Present-day strategy in the laparoscopic treatment of GERD and hiatal hernia: a single institution experience
DOI:
https://doi.org/10.5281/zenodo.14769747Keywords:
hiatal hernia, gastroesophageal reflux disease, laparoscopic surgeryAbstract
Introduction: The laparoscopic surgery changed the ideal technique in the treatment of the gastro-esophageal reflux disease (GERD) and the hiatal hernia. In spite of the experience, there are no generally accepted differentiated operative methods for different types of hiatal hernia. The objective of this paper is to share an algorithm for such differentiation of laparoscopic operative methods.
Material and Methods: We analyzed retrospectively 118 patients and compared them to 64 prospectively gathered patients. In the retrospective group were performed antireflux operations (ARO), cruroraphy and mesh buttress of the hiatus. The prospective group was gathered after defining different methods of operations according to the type and size of hiatal hernia and the presence or lack of GERD. In this group were performed ARO, cruroraphy, reinforced cruroraphy and tension-free prosthetic repair.
Results: In the retrospective group were reported 11% recurrences after just ARO and 15% after ARO with cruroraphy. A stricture of the esophagus was reported in 2% of the cases with mesh buttress of the hiatus. Bloating was reported in 20% after ARO in the same group. The patients’ satisfaction was 90.3% two years after surgery. In the prospective group was reported bloating in 13%. There were reported no recurrences and esophageal strictures with the use of two-layer U pre-shaped mesh for reinforcement or as prosthesis. The satisfaction of patients was 97.7% two years after surgery.
Conclusion: The differentiated approach to the laparoscopic treatment of GERD and hiatal hernia according to the applied algorithm improves postoperatively the results of the treatment.
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