Laparoscopic Management of Large Hiatus Hernia

Hiatal hernia is an enlarged opening in the diaphragm that allows the stomach or other abdominal organs to shift up into the chest. This may cause heartburn, chest or abdominal discomfort, discomfort with eating, shortness of breath, or no symptoms at all. Symptomatic hiatal hernias and paraesophageal hernias can be repaired in a minimally invasive manner, using 5 one-half inch incisions. The abdominal organs are placed back into their correct position, and the hernia itself is closed. Under most circumstances the patient can be discharged after a one or two night hospital stay, and return to full activities within 2 weeks.

The use of mesh is becoming more popular for large hiatal hernia (type ii-iv) repair toreduce the recurrence rate. The aim of this study was to outline the currently available literature on the use of meshin laparoscopic large hiatal hernia repair,emphasing objective outcome.

The use of mesh in the repair of large hiatal hernias is promising with respect to the reduction of anatomical recurrences. However, many different kinds and configurations of mesh are available. This systematic review of the literature is a basis for high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term. Hiatal hernias can be subdivided into sliding, tupe Iand large, types II-IV hiatal hernias. Sliding hiatal hernias typically are associated with gastroesophageal reflux disease and often are managed medically with antisecretory drugs.

In patients with a large hiatal hernia.however,surgery is the only available curative treatment option. Large hiatal hernias may be associated with severe complication such as organoaxial rotation leading to strangulation of the stomach. The risk of developing this complication in the presence of a large hiatal .hernia, however, is very limited. Therefore,a wait-and-see stance has now been the standard of care in minimally or asymptomatic patients.

However, symptomatic patients with a large hiatal hernia should be offered surgical repair. This consists of dissection of the hernia sac from the posterior mediastinum,reduction of the herniated intraabdominal organs with a tension-free intra-abdominal position of the distal esophagus, posterior cruroplasty, and the addition of an antireflux procedure . Laparoscopic repair of large hiatal hernias has good symptomatic outcomes, with a success rate of 90% after 4 tears of follow up.

There are many types of mesh available, including heavy-and light-weight polypropylene, polytetrafluoroethylene (ePTFE, and biologic meshes, additionlly, multiple configurations of these meshed are used,i.e., oval, square,or an a,u or v shape .several randomized controlled trials and observational studifs have reported the results of these different meshes usd in large hiatal hernia repair.

Some overviews describing the available techniques in the use of mesh in large hiatal hernia with a summary of the literature have been published a few years ago.nevertheless, a systematic review of the literature regarding mesh in laparoscopic large hiatal hernia repair is lacking. In addition, numerous studies with a longer follow-up after large hiatal hernia repair with the use of mesh have been published since then.