Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature

Johnson, J. M.; Carbonell, A. M.; Carmody, B. J.; Jamal, M. K.; Maher, J. W.; Kellum, J. M.; DeMaria, E. J.
March 2006
Surgical Endoscopy;Mar2006, Vol. 20 Issue 3, p362
Academic Journal
journal article
Background: Little grade A medical evidence exists to support the use of prosthetic material for hiatal closure. Therefore, the authors compiled and analyzed all the available literature to determine whether the use of prosthetic mesh in hiatoplasty for routine laparoscopic fundoplications (LF) or for the repair of large (>5 cm) paraesophageal hernias (PEH) would decrease recurrence.Methods: A literature search was performed using an inclusive list of relevant search terms via Medline/PubMed to identify papers (n = 19) describing the use of prosthetic material to repair the crura of patients undergoing laparoscopic PEH reduction, LF, or both.Results: Case series (n = 5), retrospective reviews (n = 6), and prospective randomized (n = 4) and nonrandomized (n = 4) trials were identified. Laparoscopic procedures (n = 1,368) were performed for PEH, gastroesophageal reflux disease (GERD), hiatal hernia, or a combination of the three. Group A (n = 729) had primary suture repair of the crura, and group B (n = 639) had repair with either interposition of mesh to close the hiatus or onlay of prosthetic material after hiatal or crural closure. The use of mesh was associated with fewer recurrences than primary suture repair in both the LF and PEH groups. The mean follow-up period did not differ between the groups (20.7 months for group A vs. 19.2 months for group B). None of the papers cited any instance of prosthetic erosion into the gastrointestinal tract.Conclusions: The current data tend to support the use of prosthetic materials for hiatal repair in both routine LF and the repair of large PEHs. Longer and more stringent follow-up evaluation is necessary to delineate better the safety profile of mesh hiatoplasty. Future randomized trials are needed to confirm that mesh repair is superior to simple crural closure.


Related Articles

  • Transfascial Suture Hernia: A Rare Form of Recurrence After Laparoscopic Ventral Hernia Repair. Khandelwal, Radha Govind; Bibyan, Monika; Reddy, Prasanna K. // Journal of Laparoendoscopic & Advanced Surgical Techniques;Nov2010, Vol. 20 Issue 9, p753 

    Laparoscopic repair of ventral or incisional hernia is among the most commonly performed minimally invasive procedures. Different modes of recurrence have been reported in literature, including missed defects, mesh migration, mesh infection, etc. Transfascial suture fixation in addition to...

  • Transvesical Peritoneoscopy: Initial Clinical Evaluation of the Bladder as a Portal for Natural Orifice Translumenal Endoscopic Surgery. Gettman, Marthew T.; Blum, Michael L. // Mayo Clinic Proceedings;Jul2007, Vol. 82 Issue 7, p843 

    Abdominal surgery has traditionally been performed through large Incisions Into the peritoneal cavity. In the past decade, traditional open surgery has been Increasingly replaced by minimally invasive laparoscopic and robotic techniques. In comparison to open surgery, these approaches can...

  • The Elective Surgical Management of Incisional Herniae: A Review. Thomas, G. P. // Internet Journal of Surgery;2007, Vol. 9 Issue 2, p5 

    This review article looks at the evidence available comparing the different surgical techniques for managing incisional herniae (direct suture closure, open mesh repair and laparoscopic mesh repair). Open mesh repair appears to have a lower rate of recurrence than direct suture closure....

  • Laparoscopic hernia surgery: from birth to adolescence. Ger, Ralph // Hernia;Sep2003, Vol. 7 Issue 3, p110 

    This article focuses on laparoscopic hernia surgery. The introduction of antiseptic techniques led to the commencement of modern operative surgery for the treatment of inguinal hernias. Simultaneously the anatomy of the inguinal canal became the focus of attention, attracting new descriptions...

  • Factors involved in abdominal wall closure and subsequent incisional hernia. O'Dwyer, P. J.; Courtney, C. A. // Surgeon (Edinburgh University Press);Feb2003, Vol. 1 Issue 1, p17 

    Examines related factors which contribute to incisional hernia and other chronic wound problems after laparotomy in order to provide an evidence-based approach to abdominal wall closure. Factors that influence the choice of an abdominal incision; Randomized trials comparing lateral paramedian...

  • Evaluation of quality of life after laparoscopic surgery. Korolija, D.; Sauerland, S.; Wood-Dauphinée, S.; Abbou, C. C.; Eypasch, E.; García#Caballero, M.; Lumsden, M. A.; Millat, B.; Monson, J. R. T.; Nilsson, G.; Pointner, R.; Schwenk, W.; Shamiyeh, A.; Szold, A.; Targarona, E.; Ure, B.; Neugebauer, E. // Surgical Endoscopy;Jun2004, Vol. 18 Issue 6, p879 

    Background: Measuring health-related quality of life (QoL) after surgery is essential for decision making by patients, surgeons, and payers. The aim of this consensus conference was twofold. First, it was to determine for which diseases endoscopic surgery results in better postoperative QoL than...

  • Minimally invasive incisional herniorrhaphy. Frantzides, C.T.; Carlson, M.A.; Zografakis, J.G.; Madan, A.K.; Moore, R.E. // Surgical Endoscopy;Oct2004, Vol. 18 Issue 10, p1488 

    Background: Minimally invasive incisional herniorrhaphy has become an accepted approach for incisional hernia. However, the ideal technique for this procedure is not known. The authors present their technique and personal experience with minimally invasive incisional herniorrhaphy. Methods: A...

  • Laparoscopic approach to incisional hernia. Carbajo, M.A.; Mart?n del Olmo, J.C.; Blanco, J.I.; Toledano, M.; Cuesta, C.; Ferreras, C.; Vaquero, C. // Surgical Endoscopy;Jan2003, Vol. 17 Issue 1, p118 

    Background: After more than 8 years of working in the field, we thought it would be interesting to evaluate our experience in the laparoscopic repair of abdominal wall hernias, focusing attention on the lessons learned with time. Methods: From January 1994 to November of 2000, a total of 270...

  • Treatment of Chronic Recurrent Abdominal Pain: Laparoscopy or Hypnosis? Galili, Offer; Shaoul, Ron; Mogilner, Jorge // Journal of Laparoendoscopic & Advanced Surgical Techniques;Feb2009, Vol. 19 Issue 1, p93 

    Objective: Functional chronic recurrent abdominal pain (FCRAP) is long lasting, intermittent, or constant pain affecting 15–30% of children ages 4–18 and presents a diagnostic and treatment challenge to the physician. The predictive value of diagnostic tests is questionable, and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics