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RESEARCH ARTICLE
Laparoscopic Management of Hiatus Hernia

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Mela Ram Attri , Irfan Nazir Mir , Irshad Ahmad Kumar 3
AbstrAct
Introduction: Hiatus hernia is axial type of hernia occurring at the esophageal opening of diaphragm. Large hiatal hernias have increased risk
for severe complications that can include gastric strangulation, bleeding, and perforation. This study presents our technique and results of
laparoscopic management of hiatus hernia.
Materials and methods: This study was done retrospectively on 42 patients from data over a period of last 10 years (April 2010–March 2020)
in a tertiary care hospital.
Results: Total number of patients included in our study were 42. The range of age and the mean age of patients were 22–60 years and 38.36
(SD 8.018), respectively. Heartburn (32, 76.19%) was the most common symptom. Nissen’s fundoplication was our primary choice performed in
37 (88.1%) patients. Few of our patients were comorbid and frail to whom Toupet’s repair (4, 9.52%) and gastropexy (1, 2.3%) were performed,
optimum to their conditions. Out of 42, mesh was placed in 17 (40.48%) patients including all the type IV and few of the type III patients. The
mean operative time, mean blood loss, and hospital stay were126.90 (SD 12.781 minutes), 62.14 (SD 17.605 mL), and 4.60 (SD 1.127 days),
respectively. Two patients were converted to open procedure. Recurrence occurred in three (7.1%) patients of type III hernia in whom only
fundoplication was done without mesh placement.
Conclusion: This study concluded that laparoscopic management of hiatus hernia is a feasible and safe option, with a very low morbidity and
mortality rate.
Keywords: Esophagogastroduodenoscopy, Gastroesophageal junction, Gastroesophageal reflux disease, Hiatus hernia.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1474

IntroductIon 1,3 Department of Surgery, GMC, Srinagar, Jammu and Kashmir, India
Hiatus hernia is axial type of hernia occurring at the esophageal 2 Department of Surgery, FNB Minimal Access, Sher-I-Kashmir Institute
opening of diaphragm. It is classified into four types according of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India
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to the anatomic characteristics. Type I hernia being the most Corresponding Author: Irfan Nazir Mir, Department of Surgery, FNB
common is also known as sliding hiatal hernia. Characteristic Minimal Access, Sher-I-Kashmir Institute of Medical Sciences, Soura,
feature of this type of hernia is the migration of gastroesophageal Srinagar, Jammu and Kashmir, India, Phone: +91 9906460646, e-mail:
junction (GEJ) into the posterior mediastinum. Type II, or true irfanazir@gmail.com
paraesophageal hernia, is characterized by herniation of the How to cite this article: Attri MR, Mir IN, Kumar IA. Laparoscopic
gastric fundus into the mediastinum alongside the esophagus, Management of Hiatus Hernia. World J Lap Surg 2021;14(3):208–211.
with the GEJ remaining in an intra-abdominal position. Type Source of support: Nil
III hernias, also called mixed hernias, involve herniation of the Conflict of interest: None
stomach with the GEJ into the mediastinum. Type IV hernias are
rare and are characterized by an intrathoracic stomach along
with associated viscera such as the spleen, colon, small bowel, introduced by Donahue and Bombeck in 1977 and validated by
or pancreas. Large hiatal hernias representing 5–10% of all DeMeester in 1986. In this technique, full mobilization of the GEJ
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hiatal hernias. Various symptoms occur in patients with hiatus and posterior fundus with division of the upper short gastric vessels
hernia namely obstructive symptoms (chest pain, vomiting, and a crural repair is done. The length of the wrap has been reduced
postprandial), respiratory symptoms (asthma, cough, dyspnea), over these years to the current 2.0 cm, and another modification
or gastroesophageal reflux disease (GERD). Large hiatal hernias made was ensuring a loose, “floppy” fundoplication. 8,9
have increased risk for severe complications that can include The morbidity with the open approach was mostly associated
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gastric strangulation, bleeding, and perforation. In Istanbul, with the wound. With the extension of laparoscopy to other
Nissen, in 1937, performed first fundoplication to prevent the procedures other than cholecystectomy, the morbidity of the
gastroesophageal reflux. In it, Nissen performed a transpleural procedures was avoided to a large extent; faster recovery and earlier
cardia resection and protected the anastomosis within a gastric return to normal function were achieved. This study presents our
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fold. technique and results of laparoscopic management of hiatus hernia,
Since the 1950s, the repair of hiatal hernias has been performed performed by a single surgeon, in last 10 years.
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traditionally via open laparotomy or thoracotomy. The first
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laparoscopic hiatal hernia repair was done by Cuschieri et al. in
1992. The first fundoplication without resection was performed in MAterIAls And Methods
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1955 and reported in 1956. Various modifications were introduced A retrospective cohort study of 42 patients operated
into the technique commenced by the coworker of Nissen and laparoscopically was done. We analyzed retrospectively the
Rossetti. The total wrap commonly performed nowadays was data recorded from patients who underwent laparoscopic
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