Giant hiatus hernia: closure of the difficult hiatus

Summary

Background

Repair of the large hiatus hernia has been troubled by diaphragmatic hiatal repair failure and recurrence. Use of mesh repair may reduce recurrence at a cost of increased reoperative complications and mesh fistulation. Methods of hiatal closure facilitation are described.

Methods

Techniques and accompanying intra-surgery pictures are discussed here based on personal experience from within a service performing variable 100 giant hernia repairs annually.

Results

Techniques for closure of a large hiatus without mesh repair are described with illustration, the purpose to expose various techniques utilized in a service performing more than 100 giant hernia repairs annually.

Conclusion

Techniques adopted and described in this article may facilitate both mesh and non-mesh repair of crural hiatal defects associated with giant hiatus hernia.

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Authors

Corresponding author

Correspondence to Gregory L. Falk MB.BS, FRACS, FACS.

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Conflict of interest

G.L. Falk, T.J. D’Netto, and S.C. Little declare that they have no competing interests.

Ethical standards

Prospective patient data were collated from a password-protected practice database and collated for publication. The database was approved by the institutional ethics (CH62/6/2011-092).

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Caption Electronic Supplementary Material

Video figure-of-eight suture left diaphragmatic recruitment taken during hiatus repaire. Video was taken using Stryker video camera

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Falk, G.L., D’Netto, T.J. & Little, S.C. Giant hiatus hernia: closure of the difficult hiatus. Eur Surg 51, 291–294 (2019). https://doi.org/10.1007/s10353-019-00612-4

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Keywords

  • Giant Hiatus Hernia
  • Para-oesophageal
  • Recurrence
  • Hiatus repair
  • Technique