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2007, Number 1

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Rev Mex Cir Endoscop 2007; 8 (1)

Guarner’s posterior funduplasty and hiatal plasty with laparoscopic mesh

Rendón CE, Cervantes RF, Peña GL

Language: Spanish
References: 35
Page: 19-24
PDF size: 73.56 Kb.


ABSTRACT

Objective: To report a clinical case of erosive GERD and giant hiatal hernia treated by Guarner’s posterior funduplasty with laparoscopic mesh. Description of the technique, its indications and literature review.
A case report: A 67-year old female patient with a record of gastroesophageal reflux disease, and treated with pump inhibitors for over two years with pyrosis recurrence and regurgitation, as well as dysphagia. It is practiced a laparoscopy, reporting erosive Grade III esophagitis (Savary Miller), hiatal hernia, and hypocontractile esophagus through esophageal manometry. It is practiced a Guarner’s posterior funduplasty, joining anterior face with the anterior side of the gastric fundus, surrounding the esophagus by the back part in 270° creating the funduplasty with an at least 4-cm length. The hiatal plasty is performed with two suture points below the esophagus and a suture point above it with non-absorbent material. After this, a propylene mesh is placed, covering the diaphragm pillars and fixing the mesh with circular staplers.
Conclusion: Guarner’s posterior funduplasty has demonstrated to be a secure and efficient anti-reflux technique that can be compared to Nissen’s funduplicature with regard to reflux control. However, fewer cases of complications have been reported in Guarner’s technique, specially in the grade and duration of dysphagias. The placing of the mesh in the hiatus is recommended in giant hiatal hernias or very widely opened hiatus. This happens due to the high risk of funduplicature migration and the subsequent need of a new surgery.


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