Hiatal Hernia Repair in Difficult Pathologic-Anatomic Situations at the Hiatus
Laparoscopic fundoplication is safe and effective and currently is considered as the “gold standard” surgical treatment for GERD with a success rate of about 80–95%. Due to lack of proper definition, different criteria like relief of GERD symptoms, improvement in quality of life, avoidance of postoperative complications, and patient satisfaction were considered. Patients sometime report symptoms strongly suggesting that of recurrence but with no objective evidence of reflux by pH study. There are various mechanisms described for recurrence, transdiaphragmatic herniation of wrap being the most common mechanism after laparoscopic repair. If symptoms are not effectively managed by PPIs or affecting quality of life, redo surgery is advisable and can be completed laparoscopically with results comparable to primary surgery with little increase in risk of recurrence.
Recurrent Hiatus Hernia
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Hiatal Hernia Repair in Obese Patients