Laparoscopic repair of large hiatal hernia with teres ligament: Midterm follow-up - A new surgical procedure

G. Varga, L. Cseke, K. Kalmar, O. Horvath

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Although laparoscopic repair of large, mostly paraesophageal hiatal hernias is widely applied, there is a great concern regarding the higher recurrence rate associated with this procedure. In order to reduce this high recurrence rate, several techniques have been developed, mostly applying a mesh prosthesis for hiatal reinforcement. Methods: We have recently introduced a new laparoscopic technique in which the hiatal closure is reinforced with the teres ligament. To date 26 patients have been entered into this ongoing prospective study. After the operation patients were called back on a regular basis for symptom evaluation and barium swallow. All 26 patients agreed to undergo barium swallow, with a mean follow-up of 35 months. Results: The mean operative time was 115 min. Perioperative morbidity was 11.5%, and conversion to an open procedure was performed in six cases. No mortality was registered. Anatomic recurrence, investigated by barium swallows was observed in four patients (15.3%). Of those four, only one (3.85%) had a symptomatic recurrent paraesophageal hernia; the other three had asymptomtic sliding hernias. In three of the four patients with anatomic recurrence, the diameter of the hiatal hernia was greater than 9 cm at the original operation, and the fourth patient underwent reoperation for recurrent hiatal hernia. No symptomatic recurrence was found in patients with diameter of hiatal hernia between 6 and 9 cm. Conclusions: Laparoscopic reinforcement of the hiatal closure with the ligamentum teres is safe and effective treatment for large hiatal hernias. However, it appears that patients with extremely large hiatal hernias are at greater risk of recurrence, and therefore large hernias are not suitable for this new technique.

Original languageEnglish
Pages (from-to)881-884
Number of pages4
JournalSurgical Endoscopy
Volume22
Issue number4
DOIs
Publication statusPublished - Apr 2008

Fingerprint

Hiatal Hernia
Ligaments
Recurrence
Barium
Deglutition
Hernia
Round Ligaments
Swallows
Conversion to Open Surgery
Symptom Assessment
Operative Time
Reoperation
Prostheses and Implants
Prospective Studies
Morbidity
Mortality

Keywords

  • Fundoplication
  • Gastroesophageal reflux
  • Hiatal hernia
  • Laparoscopy
  • Ligamentum teres
  • Posterior hiatoplasty

ASJC Scopus subject areas

  • Surgery

Cite this

Laparoscopic repair of large hiatal hernia with teres ligament : Midterm follow-up - A new surgical procedure. / Varga, G.; Cseke, L.; Kalmar, K.; Horvath, O.

In: Surgical Endoscopy, Vol. 22, No. 4, 04.2008, p. 881-884.

Research output: Contribution to journalArticle

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