Authors: Trevor J D’Netto Gregory L Falk
Publish Date: 2013/11/19
Volume: 18, Issue: 4, Pages: 851-857
Abstract
Laparoscopic paraoesophageal hernia repair is a challenging procedure both in surgical technical difficulty and in prevention of recurrence in the setting of operating on an older patient cohort with associated comorbidities However modifications based on sound surgical principles can lead to better outcomes This article describes and illustrates in detail the technique for the laparoscopic repair of paraoesophageal hernia without mesh with cardiooesophageal junction fixation The data and results of the study supporting this technique have been published previously by Gibson et al Surgical Endoscopy 27 618–623 2013 The previously published article has reported on the numbers of patients mean age American Society of Anesthesiologists Physical Status Classification System body mass index duration of followup complications Visick scores and quality of life pre and postoperatively The principles of complete reduction of the hernia sac preservation of both crura mobilisation of the phrenooesophageal ligament and phrenogastric attachments adequate mediastinal mobilisation of the oesophagus and the cardiooesophageal junction into the abdomen without tension preservation of both vagi a tensionfree crural repair including the fascial aspects adjacent to the diaphragm an anterior hiatal repair in combination with the recognised posterior approximation a loose fundoplication and a secure cardiopexy to the median arcuate ligament and multiple points of attachment we have found leads to good operative resultsGibson et al without the need for mesh This article outlines in detail the operative technique guided by these principles with annotated intraoperative photographs illustrating the anatomy and procedure The technique used by our team since March 2009 for the last 154 cases based on the experience of an aggregate of 544 cases since 1999 we believe results in an acceptable level of symptomatic and anatomic recurrence without using meshLaparoscopic repair of paraoesophageal hernia is the standard operative approach for our patients Compared to open operation postoperative complications were low and length of stay in hospital was greatly shortened Improved outcomes with a lower morbidity and mortality were obtained and this technique has resulted in very acceptable recurrence rates
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