Introduction. Repair of hiatal hernias has been performed traditionally via
open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia
repair in 1992, this method had a growing popularity and today it is the
standard approach in experienced centers specialized for minimally invasive
surgery. Objective. In the current study we present our experience after 200
consecutive laparoscopic hiatal hernia repairs. Methods. A retrospective
cohort study included 200 patients who underwent elective laparoscopic
hiatal hernia repair at the Department for Minimally Invasive Upper
Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia
in Belgrade from April 2004 to December 2013. Results. Hiatal hernia types
included 108 (54%) patients with type I, 30 (15%) with type III, 62 (31%)
with giant paraesophageal hernia, while 27 (13.5%) patients presented with a
chronic gastric volvulus. There were a total of 154 (77%) Nissen
fundoplications. In 26 (13%) cases Nissen procedure was combined with
esophageal lengthening procedure (Collis-Nissen), and in 17 (8.5%) Toupet
fundoplications was performed. Primary retroesophageal crural repair was
performed in 164 (82%) cases, Cleveland Clinic Foundation suture
modification in 27 (13.5%), 4 (2%) patients underwent synthetic mesh
hiatoplasty, 1 (0.5%) primary repair reinforced with pledgets, and 4 (2%)
autologous fascia lata graft reinforcement. Poor result with anatomic and
symptomatic recurrence (indication for revisional surgery) was detected in 5
patients (2.7%). Conclusion. Based on the result analysis, we found that
laparoscopic hiatal hernia repair was a technically challenging but feasible
technique, associated with good to excellent postoperative outcomes
comparable to the best open surgery series.
Laparoscopic repair of hiatal hernias: Experience after 200 consecutive cases
