[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Download PDF
Figure 1.
Tension-free repair: anterior placement of a triangular piece of mesh.

Tension-free repair: anterior placement of a triangular piece of mesh.39

Figure 2.
Tension-free repair: posterior placement of a triangular piece of mesh.

Tension-free repair: posterior placement of a triangular piece of mesh.46

Figure 3.
Tension-free repair: onlay piece of mesh, with a hole facilitating the passage of the esophagus.

Tension-free repair: onlay piece of mesh, with a hole facilitating the passage of the esophagus.

Figure 4.
Shapes of mesh designed to allow passage of the esophagus and to facilitate fixation (U shape, A shape).

Shapes of mesh designed to allow passage of the esophagus and to facilitate fixation (U shape,22,53 A shape59).

Figure 5.
Tension-free repair: piece of mesh just covering the defect below the esophagus, overlapping both pillars laterally.

Tension-free repair: piece of mesh just covering the defect below the esophagus, overlapping both pillars laterally.56

Figure 6.
Tension-free repair. After a standard closure of the hiatus, a relaxing incision lateral to the right crura is performed, and a patch is fixed with stitches or staples covering the diaphragmatic defect.

Tension-free repair. After a standard closure of the hiatus, a relaxing incision lateral to the right crura is performed, and a patch is fixed with stitches or staples covering the diaphragmatic defect.15,51

Figure 7.
Non–tension-free repair: simple crural closure with simple stitches.

Non–tension-free repair: simple crural closure with simple stitches.

Figure 8.
Non–tension-free repair: simple crural closure with continuous suture.

Non–tension-free repair: simple crural closure with continuous suture.102

Figure 9.
Non–tension-free repair with reinforcement of the crural closure to avoid the cutting effect of the stitches, using simple stitches with Teflon or Dacron pledgets.

Non–tension-free repair with reinforcement of the crural closure to avoid the cutting effect of the stitches, using simple stitches with Teflon or Dacron pledgets.18,29

Figure 10.
Non–tension-free repair with reinforcement of the crural closure, using a polypropylene strip along the crura to hold the stitches.

Non–tension-free repair with reinforcement of the crural closure, using a polypropylene strip along the crura to hold the stitches.

Figure 11.
Non–tension-free repair with reinforcement of the crural closure, using a polypropylene piece of mesh covering both edges of the pillars.

Non–tension-free repair with reinforcement of the crural closure, using a polypropylene piece of mesh covering both edges of the pillars.60

Figure 12.
Non–tension-free repair with reinforcement of the crural closure using buttress mesh. A long strip of mesh is placed below the esophagus, covering the pillar closure.

Non–tension-free repair with reinforcement of the crural closure using buttress mesh. A long strip of mesh is placed below the esophagus, covering the pillar closure.61

Figure 13.
Non–tension-free repair with reinforcement of the crural closure. Onlay mesh is placed around the esophagus once the defect has been closed.

Non–tension-free repair with reinforcement of the crural closure. Onlay mesh is placed around the esophagus once the defect has been closed.31,62

Table 1. 
Results of Laparoscopic Repair of PEH (Series With More Than 20 Cases)
Results of Laparoscopic Repair of PEH (Series With More Than 20 Cases)
Table 2. 
Recurrence After Surgical Treatment of PEH in Series With Systematic Radiologic Control
Recurrence After Surgical Treatment of PEH in Series With Systematic Radiologic Control
Table 3. 
Results of the Use of Mesh for PEH Repair
Results of the Use of Mesh for PEH Repair
Table 4. 
Results of Comparative Studies of PEH Repair
Results of Comparative Studies of PEH Repair
Table 5. 
Results of the Open Approach for PEH Repair
Results of the Open Approach for PEH Repair
Table 6. 
Complications in Relation to Prosthesis Placement for Surgical Repair of Hiatal Hernia
Complications in Relation to Prosthesis Placement for Surgical Repair of Hiatal Hernia
1.
Cuesta  MAPeet  DLKlinkerberg-Knol  EC Laparoscopic treatment of large hiatal hernias. Semin Laparosc Surg 1999;6213- 223
PubMed
2.
Floch  N Paraesophageal hernias: current concepts. J Clin Gastroenterol 1999;296- 7
PubMedArticle
3.
Hashemi  MSillin  LFPeters  JH Current concepts in the management of paraesophageal hiatal hernia. J Clin Gastroenterol 1999;298- 13
PubMedArticle
4.
Buenaventura  POSchauer  PRKeena  RJLuketich  JD Laparoscopic repair of giant paraesophageal hernia. Semin Thorac Cardiovasc Surg 2000;12179- 185
PubMed
5.
Freeman  MEHinder  RA Laparoscopic paraesophageal hernia repair. Semin Laparosc Surg 2001;8240- 245
PubMedArticle
6.
Landrenau  RJ Surgical management of paraesophageal herniation. Nyhus  LMBaker  RJFischer  JEMastery of Surgery. 3rd ed. Boston, Mass Little Brown & Co Inc1997;694- 707
7.
Litle  VRBuenaventura  POLuketich  JD Laparoscopic repair of giant paraesophageal hernia. Adv Surg 2001;3521- 38
PubMed
8.
Oelschlager  BKPellegrini  CA Paraesophageal hernias: open, laparoscopic, or thoracic repair. Chest Surg Clin N Am 2001;11589- 603
PubMed
9.
Huntington  TR Short-term outcomes of laparoscopic paraesophageal hernia repair: a case series of 58 consecutive patients. Surg Endosc 1997;11894- 898
PubMedArticle
10.
Perdikis  GHinder  RAFilipi  CJ  et al.  Laparoscopic paraesophageal hernia repair. Arch Surg 1997;132586- 590
PubMedArticle
11.
Edye  MBCanin-Endres  JGattorno  FSalky  BA Durability of laparoscopic repair of paraesophageal hernia. Ann Surg 1998;228528- 535
PubMedArticle
12.
Gantert  WAPatti  MGArcerito  M  et al.  Laparoscopic repair of paraesophageal hiatal hernias. J Am Coll Surg 1998;186428- 433
PubMedArticle
13.
Watson  DIDavies  NDevitt  PGJamieson  GG Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 1999;1341069- 1073
PubMedArticle
14.
Wu  JSDunnegan  DLSoper  NJ Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 1999;13497- 502
PubMedArticle
15.
Horgan  SEubanks  TRJacobsen  GOmelanczuk  PPellegrini  CA Repair of paraesophageal hernias. Am J Surg 1999;177354- 358
PubMedArticle
16.
Swanstrom  LLJobe  BAKinzie  LRHorvath  KD Oesophageal motility and outcome following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 1999;177359- 363
PubMedArticle
17.
Hashemi  MPeters  JHDeMeester  TR  et al.  Laparoscopic repair of large type III hiatal hernia: objective follow up reveals high recurrence rate. J Am Coll Surg 2000;190553- 561
PubMedArticle
18.
Peet  DLKlinkerberg-Knol  ECAlonso  ASietses  CEijsbouts  QAJCuesta  MA Laparoscopic treatment of large paraesophageal hernias. Surg Endosc 2000;141015- 1018
PubMedArticle
