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Laparoscopic posterior cruroplasty: a patient tailored approach

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Abstract

Background

Different surgical variations have been described for laparoscopic crural repair however, the technique is not standardized and left to the surgeons’ preference.

Objective

The purpose of this study is to describe a standardized “patient tailored” approach for laparoscopic posterior cruroplasty in the setting of elective hiatal hernia repair.

Methods

Retrospective single-center study was conducted (November 2015 to November 2019). The technical aspects of a standardized “patient tailored” laparoscopic posterior crural repair are described. Perioperative outcomes and patients’ quality of life, measured with the disease specific Gastro-Esophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) and generic Short Form-36 (SF-36), were analyzed.

Results

One hundred and forty-one patients were treated for symptomatic hiatal hernia according to the described “patient tailored” concept. Overall, 102 (72.3%) patients underwent simple suture repair while simple suture repair buttressed with biosynthetic resorbable U shaped mesh [Phasix ST®-Bard] was used in 39 (27.7%) patients. Toupet fundoplication was fashioned in all patients. The median operative time was 131 min (IQR 55–240). No intraoperative complications or conversion to open surgery occurred. The median postoperative stay was 1.8 days (range 1–7). The overall postoperative complication rate was 4.2%. The median follow-up was 21 months (IQR range 1–34) with 102 patients having a minimum follow-up of 6 months. Recurrent hernia was diagnosed in three patients (2.1%), but none required reoperation. No mesh-related complications occurred. Compared to baseline, the median GERD-HRQL (p = 0.003) and all SF-36 items (p < 0.001) were significantly improved.

Conclusion

The application of a standardized “patient tailored” concept for laparoscopic posterior cruroplasty seems safe and effective in the medium-term follow-up with promising perioperative outcomes and quality of life improvement. This approach may be valuable to assure procedure reproducibility, standardization, and to uniformly interpret the outcomes.

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Acknowledgements

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Authors and Affiliations

  1. Department of Biomedical Science for Health, Division of General Surgery, University of Milan, Istitituto Clinico Sant’Ambrogio, Via Luigi Giuseppe Faravelli, 16, 20149, Milan, Italy

    A. Aiolfi, G. Saino, A. Sozzi, G. Bonitta & D. Bona

  2. Department of Surgery, University of Insubria, Istituto Clinico Sant’Ambrogio, Milano, Italy

    M. Cavalli & G. Campanelli

  3. Department of Pathophysiology and Transplantation INCO and General Surgery, University of Milan, Istituto Clinico Sant’Ambrogio, Milan, Italy

    G. Micheletto

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  1. A. Aiolfi
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  2. M. Cavalli
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  3. G. Saino
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  4. A. Sozzi
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  5. G. Bonitta
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  6. G. Micheletto
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  7. G. Campanelli
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  8. D. Bona
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Contributions

AA, AS, and GB did the literature search. AA and DB formed the study design. Data collection done by AA, MC and GC. AA, AS, and GS analysed the data. AA, GS, GM and DB interpreted the data and AA, GC and DB critically reviewed the manuscript.

Corresponding author

Correspondence to A. Aiolfi.

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Conflict of interest

DB, MC, GS, AS, GB, GM, GC and AA declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Informed consent

Informed consent was obtained from all patients prior to all surgical procedures.

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Aiolfi, A., Cavalli, M., Saino, G. et al. Laparoscopic posterior cruroplasty: a patient tailored approach. Hernia 26, 619–626 (2022). https://doi.org/10.1007/s10029-020-02188-5

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  • DOI: https://doi.org/10.1007/s10029-020-02188-5

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