Annales de chirurgie · 2002
[Laparoscopic treatment of large hiatal hernias using a prosthesis. Report of ten cases].
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Meyer C, Buffler A, Rohr S, Lima M C
Аннотация
OBJECTIVE: To evaluate prospectively the laparoscopic surgery for giant hiatal hernias treated by fundoplication and hiatal prosthesis.
PATIENTS AND METHODS: Ten patients were included in this study. Surgical technic included the dissection of oesophageal hiatus, the sac excision and the dissection of the abdominal oesophagus to obtain a physiological length. The decision criterion for a prosthesis was the hiatus oesophagus diameter of 5 cm or more. The crura were closed and the hiatus was reinforce by a prosthesis of 15 x 15 cm. All patients underwent a fundoplication whether partial or complete.
RESULTS: Eight patients had a type III hernia, and 2 had a type II. The mean size for the hiatus was 6.5 cm (5.5-8). Eight patients underwent a total fundoplicature and 2 a partial one. The prosthesis was made of polypropylene in 5 cases. Average operating time was 182 min (78-240). One patient had postoperative morbidity, with gastroplagia which resolved. There was no mortality. Mean hospitalisation duration was 7.7 days (5-12). No one case of recurrence have been noticed after a mean follow-up of 24 months (8-40).
CONCLUSION: It appears that the large size hiatal hernia (more than 5 cm) can be treated with good results by using a prosthesis during laparoscopic fundoplication.
PATIENTS AND METHODS: Ten patients were included in this study. Surgical technic included the dissection of oesophageal hiatus, the sac excision and the dissection of the abdominal oesophagus to obtain a physiological length. The decision criterion for a prosthesis was the hiatus oesophagus diameter of 5 cm or more. The crura were closed and the hiatus was reinforce by a prosthesis of 15 x 15 cm. All patients underwent a fundoplication whether partial or complete.
RESULTS: Eight patients had a type III hernia, and 2 had a type II. The mean size for the hiatus was 6.5 cm (5.5-8). Eight patients underwent a total fundoplicature and 2 a partial one. The prosthesis was made of polypropylene in 5 cases. Average operating time was 182 min (78-240). One patient had postoperative morbidity, with gastroplagia which resolved. There was no mortality. Mean hospitalisation duration was 7.7 days (5-12). No one case of recurrence have been noticed after a mean follow-up of 24 months (8-40).
CONCLUSION: It appears that the large size hiatal hernia (more than 5 cm) can be treated with good results by using a prosthesis during laparoscopic fundoplication.