Laparoscopic Anterior Gastropexy for Giant Hiatal Hernia

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 55; no. 10; pp. 605 - 613
• Main Authors: Takii, Mamiko, Takemura, Masashi, Tada, Ryuma, Gyobu, Ken, Yamada, Masanori, Oshima, Tsutomu, Mayumi, Katsuyuki, Tanaka, Yoshinori, Fujio, Nagahisa
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.10.2022
• Subjects: anterior gastropexy; giant hiatal hernia; laparoscopy; recurrence
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2021.0133

Purpose: The number of operations for giant esophageal hiatal hernia is increasing in Japan with the increase in the elderly population, and recurrence of esophageal hiatal hernia due to kyphosis and tissue fragility has become a problem in these patients. While reinforcement of the mesh has some effect on reducing recurrence, there are increasing reports of complications peculiar to the mesh procedure and there is no consensus on its usefulness. Therefore, there is a need for a technique for reduction of recurrence that does not use mesh reinforcement. In this study, we investigated the usefulness of anterior gastropexy introduced to reduce recurrence. Materials and Methods: Background factors, surgical procedures, and postoperative results were examined retrospectively in 88 patients with type III and type IV esophageal hiatal hernia who underwent surgery from January 2010 to January 2021. Result: Type III hiatal hernia was found in 77 cases, type IV in 11 cases, and upside down stomach in 22 cases. There were 66 cases treated with Toupet fundoplication, 1 with the Nissen method, 19 with the lateral patch method, and 2 other procedures. Mesh reinforcement was performed in 24 cases (27.3%) and anterior gastropexy in 61 (69.3%). The recurrence rate in all cases was 9.1%, but this rate decreased from 18.2% to 6.1% after introduction of anterior gastropexy. There was no significant difference in the recurrence rate between cases in which only anterior gastropexy was performed and those in which only mesh was used (P=0.441). Conclusion: Anterior gastropexy using a barbed suture in giant esophageal hiatal hernia surgery may reduce recurrence compared to mesh reinforcement.