Page 15 - World Journal of Laparoscopic Surgery

Laparoscopic Approach to Repair Hiatal Hernias
associated with the procedure has decreased dramatically. Various 8. Siegal SR, Dolan JP, Hunter JG. Modern diagnosis and treatment of
studies have concluded that the laparoscopic approach is just hiatal hernias. Langenbecks Arch Surg 2017;402(8):1145–1151. DOI:
as effective as open surgery, but with reduced postoperative 10.1007/s00423-017-1606-5.
complications, recovery time, and almost the same recurrence 9. Patel HJ, Tan BB, Yee J, et al. A 25-year experience with open primary
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rates. In addition, several studies have shown that laparoscopic transthoracic repair of paraesophageal hiatal hernia. J Thorac
Cardiovasc Surg 2004;127(3):843–849. DOI: 10.1016/j.jtcvs.2003.10.054.
surgery is the medical treatment in terms of long-term symptomatic 10. Low DE, Unger T. Open repair of paraesophageal hernia: Reassess-
improvement and cost-effectiveness. 16–18 Regarding asymptomatic ment of subjective and objective outcomes. Ann Thorac Surg
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believe that asymptomatic hiatal hernias are rare and studies have 11. Luketich JD, Raja S, Fernando HC, et al. Laparoscopic repair of
shown a progression from asymptomatic to symptomatic about giant paraesophageal hernia: 100 consecutive cases. Ann Surg
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14% per year. The minimally invasive approach to repairing 2000;232(4):608–618. DOI: 10.1097/00000658-200010000-00016.
paraesophageal hernias is now the preferred approach because of 12. Kim KM, Cho YK, Bae SJ, et al. Prevalence of gastroesophageal reflux
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stay compared to the open approach. 15,20 The recurrence rate of population-based study. J Gastroenterol Hepatol 2012;27(4):741–745.
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the laparoscopic approach is similar to that of the open approach 13. Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and
and has decreased over time with increasing experience and better management of gastroesophageal reflux disease. Am J Gastroenterol
learning of the technique. 21 2013;108(3):308–328. DOI: 10.1038/ajg.2012.444.
The SAGES set out the technical considerations for surgery in 14. Iwakiri K, Kinoshita Y, Habu Y, et al. Evidence-based clinical practice
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their 2013 guidelines for the management of hiatal hernias. The guidelines for gastroesophageal reflux disease 2015. J Gastroenterol
infra diaphragmatic position of the gastroesophageal junction 2016;51:751–767. DOI: 10.1007/s00535-016-1227-8.
is one of the most important aspects of hernia repair. Collis 15. Zehetner J, Demeester SR, Ayazi S, et al. Laparoscopic versus open
gastroplasty is the answer to the short esophagus as suggested repair of paraesophageal hernia: The second decade. J Am Coll Surg
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by O’Rourke et al. in their study. None of the patients in our 16. Mehta S, Bennett J, Mahon D, et al. Prospective trial of laparoscopic
study required Collis gastroplasty. The complexity of hiatal hernia Nissen fundoplication versus proton pump inhibitor therapy for
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that surgeons need at least 20 cases of experience to achieve a Surg 2006;10(9):1312–1316. DOI: 10.1016/j.gassur.2006.07.010.
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reasonably low recurrence rate. We have been able to successfully 17. Anvari M, Allen C, Marshall J, et al. A randomized controlled trial of
carry out this operation to date without complications and without laparoscopic Nissen fundoplication versus proton pump inhibitors
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We conclude that laparoscopic repair of hiatal hernias is a viable management for gastro-oesophageal reflux disease: 5-year follow-up
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World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022) 201