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Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias

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Abstract

Background

Several attempts were made to develop an effective technique to reduce the high recurrence rate associated with the repair of large hiatal hernias.

Methods

A new laparoscopic technique was introduced to reinforce hiatal closure with the ligamentum teres. Its feasibility, safety, and efficacy were evaluated. Four patients with gastroesophageal reflux disease and large hiatal hernia (>6 cm) entered the study. After closure of the diaphragmatic crura the teres ligament was dissected, brought behind the esophagus, and sutured to the crura. A fundoplication was also added. Patients were followed with barium swallow at 3 months postoperatively.

Results

The mean operation time was 109.5 min. No intraoperative complications, perioperative morbidity, or mortality were registered. At the follow-up, barium swallows revealed no recurrence.

Conclusion

On the basis of these preliminary results laparoscopic reinforcement of the hiatal closure with the ligamentum teres seems feasible and safe; therefore this promising technique should be considered as an option for the treatment of large hiatal hernias.

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References

  1. T Bammer RA Hinder A Klaus PJ Klinger (2001) ArticleTitleFive- to eight-year outcome of the first laparoscopic Nissen fundoplications. J Gastrointest Surg 5 42–48 Occurrence Handle10.1016/S1091-255X(01)80012-3 Occurrence Handle1:STN:280:DC%2BD3M3htlGrtA%3D%3D Occurrence Handle11309647

    Article  CAS  PubMed  Google Scholar 

  2. N Basso P Rosato A Leo ParticleDe A Genco S Rea T Neri (1999) ArticleTitle“Tension-free” hiatoplasty, gastrophrenic anchorage, and 360 degree fundoplication in the laparoscopic treatment of paraesophageal hernia. Surg Laparosc Endosc Percutan Tech 9 257–262 Occurrence Handle10.1097/00019509-199908000-00005 Occurrence Handle1:STN:280:DC%2BD3czis12rtQ%3D%3D Occurrence Handle10871172

    Article  CAS  PubMed  Google Scholar 

  3. MA Carlson RE Condon KA Ludwig WJ Shulte (1998) ArticleTitleManagement of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 187 227–230 Occurrence Handle10.1016/S1072-7515(98)00162-8 Occurrence Handle1:STN:280:DyaK1cvhtVyqtg%3D%3D Occurrence Handle9740178

    Article  CAS  PubMed  Google Scholar 

  4. M Casaccia P Torelli F Panaro D Cavaliere A Ventura U Valente (2002) ArticleTitleLaparoscopic physiological hiatoplasty for hiatal hernia: new composite “A”-shaped mesh. Surg Endosc 16 1441–1445 Occurrence Handle10.1007/s00464-002-9029-x Occurrence Handle1:STN:280:DC%2BD38nktlWltA%3D%3D Occurrence Handle12085149

    Article  CAS  PubMed  Google Scholar 

  5. G Coluccio S Ponzio V Ambu R Tramontano G Cuomo (2000) ArticleTitleDislocation into the cardial lumen of a PTFE prosthesis used in the treatment of voluminous hiatal sliding hernia. A case report. Minerva Chir 55 341–345 Occurrence Handle1:STN:280:DC%2BD3cvjvFGnuw%3D%3D

    CAS  Google Scholar 

  6. NR Floch RA Hinder PJ Klingler SA Branton MH Seelig T Bammer CJ Filipi (1999) ArticleTitleIs laparoscopic reoperation for failed antireflux surgery feasible? Arch Surg 134 733–737 Occurrence Handle10.1001/archsurg.134.7.733 Occurrence Handle1:STN:280:DyaK1MzivVamsw%3D%3D Occurrence Handle10401824

    Article  CAS  PubMed  Google Scholar 

  7. CT Frantzides AK Madan MA Carlson GP Stavropoulos (2002) ArticleTitleA prospective randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137 649–652 Occurrence Handle10.1001/archsurg.137.6.649 Occurrence Handle12049534

    Article  PubMed  Google Scholar 

  8. CT Frantzides CG Richards MA Carlson (1999) ArticleTitleLaparoscopic repair of large hiatal hernia with polytetrafluoroethylene. Surg Endosc 13 906–908 Occurrence Handle10.1007/s004649901131 Occurrence Handle1:STN:280:DyaK1MzotVKlsA%3D%3D Occurrence Handle10449850

    Article  CAS  PubMed  Google Scholar 

  9. FA Granderath T Kamolz UM Schweiger R Pointner (2003) ArticleTitleLaparoscopic antireflux surgery for gastroesophageal reflux disease: experience with 668 laparoscopic procedures. Int J Colorectal Dis 18 73–77 Occurrence Handle10.1007/s00384-002-0405-8 Occurrence Handle12458385

