Laparoscopic repair of hiatal hernias: analysis of long-term results of 2500 procedures performed for 20-year period
The aim of the study was to analyze long-term results of different methods of laparoscopic hiatal repair, and to determine the role of anterior crural repair. Of 2485 patients operated between 1994 and 2016, the results from a homogeneous cohort of 1221 patients have been analyzed. The patients were divided into groups and subgroups depending on the hernia class by hiatal surface area (HSA), and the method of repair. The obtained results allow to make the following conclusions: 1. For small HH (HSA < 10 cm2) primary crural repair is the best method of repair. 2. For large HH (HSA 10 - 20 cm2), the original technique of sub-lay lightweight partially absorbable mesh repair seems to be the most optimal method. 3. Addition of anterior primary crural repair to either posterior primary crural repair or mesh repair decreases recurrence and dysphagia rates. 4. For giant HH (HSA > 20 cm2), mesh repair is acceptable method, however, it requires improvement by introduction of new techniques.