Philippe J Quilici, MD, Alexander Tovar, MD. Providence Saint Joseph Medical Center
BACKGROUND: Numerous techniques have been historically proposed in the management of gastro-esophageal reflux and para-esophageal hernias [PEH]. A follow-up study to a novel laparoscopic approach introduced in 2009 and performed in 49 patients is presented.
METHODS: All procedures were performed via laparoscopy. Thirty-two patients underwent a Nissen Fundoplication, eleven a reduction of the PEH with a Nissen fundoplication, two without a fundoplication and four with a Collis-Nissen fundoplication. In all patients, the left hepatic lobe was freed, repositioned, and anchored under and inferior to the gastroesophageal junction, propping the gastroesophageal junction anteriorly. This maneuver entirely covers and closes the diaphragmatic defect.
RESULTS: At the time of laparoscopy, a number of patients were found not to be suitable candidates for this procedure [morphology of the left hepatic love]. Forty-nine procedures were completed. One patient was re-explored on POD 2 for a tight hiatus post-Collis Fundoplication. Postoperatively, all other patients did well without notable, unusual complaints. The average length of stay was 2.2 days. Although not statistically significant, 43 patients had no recurrence of symptoms with the longest follow-up at 10 years, two patients were lost to follow-up, one patient had a recurrence of the PEH and three patients stated they are experiencing some form of gastro-esophageal reflux requiring medical management.
CONCLUSIONS: In selected patients, patients with an “at-risk” crural closure during a laparoscopic anti-reflux procedure or PEH can safely be managed via a laparoscopic antireflux procedure with the hepatic shoulder technique. This technique has shown good early postoperative results and could be used as an alternative to a laparoscopic Mesh reinforced fundoplication, in difficult crural closures or in the management of large para-esophageal hernias.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95629
Program Number: P490
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster