[New laparoscopic procedure for the treatment of large hiatal hernias: the first 20 cases]

To evaluate the effect of a new laparoscopic procedure, which was developed in our institute for reinforcement of posterior hiatoplasty.

The results of our first 20 patients of this ongoing prospective study are presented. All patients had gastro-oesophageal reflux disease and a hiatus defect greater than 6 cm. The reinforcement of the posterior hiatoplasty was carried out with ligamentum teres hepatis. The ligamentum was dissected with from the abdominal wall, brought behind the oesophagus and stitched to the right and left crura, with two non-absorbable sutures. In all patients a loose Nissen-DeMeester fundoplication was also performed. Patients were followed up with oesophagograms. The mean follow-up time was 12.4 months (range 3-24).

The mean operation time was 115 minutes (range 95-135). Conversion to open procedure was necessary in five patients due to adhesions caused by previous operation. No intraoperative complications were observed. One reoperation was necessary because of a subphrenic haematoma. There was no perioperative mortality. At follow-up two patients had atypical reflux symptoms, but functional tests showed no abnormal gastroesophageal reflux. Oesophagograms showed one recurrence, but the patients was symptom free.

On the basis of these preliminary results it seems that laparoscopic reinforcement for the closure of large hiatus hernias with ligamentum teres is a safe, feasible and effective technique.