Laparoscopic Hiatal Hernia Repair: Short-Term Results From Yemen in a Resource-Limited Setting

Background The laparoscopic minimally invasive surgery with anti-reflux procedure is the preferred method for hiatal hernia repair, showcasing a noticeable decrease in surgery-related morbidity and mortality. This study aimed to investigate various elements and variables that could affect and enhance the advantages of minimally invasive surgery for hiatal hernias and minimize the chances of complications occurring both during and after laparoscopic repair with fundoplication for hiatal hernia. Methods Hiatal hernia repair with fundoplication as anti-reflux surgery was conducted to evaluate perioperative and postoperative outcomes at Aden Hospital between 2023 and 2024. The inclusion criteria included patients with hiatal hernia and a positive history of gastroesophageal reflux treated with laparoscopic minimally invasive hernial repair involving anti-reflux procedures such as laparoscopic Nissen fundoplication or Dor fundoplication. Data on baseline population characteristics, including age and gender, as well as hernia types (type 1, 2, 3, and 4), hernia size, and the surgical techniques used were collected. Information regarding operative duration, intraoperative complications, postoperative complications, and length of hospital stay was also gathered. Follow-up assessments were conducted at one, three, six, and 12 months. Results From 2023 to 2024, a total of 21 individuals underwent minimally invasive laparoscopic hiatal hernial repair, which included 12 (57%) females and nine (43%) males, with an average age of 55 years (ages ranging from 35 to 80 years). Symptoms of gastroesophageal reflux such as heartburn manifested in 18 (85%) patients. Three (14%) patients had abdominal surgery history. The types of hiatal hernia observed were as follows: 12 patients had type 1, five had type 2, three had type 3, and one had type 4. Conversion from laparoscopic surgery to open surgery was performed in one case (4.7%). Sixteen (76.1%) patients had laparoscopic hiatal hernia repair combined with Nissen fundoplication, three (14.2%) patients had Heller myotomy with Dor fundoplication, and two (9.5%) patients underwent sleeve gastrectomy along with hiatal hernia repair. The average duration of the operation was 116 ± 60 minutes, while the average length of hospital stay was 3 ± 1.5 days. There was one (4.7%) patient with intraoperative complication (pneumothorax), and 15 (71.4%) patients were free of postoperative complications; however, four (19%) patients complained of postoperative flatulence and abdominal distension, one (4.7%) patient complained of transient recurrent reflux and dysphagia, and one (4.7%) patient had aspiration pneumonia and death. Recurrent hiatal hernia was not detected during follow-up at three to 12 months after laparoscopic surgery. Conclusions Laparoscopic hiatal hernia repair with anti-reflux surgery can be successful in resource-limited settings, providing an effective and safe option for managing hiatal hernias and alleviating gastroesophageal reflux disease.