Alumi Laparoscopic Discussion Board

Can we perform laparoscopy on failed previous open surgery for hiatus hernia
Discussion in 'All Categories' started by Dr Nik Gkampranis - Aug 23rd, 2016 2:22 am.
Dr Nik Gkampranis
Dr Nik Gkampranis
Dear Sir,

I have one patient is whom 6 year ago open fundoplication was performed for hiatus hernia. The hernia reoccurred. Can we perform laparoscopy on failed previous open surgery for hiatus hernia safely and what are the precaution we should take.

With regard
re: Can we perform laparoscopy on failed previous open surgery for hiatus hernia by Dr R K Mishra - Aug 23rd, 2016 5:16 am
Dr R K Mishra
Dr R K Mishra
Dear Dr Nik Gkampranis

In experienced hands, re-operative fundoplication surgery can be done laparoscopically. In most of the patient during re-operation malpositioning findings are found. Which shows that fundus sutured to the greater or lesser curvature or the corpus of the stomach. May be no esophageal lengthening procedures were performed in previous surgery, since adequate intra-abdominal mobilization of the esophagus should be achieved in all patients,

The vast majority of patients required complete deconstruction and reconstruction of the fundoplication during re-operation. In few cases mesh is required if a hiatal defect is greater than 5 cm. Weak crural tissue is another indication for the use of mesh in reoperations for failed hiatal hernia.

In a patient with hiatal hernia recurrence, the next most common finding is wrap slippage. It is recommended to perform routine fixation of the fundus to the anterior arch of the right crus without incorporating the esophagus into the wrap.

Majority of surgeon believe that this result can be avoided by the complete division of the short gastric vessels and the unequivocal identification of the angle of His. These maneuvers will help the surgeon to perform a fundus-to-fundus wrap, as opposed to a fundus-to-body wrap.

The revision laparoscopic fundoplication and hiatal herniorraphy is effective, but technically challenging; thus, these revisional procedures should probably be performed by experienced surgeonn in specialty hospital.

The key of success of re-operation of fundoplication is:
(1) Reconstruction of the wrap,
(2) Mobilization of fundus by division of the short gastric vessels,
(3) Correction of the angle of His,
(4) Esophageal mobilization up to 5cm and
(6) Mesh reinforcement of the cruroplasty in the face of a large hiatal defect.

With regard
Dr R K Mishra
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