Prevention of recurrence by reinforcement of hiatal closure using ligamentum teres in laparoscopic repair of large hiatal hernias.
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.
Varga
G
G
Department of Surgery, Medical Faculty, University of Pécs, H-7643 Pécs Ifjúság u.13, Hungary. gvarga@iseb.pote.hu
Cseke
L
L
Kalmár
K
K
Horváth
O P
OP
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