19.
Dahlberg  PSDeschamps  CMiller  DLAllen  MSNichols  FCPairolero  PC Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 2001;721125- 1129
PubMedArticle
20.
Wiechmann  RJFerguson  MKNaunheim  KS  et al.  Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 2001;711080- 1087
PubMedArticle
21.
Velanovich  VKarmy-Jones  R Surgical management of paraesophageal hernias: outcome and quality of life analysis, with invited commentary. Dig Surg 2001;18432- 438
PubMedArticle
22.
Khaitan  LHouston  HSharp  KHolzman  MRichards  W Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg 2002;68546- 551
PubMed
23.
Pierre  AFLuketich  JDFernando  HC  et al.  Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 2002;741909- 1916
PubMedArticle
24.
Mattar  SGBowers  SPGalloway  KDHunter  CDSmith  CD Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 2002;16745- 749
PubMedArticle
25.
Diaz  SBrunt  MKlingensmith  MEFrisella  PMSoper  NJ Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 2003;759- 67
PubMedArticle
26.
Targarona  EMNovell  JVela  S  et al.  Mid-term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 2004;181045- 1050
PubMedArticle
27.
Leeder  PCSmith  GDehn  TCB Laparoscopic management of large paraesophageal hiatal hernia. Surg Endosc 2003;171372- 1375
PubMedArticle
28.
Ponsky  JRosen  MFanning  AMalm  J Anterior gastropexy may reduce the recurrence after laparoscopic paraesophageal hernia repair. Surg Endosc 2003;171029- 1035
PubMedArticle
29.
Jobe  BAAye  RWDeveney  CWDomreis  JSHill  LD Laparoscopic management of giant type III hiatal hernia and short oesophagus: objective follow up at three years. J Gastrointest Surg 2002;6181- 188
PubMedArticle
30.
Keidar  ASzold  A Laparoscopic repair of paraesophageal hernia with selective use of mesh. Surg Laparosc Endosc Percutan Tech 2003;13149- 154
PubMedArticle
31.
Athanasakis  HTzortzinis  ATsiaoussis  JVassilakis  JSXynos  E Laparoscopic repair of paraesophageal hernia. Endoscopy 2001;33590- 594
PubMedArticle
32.
Cloyd  DW Laparoscopic repair of incarcerated paraesophageal hernias. Surg Endosc 1994;8893- 897
PubMedArticle
33.
Coster  DD Laparoscopic paraesophageal hernia repair using Surgi-pro mesh [letter]. Surg Laparosc Endosc 1996;678- 79
PubMedArticle
34.
Johnson  PEPresuad  MMitchell  T Laparoscopic anterior gastropexy for treatment of paraesophageal hernias. Surg Laparosc Endosc 1994;4152- 154
PubMed
35.
Katkhouda  NMavor  EAchanta  K  et al.  Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 2000;128784- 790
PubMedArticle
36.
Kercher  KWMatthews  BDPonsky  JL  et al.  Minimally invasive management of paraesophageal herniation in the high-risk surgical patient. Am J Surg 2001;182510- 514
PubMedArticle
37.
Koger  KEStone  JM Laparoscopic reduction of acute gastric volvulus. Am Surg 1993;59325- 328
PubMed
38.
Krahenbuhl  LSchafer  MFarhadi  JRenzulli  PSeiler  CBuchler  MW Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach. J Am Coll Surg 1998;187231- 237
PubMedArticle
39.
Luketich  JDRaja  SFernando  HC  et al.  Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 2000;232608- 618
PubMedArticle
40.
Medina  LPeetz  MRatzer  EFenoglio  M Laparoscopic paraesophageal hernia repair. JSLS 1998;2269- 272
PubMed
41.
Mosnier  HLeport  JAubert  AGuibert  LCaronia  F Videolaparoscopic treatment of paraesophageal hiatal hernia [in French]. Chirurgie 1998;123594- 599
PubMedArticle
42.
