[Laparoscopic treatment of large hiatal hernias using a prosthesis. Report of ten cases].

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.