    Article  PubMed  Google Scholar 

  10. S Horgan D Pohl D Bogetti T Eubanks C Pellegrini (1999) ArticleTitleFailed antireflux surgery. What have we learned from reoperations? Arch Surg 134 809–817 Occurrence Handle10.1001/archsurg.134.8.809 Occurrence Handle1:STN:280:DyaK1MzntFCjsA%3D%3D Occurrence Handle10443802

    Article  CAS  PubMed  Google Scholar 

  11. JG Hunter CD Smith GD Branun JP Waring TL Trus M Cornwall K Galloway (1999) ArticleTitleLaparoscopic fundoplication failures: pattern of failure and response to fundoplication revision. Ann Surg 230 595–604 Occurrence Handle10.1097/00000658-199910000-00015 Occurrence Handle1:STN:280:DyaK1MvltVGltg%3D%3D Occurrence Handle10522729

    Article  CAS  PubMed  Google Scholar 

  12. IM Janssen DJ Gouma P Klementschitsch MN Heyde Particlevan der H Obertop (1993) ArticleTitleProspective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease. Br J Surg 80 875–878 Occurrence Handle1:STN:280:ByyA2sbot1w%3D Occurrence Handle8369923

    CAS  PubMed  Google Scholar 

  13. E Kemppainen T Kiviluoto (2000) ArticleTitleFatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia. Surg Endosc 14 593 Occurrence Handle1:STN:280:DC%2BD38%2Fgsl2rtQ%3D%3D

    CAS  Google Scholar 

  14. GG Kuster S Gilroy (1993) ArticleTitleLaparoscopic technique for repair of paraesophageal hiatal hernia. J Laparoendosc Surg 3 331–338 Occurrence Handle1:STN:280:ByuD1MzgsVM%3D Occurrence Handle8268502

    CAS  PubMed  Google Scholar 

  15. C Meyer N DeManzini S Rohr CL Thiry V Perraud (1994) ArticleTitleLaparoscopic treatment of gastroesophageal reflux. Cardiopexia with the round ligament versus Nissen’s type fundoplication. Chirurgia 120 107–112

    Google Scholar 

  16. LK Nathanson S Shimi A Cuschieri (1991) ArticleTitleLaparoscopic ligamentum teres (round ligament) cardiopexy. Br J Surg 78 947–951 Occurrence Handle1:STN:280:By2D3cvms1c%3D Occurrence Handle1913114

    CAS  PubMed  Google Scholar 

  17. MG Paul RP DeRosa PE Petrucci ML Palmer SH Danovitch (1997) ArticleTitleLaparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 11 303–307 Occurrence Handle10.1007/s004649900351 Occurrence Handle1:STN:280:ByiB3snnsVE%3D Occurrence Handle9079617

    Article  CAS  PubMed  Google Scholar 

  18. NJ Soper D Dunnegan (1999) ArticleTitleAnatomic fundoplication failure after laparoscopic antireflux surgery. Ann Surg 229 669–677 Occurrence Handle10.1097/00000658-199905000-00009 Occurrence Handle1:STN:280:DyaK1M3kvFKjtg%3D%3D Occurrence Handle10235525

    Article  CAS  PubMed  Google Scholar 

  19. W Valiati KH Fuchs SM Freys M Fein J Maroske H Tigges A Thiede (2000) ArticleTitleLaparoscopic fundoplication—short- and long-term outcome. Langenbeck’s Arch Surg 385 324–328 Occurrence Handle10.1007/s004230000159 Occurrence Handle1:STN:280:DC%2BD3cvns1Wksw%3D%3D

    Article  CAS  Google Scholar 

  20. DI Watson GG Jamieson RS GamePA Williams PG Devitt (1999) ArticleTitleLaparoscopic reoperation following failed antireflux surgery. Br J Surg 86 98–101 Occurrence Handle10.1046/j.1365-2168.1999.00976.x Occurrence Handle1:STN:280:DyaK1M7kvFKitA%3D%3D Occurrence Handle10027370

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Medical Faculty, University of Pécs, H-7643 Pécs Ifjúság u.13, Hungary

    G. Varga, L. Cseke, K. Kalmár & Ö. P. Horváth

Authors
  1. G. Varga
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  2. L. Cseke
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  3. K. Kalmár
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  4. Ö. P. Horváth
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Correspondence to G. Varga.

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Varga, G., Cseke, L., Kalmár, K. et al. Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias. Surg Endosc 18, 1051–1053 (2004). https://doi.org/10.1007/s00464-003-9205-7

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