Page 51 - World Journal of Laparoscopic Surgery

Preventing Mesh Complications at Hiatus
use of falciform ligament to buttress the crural repair evaluating 2. Smith GS, Isaacson JR, Draganic BD, et al. Symptomatic and radiological
the recurrences in long-term. follow-up after para-esophageal hernia repair. Dis Esophagus
Li et al. in their study on cadavers found the average length of 2004;17(4):279–284. DOI: 10.1111/j.1442-2050.2004.00426.x.
14
the falciform ligament to be 8.3 cm. Location of falciform ligament 3. Granderath FA, Schweiger UM, Pointner R. Laparoscopic antireflux
in the body is such that it can be easily released and rotated under surgery: tailoring the hiatal closure to the size of hiatal surface area.
Surg Endosc 2007;21(4):542–548. DOI: 10.1007/s00464-006-9041-7.
the left lobe of the liver and that vascularized pedicle can be placed 4. Hazebroek EJ, Leibman S, Smith GS. Erosion of a composite PTFE/ePTFE
at the hiatus with no trouble. Hence this is an easy and simple mesh after hiatal hernia repair. Surg Laparosc Endosc Percutan Tech
technique that is easily reproducible. With this novel technique 2009;19(2):175–177. DOI: 10.1097/SLE.0b013e3181a11926.
described here in this series, using falciform ligament between the 5. Dutta S. Prosthetic esophageal erosion after mesh hiatoplasty in a
mesh and the esophagus prevents the direct contact of mesh with child, removed by transabdominal endogastric surgery. J Pediatr
the esophagus thereby providing the strength of mesh repair and Surg 2007;42(1):252–256. DOI: 10.1016/j.jpedsurg.2006.09.043.
also reducing mesh-related complications. 6. Tatum RP, Shalhub S, Oelschlager BK, et al. Complications of PTFE
However, further multicentric studies with larger sample mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008;12(5):
953–957. DOI: 10.1007/s11605-007-0316-7.
size are needed to propose this novel technique in the standard 7. Coluccio G, Ponzio S, Ambu V, et al. Dislocation into the cardial lumen
operative protocol. of a PTFE prosthesis used in the treatment of voluminous hiatal sliding
hernia, a case report. Minerva Chir 2000;55(5):341. PMID: 10953570.
conclusion 8. Granderath FA, Schweiger UM, Kamolz T, et al. Laparoscopic Nissen
fundoplication with prosthetic hiatal closure reduces postoperative
This innovative technique of using falciform ligament as a bridge intrathoracic wrap herniation: preliminary results of a prospective
between the mesh and the esophagus prevents the mesh-related randomized functional and clinical study. Arch Surg 2005;140(1):
complication without compromising the strength of hiatal repair. 40–48. DOI: 10.1001/archsurg.140.1.40.
9. Frantzides CT, Madan AK, Carlson MA, et al. A prospective,
Clinical Significance randomized trial of laparoscopic polytetrafluoroethylene (PTFE)
To prevent the recurrence of hiatus hernia, the use of prosthetic patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg
meshes is advocated in patients with large hiatal surface areas. 2002;137(6):649–652. DOI: 10.1001/archsurg.137.6.649.
Concern about the safety of mesh at the hiatus has been there. 10. Gajbhiye R, Quraishi AH, Mahajan P, et al. Dysphagia due to
This technique helps in reducing the mesh-related complication transmural migration of polypropylene mesh into esophagus. Indian
J Gastroenterol 2005;24(5):226. PMID: 16361777.
at the hiatus. 11. Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic prosthesis
Authorship Declaration to prevent recurrence after laparoscopic paraesophageal hernia
repair: long-term follow-up from a multicenter, prospective,
We, all the authors declare that all of us have contributed to this randomized trial. J Am Coll Surg 2011;213(4):461–468. DOI: 10.1016/
manuscript and are in complete agreement with the content of j.jamcollsurg.2011.05.017.
the manuscript. 12. Grossman RA, Brody FJ, Schoolfield CS, et al. Laparoscopic hiatal
hernia repair with falciform ligament buttress. J Gastrointest Surg
2018;22(7):1144–1151. DOI: 10.1007/s11605-018-3798-6.
AcknowledgMent 13. Varga G, Cseke L, Kalmar K, et al. Prevention of recurrence by
Authors would like to thank the collaboration of all the elements reinforcement of hiatal closure using ligamentum teres in
of Zen Digestive disease center, Mumbai, India. laparoscopic repair of large hiatal hernias. Surg Endosc Intervent
Tech 2004;18(7):1051–1053. DOI: 10.1007/s00464-003-9205-7.
14. Li XP, Xu DC, Tan HY, et al. Anatomical study on the morphology and
references blood supply of the falciform ligament and its clinical significance.
1. Aly A, Munt J, Jamieson GG, et al. Laparoscopic repair of large hiatal Surg Radiol Anat 2004;26(2):106–109. DOI: 10.1007/s00276-003-
hernias. Br J Surg 2005;92(5):648–653. DOI: 10.1002/bjs.4916. 0184-0.

World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 49