Rosati  RBona  SFumagalli  UChella  BPeracchia  A Laparoscopic treatment of paraesophageal and large mixed hiatal hernias. Surg Endosc 1996;10429- 431
PubMedArticle
43.
Tabet  JLacy  AMGrande  L  et al.  Paraesophageal hernias in elderly patients: an indication for laparoscopic surgery. Rev Esp Enferm Dig 1996;88801- 804
PubMed
44.
Luostarinen  MRantalainen  MHelve  OReinikainen  PIsolauri  J Late results of paraesophageal hiatus hernia repair with funduplication. Br J Surg 1998;85272- 275
PubMedArticle
45.
Carlson  MACondon  RELudwig  KASchulte  WJ Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 1998;187227- 230
PubMedArticle
46.
Kuster  GGGilroy  S Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 1993;3331- 338
PubMedArticle
47.
Edelman  DS Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 1995;532- 37
PubMed
48.
Pitcher  DECuret  MJVogt  DMMason  JZucker  KA Successful repair of praesophageal hernia. Arch Surg 1995;130590- 596
PubMedArticle
49.
Oddsdottir  MFranco  ALLaycock  WAWaring  JPHunter  JG Laparoscopic repair of paraesophageal hernia: new access, old technique. Surg Endosc 1995;9164- 168
PubMedArticle
50.
Behrns  KESchlinkert  RT Laparoscopic management of paraesophageal hernia: early results. J Laparoendosc Surg 1996;6311- 317
PubMedArticle
51.
Huntington  TR Laparoscopic mesh repair of the oesophageal hiatus. J Am Coll Surg 1997;184399- 401
PubMed
52.
Paul  MGDe Rosa  RPPetrucci  PEPalmer  MLDanovitch  SH Laparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 1997;11303- 307
PubMedArticle
53.
Frantzides  CTCarlson  MA Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorraphy. Surg Endosc 1997;11769- 771
PubMedArticle
54.
Willekes  CLEdoga  JKFreeza  EE Laparoscopic repair of paraesophageal hernia. Ann Surg 1997;22531- 38
PubMedArticle
55.
Hawasli  AZonca  S Laparoscopic repair of paraesophageal hiatal hernia. Am Surg 1998;64703- 710
PubMed
56.
Basso  NDeLeo  AGenco  A  et al.  360 Degrees laparoscopic fundoplication with tension free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc 2000;14164- 169
PubMedArticle
57.
Lambert  AWHuddart  SN Mesh hiatal reinforcement in Nissen fundoplication. Pediatr Surg Int 2001;17491- 492
PubMedArticle
58.
Meyer  CBufffler  ARohr  SLima  MC Le traitement laparoscopique des hernies hiatales de gran taille avec mise en place d’une prothese: a propos de dix cas. Ann Chir 2002;127257- 261
PubMedArticle
59.
Casaccia  MTorelli  PPanaro  FCavaliere  DVentura  AValente  U Laparoscopic physiologic hiatoplasty for hiatal hernia: new composite “A”-shaped mesh. Surg Endosc 2002;161441- 1445
PubMedArticle
60.
Kamolz  TGranderath  FABasmmer  TPasiut  MPointner  R Dysphagia and quality of life after laparoscopic Nissen funduplication in patients with and without prosthetic reinforcement of the hiatal crura. Surg Endosc 2002;16572- 577
PubMedArticle
61.
Champion  JKRock  D Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 2003;17551- 553
PubMedArticle
62.
Oelschlager  BKBarreca  MChang  LPellegrini  CA The use of small intestine submucosa in the repair of paraesophageal hernias: initial observation of a new technique. Am J Surg 2003;1864- 8
PubMedArticle
63.
Granderath  FAKamolz  TSchweiger  UMPointner  R Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Arch Surg 2003;138902- 907
PubMedArticle
64.
Hui  TTDavid  TSpyrou  MPhillips  EH Mesh crural repair of large paraesophageal hiatal hernias. Am Surg 2001;671170- 1174
PubMed
65.
