Page 14 - World Journal of Laparoscopic Surgery

Laparoscopic Approach to Repair Hiatal Hernias
lower incidence, but recently the incidence is increasing in our results
part of the world. 6
Proton pump inhibitors are a preferred treatment option for The follow-up period ranged from 12 months to 24 months. The
symptom relief. Surgical treatment is usually followed by medical mean follow-up time was about 12 months.
treatment. Depending on the severity of symptoms and the type • In total, 39 patients underwent laparoscopic hernia surgery with
7,8
of hernia affected, surgical treatment will be decided. Surgical fundoplication, including 26 women and 13 men (Table 1).
reconstruction of the paraesophageal hernia has two main goals: • Most patients present with symptoms of heartburn or epigastric
to restore normal anatomy by returning the GEJ and stomach to pain. Some of the patients presented with dyspepsia. Few
the abdomen and to correct the condition that contributed to the patients were diagnosed by chance.
development of the anatomical problem, GERD. There are several • The mean age was 42 years (25–75) (Table 2).
approaches to the surgical treatment of paraesophageal hernias; • The operating time was 150–250 minutes with an average time of
a transthoracic, transabdominal, or laparoscopic approach. 9–11 194 minutes. No patient required a switch from the laparoscopic
Laparoscopic repair is a good approach these days. It offers procedure to the open technique (Table 3).
various advantages to both the patient and the surgeon. It is • The hospital stay was 4–7 days with an average stay of 4.5 days.
generally performed by a general abdominal surgeon as it usually This included a one-day preoperative admission.
involves abdominal access. Laparoscopic repair significantly • There were no deaths during or after the procedure.
reduces postoperative complications and is the procedure of choice • Pain: A total of 15 patients complained of pain on the 1st
in most centers. postoperative day that required analgesia around the clock.
This number decreased to 5 by day 3. At the time of discharge
MAterIAls And Methods (maximum interval of 7 days and median 5.5 days), none of the
patients was in pain.
The present study protocol was reviewed and approved by • Two patients had symptoms of dysphagia at the outpatient
the Institutional Review Board of Hospital, which waived the follow-up visit. These patients showed no significant imaging
requirement for informed patient consent due to the retrospective findings and no difficulty in eating, and the symptoms were well
nature of the work. A single team of surgeons performed all of the controlled with medication.
interventions. Eighteen patients with primary hiatal hernia who
underwent laparoscopic surgery from 2009 to 2017 were examined.
Routine preoperative tests were performed (e.g., physical exam, dIscussIon
standard laboratory tests, and pulmonary function tests). In addition, The presentation of the hiatal hernia can be very different, it can
an esophagogastroduodenoscopy, computed tomography of be asymptomatic, or it can appear with different symptoms such
the thorax and abdomen, and barium esophagography were as reflux or obstructive symptoms. Diagnosing hiatal hernia is
performed preoperatively. However, esophageal manometry and difficult, but with the advent of new diagnostic tools, the rate of
24-hour ambulatory pH monitoring were not performed routinely. diagnosis has recently increased. 12,13 Because of the morbidity and
The indications for surgery were the presence of symptoms (reflux effectiveness associated with open surgery, medical treatment
14
or obstructive symptoms) and the patient’s desire for surgical repair is the preferred approach to control symptoms of GERD. But
and consent. The latter was generally true of asymptomatic cases since the introduction of laparoscopic surgery, the morbidity
discovered by chance. Consent to the operation was obtained from
the patients after they had been adequately educated about the Table 1: Sex ratio of the patient
natural course of an untreated hiatal hernia and informed about S. no. Sex No. of patients Percentage (%)
the operation, including details of the procedure and the associated
risks. Based on the postoperative clinical stability of each patient, 1 Male 13 33.33
feeding was started after it was confirmed that no abnormalities 2 Female 26 60.66
occurred. Patients who showed no symptoms on the oral soft diet
were discharged. All patients visited the outpatient department Total 39 100
2 weeks postoperatively for a general check of their condition
and symptoms. Follow-up examinations were carried out every Table 2: Age distribution of patients
3 months for the first year and every 6 months thereafter. In this S. no. Age-group No. of patients Percentage
study, clinical features, surgical factors, and postoperative outcomes
were analyzed for all patients. 1 25–35 5 12
2 36–45 11 27.5
Operative Technique 3 46–55 9 22.5
All patients were treated laparoscopically. The details were
described in previous MIES studies. 7,12 The operative procedure 4 56–65 5 12.5
7
was similar to that of Schlottmann F, et al. Five trocars with a 30° 5 66–75 4 10
angled camera and a liver retractor were used.
The procedure was completed with the following steps: First, a
hernial sac dissection was performed. Intra-abdominal esophagus Table 3: Duration of surgery
was mobilized and a tension-free length of not less than 2 cm. Then Time in mins No. of cases
the crura were approximated with simple single-button sutures. 150–200 24
Most recently, Nissen (360°) fundoplication was performed. No
gastropexy was performed. 201–250 15

200 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)