Page 28 - WJOLS - Laparoscopic Journal

Amol S Jeur

A C

B D

Figs 2A to D: Types of hiatus hernia

of giant paraesophageal and mixed hiatal hernias was • Primary closure of hiatal hernia defect with either suture
performed (Figs 2A to D). Particular attention was paid to approximation of crura or by different type of mesh
the use of meshes for reinforcement of the hiatal repair.
application (for tension free repair)
OPERATIVE PROCEDURE • After closing the hiatus a fundoplication (Nissen or
toupet) with or without collis gastroplasty will complete
The standard surgical technique include: the operation depending upon the finding of intraoperative
• Standerd five cannula technique
• Devide the lesser omentum to expose the right hilar piller assessment of short esophagus and esophageal
within the sac manometry.
• Reduction of hernia by means of atraumatic grasper in The most controversial issue in the use of prostheses in
a hand over hand fashion the hiatus is the surgical technique. Several models have
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• Complete excision of sac been proposed, which are discussed below.
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