BACKGROUND: Buttressing the crura in paraesophageal hernia (PEH) repairs with synthetic mesh may be associated with erosions and dysphagia, while biologic buttresses are expensive and do not decrease long-term recurrence rates. This study documents outcomes following laparoscopic PEH repairs using the falciform ligament as a buttress. METHODS: This is a prospective study of laparoscopic PEH repairs with a falciform ligament buttress. Preoperatively and at 6 months follow-up, medications, radiologic studies and symptom scores were recorded. Patients included had a hiatal defect greater than 5 cm, while recurrent PEH or prior gastric surgery patients were excluded. RESULTS: Thirty-four patients were included with a mean age of 61 years, and 33 patients completed postoperative evaluation with a mean follow-up of 7.1 months. The mean symptom severity decreased from 11.24 ± 1.71 to 3.24 ± 0.84, mean symptom frequency decreased from 11.62 ± 1.70 to 3.45 ± 0.85, and mean total symptom score decreased from 22.85 ± 3.40 to 6.69 ± 1.69 (p < 0.0001). Three patients had recurrences on the upper gastrointestinal (UGI) series. Only one required reoperation. CONCLUSIONS: 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.
BACKGROUND: Buttressing the crura in paraesophageal hernia (PEH) repairs with synthetic mesh may be associated with erosions and dysphagia, while biologic buttresses are expensive and do not decrease long-term recurrence rates. This study documents outcomes following laparoscopic PEH repairs using the falciform ligament as a buttress. METHODS: This is a prospective study of laparoscopic PEH repairs with a falciform ligament buttress. Preoperatively and at 6 months follow-up, medications, radiologic studies and symptom scores were recorded. Patients included had a hiatal defect greater than 5 cm, while recurrent PEH or prior gastric surgery patients were excluded. RESULTS: Thirty-four patients were included with a mean age of 61 years, and 33 patients completed postoperative evaluation with a mean follow-up of 7.1 months. The mean symptom severity decreased from 11.24 ± 1.71 to 3.24 ± 0.84, mean symptom frequency decreased from 11.62 ± 1.70 to 3.45 ± 0.85, and mean total symptom score decreased from 22.85 ± 3.40 to 6.69 ± 1.69 (p < 0.0001). Three patients had recurrences on the upper gastrointestinal (UGI) series. Only one required reoperation. CONCLUSIONS: 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.
Authors: Eelco B Wassenaar; Fernando Mier; Huseyin Sinan; Rebecca P Petersen; A Valeria Martin; Carlos A Pellegrini; Brant K Oelschlager Journal: Surg Endosc Date: 2011-11-16 Impact factor: 4.584
Authors: Rudolf J Stadlhuber; Amr El Sherif; Sumeet K Mittal; Robert J Fitzgibbons; L Michael Brunt; John G Hunter; Tom R Demeester; Lee L Swanstrom; C Daniel Smith; Charles J Filipi Journal: Surg Endosc Date: 2008-12-06 Impact factor: 4.584
Authors: Christina L Greene; Steven R DeMeester; Joerg Zehetner; Stephanie G Worrell; Daniel S Oh; Jeffrey A Hagen Journal: Surg Endosc Date: 2013-08-16 Impact factor: 4.584
Authors: Robert A Grossman; Fred J Brody; Clint S Schoolfield; Ben Biteman; Steve Zeddun Journal: J Gastrointest Surg Date: 2018-05-07 Impact factor: 3.452
Authors: H Reza Zahiri; Adam S Weltz; Udai S Sibia; Neethi Paranji; Steven D Leydorf; George T Fantry; Adrian E Park Journal: Surg Endosc Date: 2017-05-10 Impact factor: 4.584