Skip to main content
SpringerLink
Log in

Laparoscopic Repair of a Giant Hiatus Hernia—How I Do It

  • how i do it
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

The laparoscopic approach is now the technique of choice for the repair of large hiatus hernia. It is associated with a low risk of complications. However, controversy exists as to the optimal technique for laparoscopic repair. In this paper, we describe our approach. This entails full dissection of the hernia sac from the mediastinum, hiatal repair with posteriorly placed sutures, and then construction of an appropriate fundoplication. Whether the use of mesh for hiatal repair will reduce the risk of subsequent reintervention and not add any new risks is, however, unclear. For this reason, we believe that the mesh should only be used in appropriately designed clinical trials, and for now, the standard approach to laparoscopic repair of a large hiatus hernia is sutured repair.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11

Similar content being viewed by others

References

  1. Stylopoulos N, Rattner DW. The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg 2005;241(1):185–193.

    PubMed  Google Scholar 

  2. Krysztopik RJ, Jamieson GG, Devitt PG, Watson DI. A further modification of fundoplication. 90 degrees anterior fundoplication. Surg Endosc 2002;16(10):1446–1451.

    Article  PubMed  CAS  Google Scholar 

  3. Watson DI, Liu JF, Devitt PG, Game PA, Jamieson GG. Outcome of laparoscopic anterior 180-degree partial fundoplication for gastroesophageal reflux disease. J Gastrointest Surg 2000;4(5):486–492.

    Article  PubMed  CAS  Google Scholar 

  4. Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M. Laparoscopic Nissen fundoplication. Ann Surg 1994;220(2):137–145.

    Article  PubMed  CAS  Google Scholar 

  5. Catarci M, Gentileschi P, Papi C, Carrara A, Marrese R, Gaspari AL, Grassi GB. Evidence-based appraisal of antireflux fundoplication. Ann Surg 2004;239(3):325–337.

    Article  PubMed  Google Scholar 

  6. Aly A, Munt J, Jamieson GG, Ludemann R, Devitt PG, Watson DI. Laparoscopic repair of large hiatal hernias. Br J Surg 2005;92(5):648–653.

    Article  PubMed  CAS  Google Scholar 

  7. Watson DI, Davies N, Devitt PG, Jamieson GG. Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 1999;134(10):1069–1073.

    Article  PubMed  CAS  Google Scholar 

  8. Donkervoort SC, Bais JE, Rijnhart-de Jong H, Gooszen HG. Impact of anatomical wrap position on the outcome of Nissen fundoplication. Br J Surg 2003;90(7):854–859.

    Article  PubMed  CAS  Google Scholar 

  9. Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR, Schauer PR. Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 2002;74(6):1909–1915. discussion 1915–1906.

    Article  PubMed  Google Scholar 

  10. Parameswaran R, Ali A, Velmurugan S, Adjepong SE, Sigurdsson A. Laparoscopic repair of large paraesophageal hiatus hernia: quality of life and durability. Surg Endosc 2006;20(8):1221–1224.

    Article  PubMed  CAS  Google Scholar 

  11. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 2002;137(6):649–652.

    Article  PubMed  Google Scholar 

  12. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 2005;140(1):40–48.

    Article  PubMed  Google Scholar 

  13. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006;244(4):481–490.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Flinders Medical Centre, Flinders University, Room 3D211, Bedford Park, South Australia, 5042, Australia

    Bas P. L. Wijnhoven & David I. Watson

Authors
  1. Bas P. L. Wijnhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David I. Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David I. Watson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wijnhoven, B.P.L., Watson, D.I. Laparoscopic Repair of a Giant Hiatus Hernia—How I Do It. J Gastrointest Surg 12, 1459–1464 (2008). https://doi.org/10.1007/s11605-008-0473-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-008-0473-3

Keywords

Search

Navigation