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>Journals >Cirujano General >Year 2017, Issue 1


Ugalde VJF, Torices EE, Olvera HH, Shiordia PFJ
Laparoscopic treatment of paraesophageal hernia and the use of meshes
Cir Gen 2017; 39 (1)

Language: Español
References: 46
Page: 41-50
PDF: 4. Kb.


Full text




ABSTRACT

Introduction: Paraesophageal hiatal hernia represents 5-10% of the hiatal hernias that are operated. Its importance lies in the risk of serious complications. Currently laparoscopic repair is the procedure of choice. We have observed a decrease in recurrence with the use of prosthetic materials. Objectives: To assess the outcome of laparoscopic management with different types of mesh analyzing the quality of life, postoperative course, recurrence and the presence of complications in patients with paraesophageal hernia. Material and methods: A review of the evolution of 19 patients who underwent laparoscopic intervention from 2008 to 2015 was performed. All were documented by panendoscopy, computed tomography, pH-metry and manometry. They were monitored at intervals of three, six and 12 months after surgery. A study of barium swallow was performed at three and 12 months after surgery, and upper endoscopy at six months. All patients have a control scan annually. Results: Fifteen male and four female patients were operated on, aged 40-78 years; the mean operative time was 120 minutes; the average hospital stay was four days; no trans- or postoperative complications were reported; there was no conversion to open surgery. The report of clinical improvement showed excellent and good results in 15 patients; three remain with moderate dysphagia and one with mild dysphagia. Today, nine years after the first patient, there have been no complications related to the mesh used. There has been no recurrence of the hernia in any case. Conclusions: The high recurrence of paraesophageal hernia has generated an increase in the use of prosthetic materials to reinforce the closure. Bilayer and biological meshes are safe and show a low rate of postoperative complications. We believe that their use should be based on evidence from the literature and the experience of each surgical group.


Key words: Hiatal hernia, paraesophageal hernia, giant hiatal hernia, prosthetic materials, Nissen fundoplication, laparoscopic treatment.


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