Frantzides  CTMadan  AKCarlson  MAStavropoulos  GP A prospective, randomised trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 2002;137649- 652
PubMedArticle
66.
Schauer  PRIkramuddin  SMcLaughlin  RH  et al.  Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 1998;176659- 665
PubMedArticle
67.
Skinner  DBBelsey  RH Surgical management of esophageal reflux and hiatus: long-term results with 1030 patients. J Thorac Cardiovasc Surg 1967;5333- 54
PubMed
68.
Hill  LDTobias  JA Paraesophageal hernia. Arch Surg 1968;96735- 744
PubMedArticle
69.
Wichterman  KGeha  ASCahow  CEBaue  AE Giant paraesophageal hiatus hernia with intrathoracic stomach and colon: the case for early repair. Surgery 1979;86497- 506
PubMed
70.
Pearson  FGCooper  JDIlves  RTodd  TRJJamieson  WRE Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg 1983;3545- 51
PubMedArticle
71.
Ellis  FH  JrCrozier  REShea  JA Paraesophageal hiatus hernia. Arch Surg 1986;121416- 420
PubMedArticle
72.
Treacy  PJJamieson  GG An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg 1987;57813- 817
PubMedArticle
73.
Menguy  R Surgical management of large paraesophageal hernia with complete intrathoracic stomach. World J Surg 1988;12415- 422
PubMedArticle
74.
Ackermann  CBally  HHarder  F Paraesophageal hiatal hernia—risks and surgical indications. Helv Chir Acta 1989;56159- 162
PubMed
75.
Haas  ORat  PChristophe  MFriedman  SFavre  JP Surgical results of intrathoracic gastric volvulus complicating hiatal hernia. Br J Surg 1990;771379- 1381
PubMedArticle
76.
Harriss  DRGraham  TRGalea  MSalama  FD Paraoesophageal hiatal hernias: when to operate. J R Coll Surg Edinb 1992;3797- 98
PubMed
77.
Allen  MSTrastek  VFDeschamps  CPairolero  PC Intrathoracic stomach: presentation and results of operation. J Thorac Cardiovasc Surg 1993;105253- 258
PubMed
78.
Williamson  WAEllis  FHStreitz  JMShahian  DM Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 1993;56447- 451
PubMedArticle
79.
Myers  GAHarms  BAStarling  JR Management of paraesophageal hernia with a selective approach to antireflux surgery. Am J Surg 1995;170375- 380
PubMedArticle
80.
Altorki  NKYankelevitz  DSkinner  DB Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg 1998;115828- 835
PubMedArticle
81.
Maziak  DETodd  TRPearson  FG Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg 1998;11553- 60
PubMedArticle
82.
Geha  ASMassad  MGSnow  NJBaue  AE A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 2000;128623- 630
PubMedArticle
83.
Rogers  MLDuffy  JPBeggs  FDSalama  FDKnowles  KRMorgan  WE Surgical treatment of para-oesophageal hiatal hernia. Ann R Coll Surg Engl 2001;83394- 398
PubMed
84.
Low  DESimchuk  EJ Effect of paraesophageal hernia repair on pulmonary function. Ann Thorac Surg 2002;74333- 337
PubMedArticle
85.
Carlson  MARichards  CGFrantzides  CT Laparoscopic prosthetic reinforcement of hiatal herniorraphy. Dig Surg 1999;16407- 410
PubMedArticle
86.
Willwerth  BM Gastric complications associated with paraesophageal herniation. Am Surg 1974;40366- 369
PubMed
87.
Wo  JMBranum  GDHunter  JGTrus  TNMauren  SJWaring  P Clinical features of type III (mixed) paraesophageal hernias. Am J Gastroenterol 1996;91914- 916
PubMed
88.
Ellis  FH Controversies regarding the management of hiatus hernia. Am J Surg 1980;139782- 788
PubMedArticle
89.
Boerema  I Hiatus hernia: repair by right-sided, subhepatic, anterior gastropexy. Surgery 1969;65884- 893
