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Laparoscopic anti-reflux procedures with hepatic shoulder technique in the surgical management of large hiatal hernias and paraesophageal hernias: a follow-up study

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Abstract

Background

Numerous techniques have been historically proposed in the management of gastroesophageal reflux and paraesophageal hernias (PEH). A follow-up study (Quilici et al. in Surg Endosc 23(11):2620–2623, 2009) to a novel laparoscopic approach introduced in 2009 and performed in 49 patients is presented.

Methods

All procedures were performed via laparoscopy. Thirty-two patients underwent a Nissen Fundoplication, eleven a reduction of the PEH with a Nissen fundoplication, two without a fundoplication, and four with a Collis–Nissen fundoplication. In all patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect.

Results

At the time of laparoscopy, several patients were found not to be suitable candidates for this procedure (morphology of the left hepatic lobe). Forty-nine procedures were completed. One patient was re-explored on POD 2 for a tight hiatus post-Collis fundoplication. Post-operatively, all other patients did well without notable, unusual complaints. The average length of stay was 2.2 days. Although not statistically significant, 43 patients had no recurrence of symptoms with the longest follow-up at 10 years, two patients were lost to follow-up, one patient had a recurrence of the PEH and three patients stated they were experiencing some form of gastroesophageal reflux requiring medical management.

Conclusion

In selected patients, patients with an “at-risk” crural closure during a laparoscopic anti-reflux procedure or PEH can safely be managed via a laparoscopic anti-reflux procedure with the hepatic shoulder technique. This technique has shown good early post-operative results and could be used as an alternative to a laparoscopic mesh-reinforced fundoplication in difficult crural closures or in the management of large paraesophageal hernias.

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Authors and Affiliations

  1. Minimally Invasive and Bariatric Surgical Services, Providence Saint Joseph Medical Center, PSJHS, Burbank, CA, USA

    Philippe J. Quilici, Alexander Tovar, Jung Li & Tiffany Herrera

Authors
  1. Philippe J. Quilici
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  2. Alexander Tovar
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  3. Jung Li
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  4. Tiffany Herrera
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Correspondence to Philippe J. Quilici.

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Dr. Quilici, Dr. Tovar, Mrs. Jung Li, and Mrs. Tiffany Herrera have no conflicts of interest or financial ties to disclose.

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Quilici, P.J., Tovar, A., Li, J. et al. Laparoscopic anti-reflux procedures with hepatic shoulder technique in the surgical management of large hiatal hernias and paraesophageal hernias: a follow-up study. Surg Endosc 34, 2460–2464 (2020). https://doi.org/10.1007/s00464-019-07040-1

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