A new method of laparoscopic tension-free framed mesh repair of giant hiatal hernias: anatomical background and 3-year long-term results
Current techniques of laparoscopic repair of giant hiatal hernia (HH) produce high percentage of recurrences and esophageal complications. The aim of the study was to show the anatomical rationale and to assess three-year long-term results of fundamentally new method of laparoscopic repair of giant HH - tension-free framed mesh repair. From 2010 to 2013, we performed 44 operations using a new prosthesis - Rebound HRD-Hiatus hernia - a heart-shaped lightweight mesh with polytetrafluoroethylene peripheral nitinol frame with shape memory. After fixing it to the edges of the hiatus behind the esophagus, the nitinol frame prevents the prolapse of the anterior edge of prosthesis and, consequently, recurrence. It has great anatomical rationale for giant hiatal hernias as most of them have complete or partial atrophy of the aperture. The mean hiatal surface area was 37,5 ± 15,6 (21,7 - 75,4) cm2. Long-term results were studied in 40 patients at a mean follow-up period of 47,0 ± 7,8 (36 - 61) months. There were no true anatomical recurrences in the cohort. There were 2 false anatomical recurrences, 2 symptomatic and 1 asymptomatic reflux recurrences. There were no cases of persisting dysphagia or strictures of the esophagus. Three-year long-term results showed that the new method of tension-free framed mesh repair provides the absence of anatomical recurrences and complications. It apparently requires practical usage and could be further studied in prospective randomized trials.