title: Laparoscopic repair of giant hiatus hernia: prosthesis is not required for successful outcome.
abstract: BACKGROUND
  Giant hiatus hernia (GHH) are difficult to manage effectively. This study reports a laparoscopic, prosthesis-free technique to repair of GHH.
  
  
  METHODS
  Retrospective analysis of a prospectively populated database of a single surgeon's experience of GHH (>30 % intrathoracic stomach) repair using a novel, uniform technique was performed. Routine postoperative endoscopy, quality of life (QOL), and Visick scoring was conducted.
  
  
  RESULTS
  Surgery was conducted in 100 patients (70F, 30 M). Mean (standard deviation [SD]) age was 69.1 (±11.4), median (interquartile range) ASA was 2 (range, 2-3), and mean (SD) body mass index (BMI) was 29.1 (±4.5). Mean follow-up was 574.1 (±240.5) days. One (1 %) patient was converted to an open procedure due to technical issues. Median stay was 2.5 days (range, 2-4). One postoperative death occurred secondary to respiratory sepsis. Eight (8 %) patients had perioperative complications: 4 major (PE, non-ST elevation MI, postoperative bleed managed conservatively, infected mediastinal fluid collection); and 4 minor (pneumothorax, asymptomatic troponin leak, subacute small bowel obstruction, and urinary retention). Ninety-nine (99 %) patients had objective screening for recurrence at 3-6 months. Two (2 %) patients have had symptomatic recurrence of their hiatus hernia; both involved a recurrent fundal herniation. Another seven (7 %) had small (<2 cm), asymptomatic recurrences diagnosed only on routine follow-up. Seven (7 %) patients have required reintervention for dysphagia with endoscopic dilatation conducted to good effect in all cases. Two (2 %) patients have required revisional surgery: one for a symptomatic recurrence at 3 months and a second for recurrent mediastinal collection. The Visick score fell from a mean (SD) of 3 (±1.1) to 1.7 (±0.8) postoperatively (p < 0.0001). The mean (SD) QOL preoperatively was 87.8 (±24) versus 109.1 (±22.3) postoperatively (p < 0.0001).
  
  
  CONCLUSIONS
  GHH can be managed safely and effectively laparoscopically, without the use of a prosthesis.
authors.affiliation: Concord Repatriation General Hospital, Concord, Sydney, NSW 2012, Australia. simoncgibson@hotmail.com
authors.forename: Simon C
authors.initials: SC
authors.lastname: Gibson
authors.forename: Simon C K
authors.initials: SC
authors.lastname: Wong
authors.forename: Simon K
authors.initials: SK
authors.lastname: Wong
authors.forename: Alice C
authors.initials: AC
authors.lastname: Dixon
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Falk
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000473:pathology / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome