Page 13 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Laparoscopic Approach to Repair Hiatal Hernias: Our

Experience in a Tertiary Care Hospital

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Manzoor Ahmad , Ajay Thakral , Divya Prasad , Musharraf Husain 4
Received on: 09 September 2021; Accepted on: 06 September 2022; Published on: 07 December 2022
AbstrAct
Introduction: Hiatal hernia is commonly associated with the symptomatic gastroesophageal reflux disease (GERD). Protrusion of any abdominal
structure other than the esophagus into the thoracic cavity through the hiatus of the diaphragm. The relationship between hiatal hernia and
gastroesophageal reflux and proposed surgical options to correct the defect as established by the Allison, namely returning the stomach to
the abdomen and repairing the diaphragmatic hiatus. Proton pump inhibitors are a preferred treatment option for symptomatic relief. Surgical
treatment usually follows medical treatment. Depending on the severity of symptoms and type of hernia involved, surgical treatment is decided.
Laparoscopic repair is a good approach nowadays. It offers various benefits to both the patient and the surgeon. It is generally performed by
a general abdominal surgeon because it usually involves an abdominal approach. Laparoscopic repair significantly decreases postoperative
complications and is the procedure of choice in most centers.
Materials and methods: The present study protocol was reviewed and approved by the Institutional Review Board of Hospital, which waived the
requirement for informed patient consent based on the retrospective nature of the work. A single team of surgeon performed all the procedures.
Eighteen patients with primary hiatal hernia who underwent laparoscopic surgery from 2016 to 2018 were examined.
Results: The follow-up period was between 12 months and 24 months. The average follow-up period was around 18 months.
• Thirty-nine patients underwent laparoscopic hernia repair with fundoplication, of which 26 were females and 13 males.
• Most of the patients present with symptoms of heartburn or epigastric pain. Some of the patients presented with dyspepsia. Few patients
were diagnosed incidentally.
• The average age was 42 years (25–75).
• Operative time was 150–250 minutes with a mean time of 194 minutes. No patient needed conversion from laparoscopic procedure to open
technique.
• The hospital stay was 4–7 days with an average stay of 4.5 days. These included one-day preoperative admission.
• There were no deaths during or after the procedure.
• Pain: A total of 15 patients complained of pain on post-op day 1 who needed round-the-clock analgesia. This number fell to 5 by day 3. At the
time of discharge (maximum interval being 7 days and median being 5.5 days), none of the patients had complaints of pain.
• Two patients had symptoms of dysphagia at the outpatient follow-up. These patients showed no notable findings on imaging examination
and no difficulties with feeding, the symptoms were well-controlled with medication.
Conclusion: We conclude that laparoscopic repair of hiatal hernia is a feasible technique with satisfactory surgical outcomes. Although it is a
complex operation with a substantial learning curve, thoracic surgeons who have adequate experience with laparoscopy would be capable
of performing the operation.
Keywords: Esophagogastroduodenoscopy, Gastroesophageal junction, Gastroesophageal reflux disease, Hiatus hernia, Laparoscopy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1533

IntroductIon 1–4 Department of General Surgery, Hamdard Institute of Medical
Hiatus hernia is the bulging of an abdominal structure Sciences and Research, Delhi, India
other than the esophagus into the chest cavity through the Corresponding Author: Manzoor Ahmad, Department of General
hiatus of the diaphragm. Hiatal hernia is often associated with Surgery, Hamdard Institute of Medical Sciences and Research, Delhi,
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symptomatic GERD. The relationship between hiatal hernia India, Phone: +91 9811904143, e-mail: Drmanzor50@gmail.com
and gastroesophageal reflux and proposed surgical options for How to cite this article: Ahmad M, Thakral A, Prasad D, et al.
correcting the defect, as noted by Allison, namely, returning the Laparoscopic Approach to Repair Hiatal Hernias: Our Experience in a
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stomach to the abdomen and repairing the diaphragmatic hiatus. Tertiary Care Hospital. World J Lap Surg 2022;15(3):199–201.
The GEJ to become intrathoracic consists of a combination of hiatus Source of support: Nil
enlargement, lengthening of the phrenoesophageal ligament, Conflict of interest: None
and increased intra-abdominal pressure. There are four types of
hiatal hernia. Type I, sliding hiatal hernias, make up almost 95%
of all hiatal hernias. The other three types of hiatal hernias are It is difficult to determine the actual incidence of a hiatal hernia
broadly classified as paraesophageal. Compared to a type I hernia, because an asymptomatic hiatal hernia often goes undetected.
which does not have a hernial sac, all PEHs are covered all around However, the symptomatic hernia associated with GERD should
by a peritoneum layer, which forms a real hernial sac. Type II PEH be examined pathophysiologically, as the incidence of GERD is
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is the rarest. 3,4 increasing worldwide. Compared to the West, the East has the

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