• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Laparoscopic Paraesophageal Hernia Repair With Falciform Ligament Buttress

Jeffrey N Harr, MD, MPH, Fred Brody, MD, MBA. The George Washington University

Introduction:

Laparoscopic paraesophageal hernia repairs have been performed since the early 1990’s with a wide range of methods and recurrence rates. Multiple techniques are used to decrease recurrence rates, including buttressing the repair with synthetic and biological mesh. However, synthetic mesh is associated with erosions and dysphagia, and biologic buttresses are expensive and have not shown long-term decreases in recurrence rates. Therefore, a laparoscopic repair using the falciform ligament as a buttress may improve outcomes with minimizing complications.

Methods:

A prospective database was established for patients undergoing a laparoscopic paraesophageal hernia repair. Baseline demographics, operative details, and preoperative symptom questionnaires were obtained. The questionnaire evaluated vomiting, nausea, early satiety, bloating, postprandial fullness, epigastric pain, epigastric burning, chest pain, chest burning, and dysphagia. Each symptom was scored in terms of severity and frequency. All laparoscopic paraesophageal hernias were repaired in a similar fashion using a standard 5-port foregut technique. The hiatal hernia was reduced, and the sac was mobilized and excised. The crura were then reapproximated with interrupted sutures. The falciform ligament was divided with extension to the liver edge. The flap was rotated under the left lateral segment, and splayed over the crural repair. The flap was then secured to the crura, and a fundoplication was performed. Postoperatively, all patients underwent an upper gastrointestinal series at six months and a symptom questionnaire was completed. Pre- and postoperative symptom scores were compared using a t-test with significance of p<0.05.

Results:

To date, 41 patients have undergone a laparoscopic paraesophageal hernia repair with a falciform ligament buttress. The mean age was 61.4 years, and 61% were female. Six-month follow-up is available for 27 patients. There were no conversions to laparotomy. There have been 3 (7.5%) radiologic recurrences, but only 1 patient became symptomatic requiring reoperation. Presently, all patients remain off H2 blockers or PPI’s. All symptom categories were significantly improved in both severity and frequency except for early satiety. In addition, total symptom scores were significantly decreased at 6 months (Table 1).

Table 1

Category

Mean ± SEM

(Pre-Op)

Mean ± SEM

(Post-Op)

p-value

Total Symptoms Severity

12.04±2.04

3.27±1.03

< 0.0001

Total Symptoms Frequency

12.41±2.03

3.46±1.03

< 0.0001

Total Symptoms Score

24.44±4.06

6.48±2.03

< 0.0001

Conclusion:

Early data suggests that laparoscopic paraesophageal hernia repair using the falciform ligament as a buttress is a viable option to repair large hiatal hernias. The falciform ligament is readily available in most patients, and avoids the cost of a biological mesh, and the possible complications of synthetic mesh. Long-term follow-up is required to verify the utility of this approach to decrease recurrence rates of paraesophageal hernia repairs.

135

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2015 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons