Controversies in paraesophageal hernia repair; a review of literature

Draaisma, Werner A.; Gooszen, H. G.; Tournoij, E.; Broeders, I. A. M. J.

doi:10.1007/s00464-004-2275-3

Cited by 129 publications

(125 citation statements)

References 51 publications

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“…Several repair techniques have been described, the most common one involving the reinforcement of the hiatal closure by implantation of mesh around the esophageal hiatus. Although studies have demonstrated a decrease in the PEH recurrence rate with mesh reinforcement [17,18], this technique remains controversial [15,19,20]. The use of synthetic mesh can lead to dysphagia or odyngophagia in up to 21.7% of patients, likely due to esophageal stenosis and periesophageal mesh-induced fibrosis [5,12,21,22].…”

Section: Discussionmentioning

confidence: 99%

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

et al. 2015

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Background: Obtaining a tension-free repair for giant paraesophageal hernias (PEH) is often challenging. Many different techniques have been proposed, including laparoscopic posterior hiatoplasty with the use of prosthetic or biologic mesh as well as the use of autologous teres or falciform ligament flaps. In this report, we describe the use of the left triangular ligament as an onlay autologous vascularized flap to bridge the anterior residual defect after posterior cruroplasty. Methods: A novel technique of paraesophageal hiatal hernia repair is described. Posterior hiatoplasty is performed, including the approximation of the diaphragmatic crural fibers to the extent possible. The left triangular ligament is then mobilized and sutured to the right and left crural fibers lining the esophageal hiatus to seal the anterior residual diaphragmatic defect. Results: This technique has been performed in 4 patients with a mean age of 71 years and a 3:1 female to male ratio. The average hiatal defect size was 5.5 cm and the average length of operation was 122 min. There was no evidence of radiologic or clinical recurrence on follow-up. Conclusion: The use of the left triangular ligament flap is feasible and may be a valuable tool for closure of an anterior diaphragmatic defect in giant PEHs. Additional studies to validate its long-term function are needed.

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Section: Discussionmentioning

confidence: 99%

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

et al. 2015

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“…Laparoscopic repair of paraesophageal hernias is superior to open repair, with an associated decreased length of hospital stay, complication rate and recurrence rate (Draaisma et al, 2005). Long-term good functional results are observed in 75% and (symptomatic) recurrences in 15% after large paraesophageal hernia repair (Poncet et al, 2010).…”

Section: Paraesophageal Hernia Repairmentioning

confidence: 99%

Laparoscopic Hernia Repair

Deerenberg¹,

Mulder²,

Lange³

2011

Updated Topics in Minimally Invasive Abdominal Surgery

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“…9) Traditionally, elective surgical repair has been recommended for all patients with PHH considered being medically operable. 10,11) Much of this recommendation is based on the classical studies such as that of Skinner et al, 12) who in 1967 found that type II PHH carried a 29% mortality rate in asymptomatic patients due to incarceration with strangulation. Some surgeons think that PHH enlarge with time making surgery more difficult and the increasing age of the patient, which may increase the risk of complications.…”

Section: Indications For Surgerymentioning

confidence: 99%

“…Some authors still advocate suture closure of the hiatal gap in all cases, 87) whereas biologic implant engineering represents a promising field in hiatal hernia surgery. Antireflux procedure Although limited data confirm the need for fundoplication, most surgeons perform an antireflux procedure when repairing a PHH 11) because the fundoplication helps to anchor the stomach in the abdomen and because of the need to create a barrier to reflux. The extensive dissection necessary for full mobilization of the hernia sac and esophagus destroys anti-reflux mechanism and resulting in postoperative reflux.…”

Section: Crural Repairmentioning

confidence: 99%

“…67,68) Furthermore, the safety of the use of the prosthesis is a matter of concern, because short-and long-term dysphagia as a result of reactive fibrosis around the esophagus, and erosion and fistulization of the foreign material to the viscera have been reported. 8,11,27,69) In order to minimize these adverse effects, a variety of materials have evolved. Different mesh shapes have also been appraised with regard to dysphagia and recurrence rates (Table 2, Fig 1).…”

Section: Crural Repairmentioning

confidence: 99%

See 1 more Smart Citation

Paraesophageal Hernia Repair

Mori

Nagao

Sugiyama

2012

Ann Thorac Cardiovasc Surg

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Paraesophageal hiatal hernia (PHH), accounting for only 5% of all hiatal hernias, may result in potentially life threatening complications such as obstruction, acute dilatation, perforation, or bleeding of the gastric mucosa. It is traditionally believed that PHH is an indication for surgery. The repair of paraesophageal hernia is technically challenging and controversial. The purpose of this article is to overview the current status of indication of surgery; operative techniques including hernia sac resection, esophageal lengthening procedure, crural repair, and additional antireflux procedure. Results: All symptomatic patients should be surgically treated, when operation is possible. It seems reasonable that asymptomatic or minimally symptomatic patients do not necessarily require surgery and that a more selective approach should be used. The penetration rate is not high, laparoscopic approach is currently the standard care. The hernia sac should be excised and resected circumferentially. Collis-Nissen procedure continues to be the method of choice also in the laparoscopic era, when lengthening procedure of the shortened esophagus is in consideration. Although symptomatic recurrence after suture closure of the crura is uncommon, primary repair is associated with a high rate of anatomic recurrence. Prosthetic mesh repair is reportedly associated with a recurrence rate as low as 5%, at the price of rare but serious complications such as erosion and fibrosis. Although scientific proof is lacking, fundoplication is the most common procedure to be added after crural repair.

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Controversies in paraesophageal hernia repair; a review of literature

Abstract: Treatment based on standardized protocols for preoperative assessment and postoperative follow-up is required to clarify the current controversies.

Cited by 129 publications

References 51 publications

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

New Surgical Approach for Giant Paraesophageal Hernia Repair: Closure of the Esophageal Hiatus Anteriorly Using the Left Triangular Ligament

Laparoscopic Hernia Repair

Paraesophageal Hernia Repair

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