Laparoscopic antireflux surgery and repair of hiatal hernia.

Laparoscopic mobilization of the esophagus and esophagogastric (O-G) junction enables the safe and effective performance of endoscopic antireflux surgery for intractable reflux esophagitis. The two antireflux procedures that we have evaluated in clinical practice at this institution are the ligamentum teres cardiopexy (n = 9) and partial posterior fundoplication (n = 5). More recently, laparoscopic repair of large symptomatic hiatal hernia (sliding, paraesophageal, and mixed) has also been introduced (n = 4). The procedure entails reduction of the hernia, mobilization of the O-G junction with crural repair by a continuous suture technique employing a special preformed jamming loop knot, followed by total fundoplication, which is fixed proximal to the anterior margin of the diaphragmatic hiatus and distal to the O-G junction. The early results (maximum follow-up 18 months) of this experience have been favorable, with minimal morbidity, early hospital discharge, and effective control of reflux symptoms without adverse sequelae. Laparoscopic antireflux surgery is an alternative to long-term medication in patients with intractable esophagitis, and laparoscopic repair of large hiatal hernias offers significant advantage over the conventional open surgical approach in terms of rapid convalescence.