to patients aged <80 years. In conclusion, elective paraesophageal hiatal hernia repair can be performed in octogenarians, especially in patients without comorbidity. Findings suggest improvement in symptoms in short-term follow up, with minimal morbidity and mortality. With regard to surgical techniques, laparoscopy and fundoplication were performed safely. Octogenarians need to be included in future clinical trials to further evaluate the optimal surgical intervention. Preoperative risk assessment by clinical prediction rules should guide operative intervention, in order to evaluate risks and benefits in this challenging population.
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Affiliation(s)
| | | | | | - E P Jansma
- Medical library, VU University Medical Center, Amsterdam, The Netherlands
| | - F Daams
- Department of Gastrointestinal Surgery
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Laparoscopic Hiatal Hernia Repair with Falciform Ligament Buttress. J Gastrointest Surg 2018; 22:1144-1151. [PMID: 29736666 DOI: 10.1007/s11605-018-3798-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/24/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Using synthetic mesh to buttress the crural repair during laparoscopic hiatal hernia repair may be associated with dysphagia and esophageal erosions, while a biologic mesh is expensive and does not decrease long-term recurrence rates. This study documents outcomes of laparoscopic paraesophageal hernia repairs using the falciform ligament to reinforce the crural repair. METHODS This is a prospective study of laparoscopic paraesophageal hernia repairs with a falciform ligament buttress. Preoperatively and at 6 and 12 months postoperatively, medications, radiologic studies, and symptom severity and frequency scores were recorded. Patients with a hiatal defect greater than 5 cm were included, while patients with recurrent hiatal hernia repairs or prior gastric surgery were excluded. Symptom scores were compared pre- and postoperatively with a p < 0.05 considered significant. RESULTS One hundred four patients were included with a mean age of 62.4 years, and 57 patients underwent an upper gastrointestinal series at least 12 months from the initial operation with a mean follow-up of 20.6 months. The mean symptom severity score decreased from 14.32 ± 0.93 to 4.75 ± 0.97 (p < 0.001), mean symptom frequency score decreased from 14.99 ± 0.97 to 5.25 ± 0.99 (p < 0.001), and mean total symptom score decreased from 29.31 ± 1.88 to 10.00 ± 1.95 (p < 0.001). Five patients developed recurrent hiatal hernias on upper gastrointestinal series, but only three required operative intervention. CONCLUSIONS Laparoscopic paraesophageal hernia repair with a falciform ligament buttress is a viable option for a durable closure. Ongoing follow-up will continue to illuminate the value of this approach to decrease morbidity and recurrence rates for hiatal hernia repair.
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12
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Abstract
High rates of recurrence in hiatus hernia and antireflux surgery led to the introduction of different methods for diaphragm closure. Prosthetic diaphragm closure with meshes remains a controversial issue in the literature. Available data show lower recurrence rates after prosthetic diaphragm closure; however, there is no clear standard for the indications and technique. Despite the availability of a few prospective randomized trials, a clear recommendation regarding this issue cannot currently be given.
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Nikonov EL. [Surgical treatment of the diaphragmatic hernia and the possibility of new endoscopic procedures]. Khirurgiia (Mosk) 2018:96-105. [PMID: 29798999 DOI: 10.17116/hirurgia2018596-105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- E L Nikonov
- N.I. Pirogov Russian National Research Medical University, Moscow, Russia
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14
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Wang WP, Ni PZ, Chen LQ. Laparoscopic surgical treatment of esophageal hiatal hernia. Shijie Huaren Xiaohua Zazhi 2016; 24:3087-3097. [DOI: 10.11569/wcjd.v24.i20.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Types II, III and IV esophageal hiatal hernia (EHH) which presents obvious symptoms or leads to potentially fatal complications requires surgical treatment. Laparoscopy has been used to repair EHH in the last two decades globally and proved to be minimally invasive compared to conventional open surgery. This review summarizes current status and prospectives of laparoscopic application in EHH treatment. The published articles on minimally invasive laparoscopic surgical treatment of EHH in PubMed, Cochrane Library and EMBASE databases were retrieved and analyzed. From 1992 to 2015, 86 English articles involving a total of 4771 patients receiving laparoscopic treatment for EHH were retrieved. Perioperative information including safety and feasibility of procedure, postoperative complications, and short/long-term outcome after laparoscopic repair was retrospectively analyzed. Laparoscopic surgical treatment of EHH is a safe, feasible and minimally invasive procedure with fast recovery after repair, low postoperative morbidity and recurrence.
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Cardiopexy with Ligamentum Teres in Patients with Hiatal Hernia and Previous Sleeve Gastrectomy: An Alternative Treatment for Gastroesophageal Reflux Disease. Obes Surg 2016; 25:1539-43. [PMID: 25990381 DOI: 10.1007/s11695-015-1740-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Fifty percent of patients who have undergone sleeve gastrectomy have gastroesophageal reflux disease (GERD). Surgical reinforcement of the lower esophageal sphincter is necessary to prevent acid reflux. Here, we describe ligamentum teres cardiopexy, a surgical technique that reinforces the lower esophageal sphincter and restores its competence with a new valve, in patients with previous sleeve gastrectomy and hiatal hernia. METHODS Included in the study were 15 patients (age, 35.6 ± 15.2 years; 13 females [86.6 %]; mean pre-cardiopexy body mass index, 21.94 kg/m(2)) with sleeve gastrectomy who presented with hiatal hernia and gastroesophageal reflux disease and underwent ligamentum teres cardiopexy. In this procedure, the ligamentum teres is released from its umbilical connection and the hernia reduced by manual traction, freeing the last 3-5 cm of esophagus in the abdomen. The distal ligamentum teres is fixed with one stitch to the apex of the angle of His, one at the gastroesophageal junction, and one joining the gastric fundus to the esophagus. The remainder of the ligamentum teres is fixed over itself with four to six stitches, forming a necktie cardiopexy. The procedure concludes with diaphragmatic crus closure. RESULTS After 6 months, 13 patients (86.6 %) achieved successful results, defined as resolution of GERD, no proton-pump inhibitor (PPI) use, and manometry measurement over 12 mmHg after surgery. Two patients (13.3 %) required continued proton-pump inhibition. CONCLUSIONS Ligamentum teres cardiopexy combined with closure of the gastric crus is a good alternative treatment for gastroesophageal reflux disease in patients with previous sleeve gastrectomy and hiatal hernia.
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Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27:4409-28. [PMID: 24018762 DOI: 10.1007/s00464-013-3173-3] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Geoffrey Paul Kohn
- Department of Surgery, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,
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Modern treatment of paraesophageal hernia: preoperative evaluation and technique for laparoscopic repair. Surg Laparosc Endosc Percutan Tech 2012; 22:297-303. [PMID: 22874677 DOI: 10.1097/sle.0b013e31825831af] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article reviews the preoperative evaluation of patients with paraesophageal hernia (PEH) and details the principles and components of a laparoscopic PEH repair. Complete hernia sac dissection and excision, adequate esophageal mobilization, reapproximation of the crura, and creation of an antireflux barrier make up the key steps in any repair and are described. Although the preferred operative approach to PEH has undergone significant modification, especially since the introduction of minimally invasive laparoscopic techniques, many controversies still exist. The decision of whether to use mesh to reinforce the crural closure remains an unresolved issue in the surgical literature, and further evolution in this and other areas of PEH surgery is sure to occur in the near future.
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Vereczkei A, Varga G, Tornoczky T, Papp A, Horvath ÖP. A new experimental method for hiatal reinforcement using connective tissue patch transfer. Dis Esophagus 2012; 25:465-9. [PMID: 21951298 DOI: 10.1111/j.1442-2050.2011.01265.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The closure of a large hiatal hernia still represents a challenge for the surgeon. Mesh reinforcement of a hiatoplasty generally decreases recurrence rate. An artificial mesh is cheaper compared with a biologic one, but has a higher complication rate. Our aim was to introduce a new biologic reinforcement method with less expenses. During organ donation for transplantation, tissue islets from pericardium and fascia lata were cryopreserved in a tissue bank. Later, the grafts were transplanted on the diaphragm of mongrel dogs. After 1, 3, and 6 months, the animals were sacrificed, and the transplanted patches were macroscopically and microscopically examined. There were no macroscopic signs of inflammation, abcedation, or significant adhesion formation. The grafts were well recognizable, with palpable thickening and moderate shrinkage. Microscopically, an organization process with fibrosis, neovascularization, and peritoneal integration could be observed. Reinforcement of a hiatoplasty with connective tissue transfer either with cryopreserved or autologous tissue is a good option. This is a cheap and easy method, which should also be tested in human interventions.
