title: Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias.
abstract: OBJECTIVE
  Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative.
  
  
  METHODS
  In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months.
  
  
  RESULTS
  The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients.
  
  
  CONCLUSIONS
  LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.
authors.affiliation: Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors.forename: Georg R
authors.initials: GR
authors.lastname: Linke
authors.forename: Tobias
authors.initials: T
authors.lastname: Gehrig
authors.forename: Lena V
authors.initials: LV
authors.lastname: Hogg
authors.forename: Anna
authors.initials: A
authors.lastname: Göhl
authors.forename: Hannes
authors.initials: H
authors.lastname: Kenngott
authors.forename: Fritz
authors.initials: F
authors.lastname: Schäfer
authors.forename: Lars
authors.initials: L
authors.lastname: Fischer
authors.forename: Carsten N
authors.initials: CN
authors.lastname: Gutt
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000517:prevention & control; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome