Advertisement

Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Prosthetic mesh repair of large and recurrent diaphragmatic hernias

Abstract

Background

Laparoscopic repair of large paraesophageal hernias (PEH) is associated with significant recurrence rates. Use of prosthetic mesh to complete tension-free repair of the hiatus has been suggested to decrease the recurrence rate.

Methods

Fifty-nine patients with large (n = 44) or recurrent (n = 15) PEH were operated on via the laparoscopic approach with the use of prosthetic mesh. Patients were followed with office visits and phone interviews. All patients were referred for barium studies. Data analysis included all patients, including conversions, on an intention-to-treat basis.

Results

Followup was completed in 56 (95%) patients. Mean followup time was 28.4 months. Forty patients (74%) had significant relief of all symptoms. Barium studies were performed in 45 patients (80.3%), including all symptomatic patients. Fifteen patients (33%) had a small sliding hernia, six (13.3%) had recurrent PEH, and four (8.8%) had narrowing of the gastroesophageal junction. Most patients with small hiatal hernias were symptomatic (60%). All responded to medical treatment.

Conclusions

Laparoscopic repair of large PEH with reinforcement mesh is feasible and safe with excellent short-term results. Long-term followup shows a low PEH recurrence requiring reoperation, but a significant number of patients develop symptomatic recurrent small hiatal hernias that can be managed nonoperatively.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Altorki NK, Yankelevitz D, Skinner DB (1998) Massive hiatal hernias: the anatomic basis for repair. J Thorac Cardiovasc Surg. 115: 828–835

  2. 2.

    Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos DJ, Gagne DJ, Caushaj PF, Landreneau RJ, Keenan RJ (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18: 444–447

  3. 3.

    Arendt T, Stuber E, Monig H, Folsch UR, Katsoulis S (2000) Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 51: 607–610

  4. 4.

    Carlson MA, Condon RE, Ludwig KA, Schoulte WJ (1998) Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatal hernia repair. J Am Coll Surg 187: 227–230

  5. 5.

    Champion JK, Rock D (2003) Lparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 17: 551–553

  6. 6.

    Deschamps C, Trastek VF, Allen MS, Pairolero PC, Johnson JO, Larson DR (1997) Long term results after reoperation for failed antireflux procedures. J Thorac Cardiovasc Surg 113: 545–551

  7. 7.

    Frantzides CT, Richards CG, Carlson MA (1999) Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 13: 906–908

  8. 8.

    Frantzides T, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137: 649–652

  9. 9.

    Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 128: 623–630

  10. 10.

    Granderath FA, Schweiger UM, Kamolz T (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation. Arch Surg 140: 40–48

  11. 11.

    Hashemi M, Peters JH, Demeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type 3 hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 190: 553–560

  12. 12.

    Horgan S, Pohl D, Bogetti D, Eubanks T, Pellegrini C (1999) Failed antireflux surgery. Arch Surg 134: 809–817

  13. 13.

    Hunter JG, Swanstrom L, Waring JP (1996) Dysphagia after laparoscopic antireflux surgery: the impact of operative technique. Ann Surg 224: 51–57

  14. 14.

    Leeder PC, Smith G, Dehn TCB (2003) Laparoscopic management of large paraesophageal hiatal hernias. Surg Endosc 17: 1372–1375

  15. 15.

    Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura O, Litle VR, Schauer PR (2002) Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 74: 1909–1916

  16. 16.

    Pitcher DE, Curet MJ, Martin DT, Vogt DM, Mason J, Zucker KA (1995) Successful laparoscopic repair of paraesophageal hernia. Arch Surg 130: 590–596

  17. 17.

    Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KK, Schraut WH, Luketich JD (1998) Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 176: 659–665

  18. 18.

    Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia: lont-term results with 1030 patients. J Thorac Cardiovasc Surg 53: 33–54

  19. 19.

    Soper NJ, Dunnegan D (1999) Anatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229: 669–677

  20. 20.

    Targarona EM, Bendahan G, Balague C, Garriga J, Trias M (2004) Mesh in the hiatus. A controversial issue. Arch Surg 139: 1286–1296

  21. 21.

    Willekes CL, Edoga JK, Frezza EE (1997) Laparoscopic repair of paraesophageal hernia. Ann Surg 225: 31–38

  22. 22.

    Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13: 497–502

Download references

Author information

Correspondence to Amir Szold.

Additional information

Presented at the 14th European Association of Endoscopic Surgeons International Congress, 13–16 September 2006, Berlin, Germany

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lubezky, N., Sagie, B., Keidar, A. et al. Prosthetic mesh repair of large and recurrent diaphragmatic hernias. Surg Endosc 21, 737–741 (2007). https://doi.org/10.1007/s00464-007-9208-x

Download citation

Keywords

  • Laparoscopic
  • Paraesophageal hernia
  • Mesh