Page 30 - WJOLS - Laparoscopic Journal

Amol S Jeur

Fig. 7: Tension-free repair: Piece of mesh just covering the defect Fig. 9: Nontension-free repair with reinforcement of the crural closure
below the esophagus, overlapping both pillars laterally 16 to avoid the cutting effect of the stitches, using simple stitches with
Teflon or Dacron pledgets 19,20

Fig. 8: Tension-free repair. After a standard closure of the hiatus, a Fig. 10: Nontension-free repair with reinforcement of the crural
relaxing incision lateral to the right crura is performed, and a patch is closure, using a polypropylene strip along the crura to hold the stitches
fixed with stitches or staples covering the diaphragmmatic defect 17,18

covering the diaphragmmatic defect (Fig. 8). Described
17
by Huntington in 1997, it has been also proposed by
Horgan et al. 18

Nontension-free Techniques

A buttress mesh technique has also been described (Figs 9
to 11). A long strip of mesh is placed below the esophagus,
covering the pillar closure (Fig. 12). The advantage is that
it avoids the encircling of the esophagus, reducing the risk
22
of dysphagia or erosion. Champion and Rock reported
good results in a series of 52 cases, with a recurrence rate Fig. 11: Nontension-free repair with reinforcement of the crural closure,
of 2%. using a polypropylene piece of mesh covering both edges of the pillars 21

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