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Affiliation(s)
- A Vereczkei
- Departments of Surgery, Medical School University of Pécs, Pécs, Hungary.
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Kelemen D, Papp R, Baracs J, Horváth OP. [Our efforts to decrease surgical complications following pancreatic resections]. Magy Seb 2012; 65:52-57. [PMID: 22512879 DOI: 10.1556/maseb.65.2012.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The most frequent surgical complications following pancreatic resections are pancreatic fistula and delayed gastric emptying. The aim of the authors was to analyse these complications in their own practice. MATERIAL AND METHODS Clinical data of 287 patients were reviewed, who were radically operated on for malignant pancreatic or periampullary tumours during 14 years period. The most common neoplasm was pancreatic adenocarcinoma, located in the head of the pancreas. Pylorus-preserving pancreatoduodenectomy was most frequently performed. In the early period pancreatogastrostomy and double-layer pancreatojejunostomy were preferred during the reconstruction, as well as retrocolic duodeno-, and gastrojejunostomy, respectively. Later the authors turned to the single-layer implantation pancreatojejunostomy and to the antecolic reconstruction, the latter was completed with Braun anastomosis. RESULTS In the postoperative course complications occurred in 39%, reoperation was done in 5.6%, and the early mortality rate was 3.8%. The rate of pancreatic fistula decreased to 5.9% following single-layer pancreatojejunostomy, and the difference was significant compared to the 17.6% rate after pancreatogastrostomy. Due to the antecolic reconstruction the frequency of delayed gastric emptying has reduced from 10.2% to 2.1%, which is a statistically significant difference. CONCLUSIONS As a result of changes in the surgical techniques during the 14 years period, the frequency of pancreatic fistula and delayed gastic emptying has dramatically decreased, which underlines the need of continuous progress in surgical methods.
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Affiliation(s)
- Dezső Kelemen
- Pécsi Tudományegyetem, Klinikai Központ Sebészeti Klinika.
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Win TS, Collins DP, El-Muttardi N. Prevention of gastrointestinal herniation into the chest following omental transposition by the use of ligamentum teres. J Plast Reconstr Aesthet Surg 2011; 65:134-7. [PMID: 21865104 DOI: 10.1016/j.bjps.2011.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 07/24/2011] [Indexed: 10/17/2022]
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Antoniou SA, Koch OO, Antoniou GA, Pointner R, Granderath FA. Mesh-reinforced hiatal hernia repair: a review on the effect on postoperative dysphagia and recurrence. Langenbecks Arch Surg 2011; 397:19-27. [DOI: 10.1007/s00423-011-0829-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 07/11/2011] [Indexed: 10/18/2022]
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Horváth OP. [The use of mesh in the surgical treatment of hiatal hernias]. Magy Seb 2010; 63:312-5. [PMID: 20965864 DOI: 10.1556/maseb.63.2010.5.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary suture repair of large hiatal hernias is associated with high recurrence rate, but the use of mesh may improve the results. There is no agreement about the ideal size, shape, or material of these mesh prosthesis, or the way those should be fixed to the crura. One of the biggest concerns of insetting a prosthetic material at the hiatus is erosion into the stomach, esophagus, or both. Cardiac injury at the time of mesh anchorage is a rare but potentially fatal complication. Introduction of biomaterials into clinical practise has completely changed the outlook of these surgical procedures.
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Affiliation(s)
- Ors Péter Horváth
- Pécsi Tudományegyetem Klinikai Központ Sebészeti Klinika 7624 Pécs Ifjúság útja 13.
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Horváth OP. [János Balassa memorial lecture]. Magy Seb 2009; 62:171-179. [PMID: 19679525 DOI: 10.1556/maseb.62.2009.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Ors Péter Horváth
- Pécsi Tudományegyetem Klinikai Központ Sebészeti Klinika 7624 Pécs Ifjúság útja 13.
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