PubMed
90.
Carter  RBrewer  LDHinshaw  A Acute gastric volvulus. Am J Surg 1980;14099- 106
PubMedArticle
91.
Hallissey  MTRatliff  DATemple  JG Paraoesophageal hiatus hernia: surgery for all ages. Ann R Coll Surg Engl 1992;7423- 25
PubMed
92.
Hill  LD Incarcerated paraesophageal hernia: a surgical emergency. Am J Surg 1973;126286- 291
PubMedArticle
93.
Teague  WJAckroyd  RWatson  DIDevitt  PG Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 2000;87358- 361
PubMedArticle
94.
Stylopoulos  NGazelle  GSRattner  DW Paraesophageal hernias: operation or observation? Ann Surg 2002;236492- 501
PubMedArticle
95.
Pros  ITargarona  EMAngás  J  et al.  Tratamiento quirúrgico del vólvulo gástrico. Cir Esp 1992;51449- 453
96.
Caskey  CIZerhouni  EAFishman  EKRahmouni  AD Aging of the diaphragm: a CT study. Radiology 1989;171385- 389
PubMed
97.
Purkiss  SFArgano  VAKuo  JLewis  CT Oesophageal erosion of an Angelchik prosthesis: surgical management using fundoplication. Eur J Cardiothorac Surg 1992;6517- 518
PubMedArticle
98.
Crookes  PFDeMeester  TR The Angelchik prosthesis: what have we learned in fifteen years? Ann Thorac Surg 1994;571385- 1386
PubMedArticle
99.
Benjamin  SBKerr  RCohen  DMotaparthy  VCastell  DO Complications of the Angelchik antireflux prosthesis. Ann Intern Med 1984;100570- 575
PubMedArticle
100.
Abu-Abeid  SKeidar  AGavert  NBlanc  ASzold  A The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity. Surg Endosc 2003;17861- 863
PubMedArticle
101.
Basso  NRosato  PDe Leo  AGenco  ARea  SNeri  T “Tension-free” hiatoplasty, gastrophrenic anchorage, and 360° fundoplication in the laparoscopic treatment of paraesophageal hernia. Surg Laparosc Endosc Percutan Tech 1999;9257- 262
PubMedArticle
102.
Cuschieri  AShimi  SNathanson  LK Laparoscopic reduction, crural repair and fundoplication of large hiatal hernia. Am J Surg 1992;163425- 430
PubMedArticle
103.
Agwunobi  AOBancewicz  JAttwood  SEA Simple laparoscopic gastropexy as the initial treatment of paraesophageal hiatal hernia. Br J Surg 1998;85604- 606
PubMedArticle
104.
Casabella  FSinanan  MHorgan  SPellegrini  CA Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 1996;171485- 489
PubMedArticle
105.
Trus  TLBax  TRichardson  WS  et al.  Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1997;1221- 228
PubMedArticle
106.
Kemppainen  EKiviluoto  T Fatal cardiac tamponade after emergency tension free repair of a large paraesophageal hernia. Surg Endosc 2000;14593
PubMed
107.
Baladas  HGSmith  GSRichardson  MADempsey  MBFalk  GL Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 2000;1372- 74
PubMedArticle
108.
Arendt  TStuber  EMonig  HFolsch  URKatsoulis  S Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 2000;51607- 610
PubMedArticle
109.
Simpson  BRicketts  RRParker  PM Prosthetic patch stabilization of crural repair in antireflux surgery in children. Am Surg 1998;6467- 69
PubMed
110.
Ludemann  RWatson  DIJamieson  GG Influence of follow-up methodology and completeness on apparent clinical outcome of funduplication. Am J Surg 2003;186143- 147
PubMedArticle
111.
Terry  MSmith  CDBranum  GDGalloway  KWaring  JPHunter  JG Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 2001;15691- 699
PubMedArticle
112.
Trus  TLLaycock  WSWaring  JPBranum  GDHunter  JG Improvement in quality of life measures after laparoscopic antireflux surgery. Ann Surg 1999;229331- 336
PubMedArticle
Review
December 01, 2004

