Repair of a Hiatal Defect Using a Rotational Falciform Flap

Background: Closure of the hiatal defect in laparoscopic surgery of the foregut remains a challenging problem. Over the years, several materials have been used- varying compounds of nonabsorbable synthetics as well as absorbable biologic material. Yet, there is a high recurrence rate associated with primary closure and an unacceptably high rate of esophageal erosion and stricture associated with both synthetic and biologic material. Adding to the complexity of hiatal hernia repairs is the highly dynamic nature of the region, in which exists esophageal peristalsis and constant diaphragmatic excursion. We describe the use of the falciform ligament as a rotational flap for repair of such hiatal defects.

Method: To create a rotational flap of the falciform ligament, ultrasonic dissection is used to detach the falciform from the anterior abdominal wall. Once fully mobilized, the flap is rotated to reach the esophageal hiatus. The flap is secured to the right crus using 2-3 interrupted sutures of 2-0 silk. On the left side, the flap is broadly attached to the diaphragm posteriorly and the crus anteriorly to provide overlapping coverage of the defect. Once the flap is sewn to the left crus, the flap completely covers the hiatal defect. As experience accrues, we are engaged in longitudinal follow-up.

Session: Podium Video Presentation

Program Number: V002

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