title: Laparoscopic Repair of Paraesophageal Hernias with a Falciform Ligament Buttress.
abstract: BACKGROUND
  Buttressing the crura in paraesophageal hernia (PEH) repairs with synthetic mesh may be associated with erosions and dysphagia, while biologic buttresses are expensive and do not decrease long-term recurrence rates. This study documents outcomes following laparoscopic PEH repairs using the falciform ligament as a buttress.
  
  
  METHODS
  This is a prospective study of laparoscopic PEH repairs with a falciform ligament buttress. Preoperatively and at 6 months follow-up, medications, radiologic studies and symptom scores were recorded. Patients included had a hiatal defect greater than 5 cm, while recurrent PEH or prior gastric surgery patients were excluded.
  
  
  RESULTS
  Thirty-four patients were included with a mean age of 61 years, and 33 patients completed postoperative evaluation with a mean follow-up of 7.1 months. The mean symptom severity decreased from 11.24 ± 1.71 to 3.24 ± 0.84, mean symptom frequency decreased from 11.62 ± 1.70 to 3.45 ± 0.85, and mean total symptom score decreased from 22.85 ± 3.40 to 6.69 ± 1.69 (p < 0.0001). Three patients had recurrences on the upper gastrointestinal (UGI) series. Only one required reoperation.
  
  
  CONCLUSIONS
  Laparoscopic PEH repair with a falciform ligament buttress is a viable option. Ongoing follow-up will demonstrate the utility of this approach to decrease morbidity and recurrence rates for paraesophageal hernia repairs.
authors: Department of Surgery, The George Washington University Medical Center, 2150 Pennsylvania Ave, NW, Suite 6B, Washington, DC, 20037, USA.
authors: Raymond
authors: R
authors: Laird
authors: Fred
authors: F
authors: Brody
authors: Jeffrey N
authors: JN
authors: Harr
authors: Nathan G
authors: NG
authors: Richards
authors: Steve
authors: S
authors: Zeddun
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008022:Ligaments / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D063189:Symptom Assessment