Laparoscopic Repair of Hiatal Hernia

Kook Joo Na, Ju Sik Yun, Seok Kim, Sang Yun Song

Lung and Esophageal Cancer Clinic, Chonnam National University Hwasun Hospital, Jeollanamdo, Korea (South)

Date, time and location: 2018.05.26 13:30, Congress Hall, 2F–C

Abstract

Objective

Laparoscopic hiatal hernia repair is a complex operation and seems to be associated with a high recurrence rates. We introduce our experience with laparoscopic repair of hiatal hernia

Methods

We performed minimally invasive esophageal surgery (MIES) in esophageal cancer patients since September 2004, and began performing laparoscopic repair of hiatal hernia in January 2006. 18 consecutive patients had undergone this approach.

Results

There were 1 male and 17 female with a median age of 73 years (range, 37–81 years). Nine patients (50%) were symptomatic. Among them, 6 (75%) suffered from reflux symptoms such as heartburn. 4 patients had a history of abdominal surgery. The type of hiatal hernia was I in 3 patients, II in 9, III in 5, and IV in 1. Out of the 18 laparoscopic procedures, two required a conversion (11.1%): one due to relatively small abdominal cavity and large liver and one due to severe adhesion. All the patients underwent complete hernia sac dissection, crural reapproximation, and Nissen fundoplication (antireflux procedure) routinely. Modified Collis gastroplasty (esophageal lengthening procedure) was used in five patients (27.8%). The mean operation time was 213.8± 70.1 min (range, 120~425 min) and mean hospital stay was 6.2± 1.5 days (range, 4~9 days). There were no postoperative complications. At the time of last follow-up, 83.3% of patients were asymptomatic, despite three patients complained of reflux or dysphagia. Recurrent hiatal hernia was shown on a esophagogram in one patient at 3.5 years after laparoscopic surgery. This patient was being considered for revision surgery.

Conclusions

Laparoscopic repair of hiatal hernia is a feasible technique with a satisfactory surgical outcomes. It can be performed by thoracic surgeons experienced in the laparoscopic approach.