Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress

• DOI: 10.1007/s11605-015-2796-1
• Publication Date: 2015-03-18T18:57:37Z
• Authors: Raymond Laird; Fred Brody; Jeffrey N. Harr; Nathan G. Richards; Steve Zeddun
• Keywords: Male; Ligaments; Middle Aged; Radiography; 03 medical and health sciences; Hernia, Hiatal; 0302 clinical medicine; Recurrence; Humans; Female; Laparoscopy; Prospective Studies; Symptom Assessment; Herniorrhaphy; Aged; Follow-Up Studies

Buttressing the crura in paraesophageal hernia (PEH) repairs with synthetic mesh may be associated with erosions and dysphagia, while biologic buttresses are expensive and do not decrease long-term recurrence rates. This study documents outcomes following laparoscopic PEH repairs using the falciform ligament as a buttress.This is a prospective study of laparoscopic PEH repairs with a falciform ligament buttress. Preoperatively and at 6 months follow-up, medications, radiologic studies and symptom scores were recorded. Patients included had a hiatal defect greater than 5 cm, while recurrent PEH or prior gastric surgery patients were excluded.Thirty-four patients were included with a mean age of 61 years, and 33 patients completed postoperative evaluation with a mean follow-up of 7.1 months. The mean symptom severity decreased from 11.24 ± 1.71 to 3.24 ± 0.84, mean symptom frequency decreased from 11.62 ± 1.70 to 3.45 ± 0.85, and mean total symptom score decreased from 22.85 ± 3.40 to 6.69 ± 1.69 (p < 0.0001). Three patients had recurrences on the upper gastrointestinal (UGI) series. Only one required reoperation.Laparoscopic PEH repair with a falciform ligament buttress is a viable option. Ongoing follow-up will demonstrate the utility of this approach to decrease morbidity and recurrence rates for paraesophageal hernia repairs.