Robert A Grossman, MD, Ben Biteman, MD, Fred Brody, MD, MBA. George Washington University
Introduction: Laparoscopic paraesophageal hernia repair may entail some type of mechanic buttress of the cruraplasty to provide a durable repair. However, the optimal type of buttress has not been clearly defined. Mesh, whether synthetic or biologic, is typically used; unfortunately synthetic mesh has a risk of enteric injury, and biologic mesh is costly. The falciform ligament is an inexpensive, autologous material present in the abdomens of most patients, and can easily be used to buttress a cruraplasty. This video details a laparoscopic paraesophageal hernia repair with a falciform flap buttress and the clinical outcomes with one year follow up.
Methods: All patients undergo a thorough history and physical examination, with subsequent esophagogastroduodenoscopy. Additionally all patients receive an upper gastrointestinal series or computed tomography. Manometry and pH studies are attempted in the majority of patients. A symptom severity and frequency survey is administered to all patients preoperatively, and at six and twelve months post-operatively. At twelve months, a repeat upper gastrointestinal series is obtained to assess for recurrence.
Results: To date, seventy-six patients have undergone a laparoscopic paraesophageal hernia repair with a falciform flap. Forty-six patients have one year follow up data. The average age is 61.15, and the average preoperative BMI is 27.99. Eighteen of the forty-six patients are male. Five patients (10.9%) had a radiographic recurrence, but only three required reoperation for symptoms. No recurrences have occurred within the past two years. Patient-reported symptom severity and frequency decreased significantly in all categories at twelve months post-operatively (p<0.001).
Conclusion: The falciform ligament can safely and successfully be used as a substitute for mesh during a laparoscopic repair of a paraesophageal hernia. It is an inexpensive and quick means of buttressing the cruraplasty without the concomitant risks or expense of mesh insertion.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79858
Program Number: V077
Presentation Session: Foregut 2
Presentation Type: Video