title: Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias.
abstract: BACKGROUND. Several attempts were made to develop an effective technique to reduce the high recurrence rate associated with the repair of large hiatal hernias.
  
  
  METHODS
  A new laparoscopic technique was introduced to reinforce hiatal closure with the ligamentum teres. Its feasibility, safety, and efficacy were evaluated. Four patients with gastroesophageal reflux disease and large hiatal hernia (>6 cm) entered the study. After closure of the diaphragmatic crura the teres ligament was dissected, brought behind the esophagus, and sutured to the crura. A fundoplication was also added. Patients were followed with barium swallow at 3 months postoperatively.
  
  
  RESULTS
  The mean operation time was 109.5 min. No intraoperative complications, perioperative morbidity, or mortality were registered. At the follow-up, barium swallows revealed no recurrence.
  
  
  CONCLUSIONS
  On the basis of these preliminary results laparoscopic reinforcement of the hiatal closure with the ligamentum teres seems feasible and safe; therefore this promising technique should be considered as an option for the treatment of large hiatal hernias.
authors.affiliation: Department of Surgery, Medical Faculty, University of Pécs, H-7643 Pécs Ifjúság u.13, Hungary. gvarga@iseb.pote.hu
authors.forename: G
authors.initials: G
authors.lastname: Varga
authors.forename: L
authors.initials: L
authors.lastname: Cseke
authors.forename: K
authors.initials: K
authors.lastname: Kalmár
authors.forename: O P
authors.initials: OP
authors.lastname: Horváth
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D055502:Secondary Prevention; D013524:Surgical Flaps; D016896:Treatment Outcome