Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias

Varga, Gábor; Cseke, László; Kalmár, Katalin; Horváth, Örs Péter

doi:10.1007/s00464-003-9205-7

Cited by 27 publications

(16 citation statements)

References 20 publications

(15 reference statements)

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“…No recurrences were noted after 3 months. 28 This is a potentially useful technique; however, it does involve additional dissection, and the small numbers and short follow-up reported make it difficult to recommend as a strong alternative at this point. There are a host of mesh biomaterials that have come on the market in the last few years.…”

Section: Alternatives To Synthetic Meshmentioning

confidence: 98%

Complications of PTFE Mesh at the Diaphragmatic Hiatus

Tatum

Shalhub

Oelschlager

et al. 2008

Journal of Gastrointestinal Surgery

129

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Paraesophageal hernia repair has been associated with a recurrence rate of up to 42%. Thus, in the last decade, there has been increasing interest in the use of mesh reinforcement of the hiatal repair. Polytetrafluoroethylene (PTFE) is one of the materials that have been used for this purpose, as it is thought to induce minimal tissue reaction. We report two cases in which complications specific to the use of PTFE mesh in this location developed over time. In the first patient, a gastrectomy was required to remove a large PTFE mesh which had eroded into the esophagogastric junction and gastric cardia. The second patient experienced severe dysphagia resulting from a stricture caused by the implant, requiring removal of the mesh. Although such complications have only rarely been reported, the severity and consequences of these incidents, as reported in the literature and in light of our observations, suggest that an alternative to PTFE should be considered for crural reinforcement during paraesophageal hernia repair.

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Section: Alternatives To Synthetic Meshmentioning

confidence: 98%

Complications of PTFE Mesh at the Diaphragmatic Hiatus

Tatum

Shalhub

Oelschlager

et al. 2008

Journal of Gastrointestinal Surgery

129

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“…Although there have been few complications related to prosthetic mesh after laparoscopic antireflux surgery or large hiatal hernia repair, some authors recommend the use of biomaterials or autologous tissue to avoid any risk of complication secondary to prosthetic mesh. Varga et al [54] advocated the use of ligamentum teres for reinforcement of the hiatal crura in four patients with a hiatal hernia ‡6 cm. Similarly, the successful use of biomaterial has been described by Oelschlager et al [43].…”

Section: Complications Of Prosthetic Crural Closurementioning

confidence: 99%

“…Another approach to crural closure with biomaterial has been described by Varga et al [54]. In this study, the hiatoplasty was performed with the ligamentum teres in LARS, laparoscopic antireflux surgery; LPEHR, laparoscopic paraesophageal hernia repair; n.a., not available; PTFE, polytetrafluoroethylene; RELARS, revisional laparoscopic antireflux surgery; PEHR, paraesophageal hernia repair addition to simple sutures.…”

Section: Introductionmentioning

confidence: 99%

Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery

Granderath

Carlson

Champion³

et al. 2006

Surg Endosc

151

108

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Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates. The type of mesh, particularly the size and shape, is still controversial and is a matter for future research in this field.

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“…Varga et al utilized the teres ligament to reinforce the crural repair in large PEHs with a radiologic recurrence of 15% over a 3-year follow-up period [25]. Recently, Park et al proposed the use of the falciform ligament as an autologous flap to either reinforce the posterior hiatoplasty in giant PEH repairs or to bridge a residual posterior hiatal defect [16].…”

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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Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias

Abstract: On the basis of these preliminary results laparoscopic reinforcement of the hiatal closure with the ligamentum teres seems feasible and safe; therefore this promising technique should be considered as an option for the treatment of large hiatal hernias.

Cited by 27 publications

References 20 publications

Complications of PTFE Mesh at the Diaphragmatic Hiatus

Complications of PTFE Mesh at the Diaphragmatic Hiatus

Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery

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

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