Research Article
Volume 8 Issue 3 - 2021
Surgical Management of Esophageal Hiatus Hernia
Suren Stepanyan1,2*, Vahe Hakobyan1,2, Areg Petrosyan1,2, Rafael Mesropyan1,2, Hayk Yeghiazaryan1,2, Andranik Aleksanyan1,2, Hayk Safaryan1,2, Hakob Shmavonyan1,2, Karen Papazyan1,2 and Ani Babayan1,2
1Yerevan State Medical University, Department of Surgery 1 (Yerevan, Armenia)
2Mickaelyan Institute of Surgery, Clinic of Surgery (Yerevan, Armenia)
*Corresponding Author: Suren Stepanyan, Yerevan State Medical University, Department of Surgery 1 (Yerevan, Armenia).
Received: December 16, 2020; Published: February 27, 2021




Abstract

Background: There is no unique operative technique accepted for esophageal hiatal hernia until now, and many different procedures with numerous modifications are reported. Repair of large hiatal hernia is a technically challenging procedure with significant perioperative morbidity and high risk of recurrence.

Methods: Laparoscopic and open procedures with suture-only method and mesh reinforcement were performed. In all groups crural closure was performed with two or three interrupted nonabsorbable sutures between the right and left diaphragmatic pillars. Nissen or Nissen-Rossetti fundoplications performed as the antireflux procedures in all cases.

Results: There were 26 type I, 39 type II, 25 type III, and 12 type IV hiatal hernias. In 100 cases operations were performed from a planned elective list after regular admission, in 2 cases performed urgent open procedures for strangulated hiatal hernia. The conversion to open surgery was performed in 3 cases due to adhesions in upper abdomen after previous operation – open cholecystectomy. There were no cases of persistent dysphagia, that requires endoscopic balloon dilation or reoperation. No intraoperative complications were detected in both groups. There was no in-hospital mortality. There were no mesh related complication in mesh reinforcement group.

Two patients in the group without mesh reinforcement had hernia reccurence, they underwent reoperation with satisfactory results.

Conclusion: Hiatal hernia repair with mesh reinfocement is the safe and reliable method of procedure for HH. The less traumatic and effective is laparoscopic hernioplasty with mesh. Combination of hiatoplasty and antireflux procedure is mandatory operations for HH.

 

Keywords: Hiatal Hernia; Hiatal Hernia Repair; Laparoscopic Fundoplication; Mesh Reinforcement; Polypropylene Mesh

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Citation: Suren Stepanyan.,et al. “Surgical Management of Esophageal Hiatus Hernia”. EC Gastroenterology and Digestive System 8.3 (2021): 154-168.

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