Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress

Laird, R.; Brody, Fred; Harr, Jeffrey N.; Richards, Nathan G.; Zeddun, Steve

doi:10.1007/s11605-015-2796-1

Cited by 11 publications

(4 citation statements)

References 19 publications

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“…12 Furthermore, falciform ligament was utilized as a natural biological buttress or mesh hiatoplasty to prevent recurrence during paraesophageal hernia repair. [13][14][15][16] A total of n = 153 patients received falciform ligament for cural closure. All involved studies reported decreased recurrence compared to primary closure, although no comparisons were made with mesh closures.…”

Section: Gastrointestinal Surgerymentioning

confidence: 99%

“…Laird and Harr reported a prospective experience of 34 patients, noting that both symptom frequency and severity decreased significantly by 1 year follow-up. 15 Runkel et al reported 78 cases of falciform ligament repair compared to 229 controls, and noted that recurrence was 15% compared to 72% in treatment of concamintant hiatal hernia following bariatric surgery.…”

Section: Gastrointestinal Surgerymentioning

confidence: 99%

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Utility of Falciform Ligament in Abdominal Surgery: A Systematic Review

Liu

Saber

2022

The American Surgeon™

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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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Section: Gastrointestinal Surgerymentioning

confidence: 99%

Section: Gastrointestinal Surgerymentioning

confidence: 99%

Utility of Falciform Ligament in Abdominal Surgery: A Systematic Review

Liu

Saber

2022

The American Surgeon™

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“…Currently, the falciform ligament flap is used in pancreatic surgery to reduce postoperative morbidity 23 – 25 . Moreover, the falciform ligament flap can be applied for laparoscopic repair of the crural defect caused by paraesophageal hernia 26 , 27 .…”

Section: Introductionmentioning

confidence: 99%

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Rahimli

Perrakis

Schellerer

et al. 2020

Sci Rep

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Whether sealing the hepatic resection surface after liver surgery decreases morbidity is still unclear. Nevertheless, various methods and materials are currently in use for this procedure. Here, we describe our experience with a simple technique using a mobilized falciform ligament flap in minimally invasive liver surgery (MILS). We retrospectively analyzed the charts from 46 patients who received minor MILS between 2011 and 2019 from the same surgical team in a university hospital setting in Germany. Twenty-four patients underwent laparoscopic liver resection, and 22 patients received robotic-assisted liver resection. Sixteen patients in the laparoscopic group and fourteen in the robotic group received a falciform ligament flap (FLF) to cover the resection surface after liver surgery. Our cohort was thus divided into two groups: laparoscopic and robotic patients with (MILS + FLF) and without an FLF (MILS−FLF). Twenty-eight patients (60.9%) in our cohort were male. The overall mean age was 56.8 years (SD 16.8). The mean operating time was 249 min in the MILS + FLF group vs. 235 min in the MILS−FLF group (p = 0.682). The mean blood loss was 301 ml in the MILS + FLF group vs. 318 ml in the MILS−FLF group (p = 0.859). Overall morbidity was 3.3% in the MILS + FLF group vs. 18.8% in the MILS−FLF group (p = 0.114). One patient in the MILS−FLF group (overall 2.2%), who underwent robotic liver surgery, developed bile leakage, but this did not occur in the MILS + FLF group. Covering the resection surface of the liver after minor minimally invasive liver resection with an FLF is a simple and cost-effective technique that does not prolong surgical time or negatively affect other perioperative parameters. In fact, it is a safe add-on step during MILS that may reduce postoperative morbidity. Further studies with larger cohorts will be needed to substantiate our proof of concept and results.

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“…[3] Radiological recurrence was 15% and symptomatic recurrence was 4%. Grossman and co-workers [8] used a 10 mm camera, a 12 mm trocar, and three 5 mm trocars in their study consisting of 104 cases and they used the falciform ligament to support the primary repair of the hiatal defect, before fundoplication. They reported that this technique was well tolerated with minimal complications, and radiological recurrence rate was %8.8 in one year follow up.…”

mentioning

confidence: 99%

Falciform ligament instead of mesh for mini-laparoscopic hiatal hernia repair

Kaplan¹

2018

Laparosc Endosc Surg Sci

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To the Editor, Hiatal hernia is migration of stomach partially into thoracic cavity due to the enlargement of diaphragmatic crus. Anatomically there are four groups of hiatal hernia and type 1 (gastro-esophageal junction into the thoracic cavity) is the most common. More than 90% of type 1 hiatal hernia is associated with gastro-esophageal reflux disease. [1] In symptomatic patients, the first line treatment is long-term medical therapy. Today, the best alternative treatment to medical therapies at gastro-oesophageal reflux disease with hiatal hernia is laparoscopic Nissen fundoplication and cruroplasty. Strengthening the cruroplasty with a mesh is nowadays frequently recommended because it reduces the recurrence rates. [2] However, there were cases in the literature in which falciform ligament were used instead of mesh for the prevention of mesh complications.

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Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress

Abstract: Laparoscopic PEH repair with a falciform ligament buttress is a viable option. Ongoing follow-up will demonstrate the utility of this approach to decrease morbidity and recurrence rates for paraesophageal hernia repairs.

Cited by 11 publications

References 19 publications

Utility of Falciform Ligament in Abdominal Surgery: A Systematic Review

Utility of Falciform Ligament in Abdominal Surgery: A Systematic Review

A falciform ligament flap surface sealing technique for laparoscopic and robotic-assisted liver surgery

Falciform ligament instead of mesh for mini-laparoscopic hiatal hernia repair

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