Mesh in the HiatusA Controversial Issue

Author Affiliations

Author Affiliations: Service of Surgery, Hospital de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.

Arch Surg. 2004;139(12):1286-1296. doi:10.1001/archsurg.139.12.1286
Abstract

Objective  To analyze the experience acquired to date on the use of prosthetic mesh to prevent recurrence after laparoscopic repair of paraesophageal hernia.

Data Sources  Current English-language literature review.

Study Selection  Case reports, series, and opinion articles on the use of mesh for paraesophageal hernia repair.

Data Extraction and Synthesis  Study type and results were analyzed. Most articles were short case series. Few comparative or randomized trials assessing the procedure have been published to date. The information available showed that the use of a mesh for hiatal repair was safe and prevented recurrence. However, data on the long-term results were lacking, and infrequent but severe complications may arise.

Conclusions  The mesh should be used selectively, and the decision to proceed should be based on clinical experience. In light of the evidence available, however, it appears to be safe, and the fears expressed in the past have not been confirmed.

INTRODUCTION

Success in the development of laparoscopic fundoplication has made this procedure a valid alternative to medical therapy for the treatment of gastroesophageal reflux. Thanks to the experience acquired, the laparoscopic approach is now used to treat more complex situations, such as paraesophageal hernia (PEH) or type III (mixed) hiatal hernia.18 The results of several series have shown that laparoscopic repair is also feasible and safe, despite the increased technical difficulty, and its immediate and short-term results are excellent943 (Table 1). However, the incidence of recurrences may be high: as much as 42% in one series (Table 2).

One of the most demanding laparoscopic technical steps is crural closure, especially when the gap is wide and the closure inevitably entails a tension repair. Some authors recommend the use of prosthetic mesh to reinforce the hiatal closure4466 (Table 3 and Table 4), but others argue against it. This review analyzes the experience accumulated so far on the use of mesh to reinforce the hiatus to prevent recurrence after laparoscopic repair of PEH.

THE PROBLEM

Laparoscopic repair of PEH and mixed hiatal hernias is a feasible, safe, but complex procedure. The experience during the past 15 years suggests that viscera reduction, sac excision, retrogastric crural closure, and fundoplication are the key technical factors.18 Fixation of the gastric plicature, abdominal wall gastropexy, and gastrostomy are more controversial technical steps for maintaining the stomach in place in the abdomen. Although controlled comparative trials with the open approach are lacking (Table 4), the immediate clinical outcome of laparoscopic PEH repair is highly satisfactory. However, the recurrence rate is higher than expected after midterm follow-up—as high as 42% when compared with the open approach6695 (Table 5)—and some authors have suggested that the laparoscopic approach is unsuitable.17 The main reason for the failure of the hiatal repair is tension. Recurrence has been related to the mean diameter of the hiatus (>10 cm in some cases). Another factor is the anatomy of the pillars. The hiatal crus is a fleshy structure without tendinous reinforcement. Standard sutures may cut the muscle, and when the hiatus is particularly wide and the pillars are approached, the lateral portions of the diaphragm near the crura become tense, with a potential risk of disruption.

Currently, all hernia repairs are tension free (for example, the Lichtenstein repair or ventral hernia repair). However, performing a tension-free repair in the hiatus is technically very demanding, because of the oblique situation of the pillars and the difficulty of fixing the mesh. Furthermore, the hiatus is a complex anatomic structure in which the esophagus moves during respiratory excursion of the diaphragm,96 whereas in inguinal or ventral hernia repair the mesh passively supports the intra-abdominal viscera. This means that any prosthetic mesh will be in contact with the esophagus, and so there is a theoretical risk of esophageal erosion and complication. This fact—along with evidence of mechanical complications after placement of mesh for repair of abdominal wall defects and complications with mechanical devices located in the cardia (such as the Angelchik device9799 and with the bands used in treatment of morbid obesity100)—seems to argue against the placement of foreign bodies in the hiatus. However, some surgeons report that the use of mesh in the hiatus is safe and the outcome acceptable (Table 3 and Table 4).

RECURRENCES

Analysis of recurrences shows different patterns for time of presentation and shape (Table 2). Immediate recurrent hernias are usually secondary to total disruption of the hiatal closure with a relapsing PEH. Long-term recurrences may adopt several patterns: complete recurrent PEH, fundoplication migration, or a small sliding hernia, without a clear recurrence of the paraesophageal sac. In the latter subgroup, the incidence of symptoms is variable, and most are identified only by esophagogram. Recurrences of symptoms are treated surgically. However, there is tacit agreement that nonsymptomatic recurrences, especially in cases of small sliding hernias, do not require repair. Recurrent hernias of any type should be considered as technical failures, although the long-term outcome of asymptomatic recurrent hernias is unknown.

METHODS

A systematic PubMed search looking for all of the studies published in English in relation to treatment of paraesophageal and mixed hiatal hernias was performed. Particular attention was paid to the use of meshes for reinforcement of the hiatal repair.

SURGICAL TECHNIQUE

The most controversial issue in the use of prostheses in the hiatus is the surgical technique. Several models have been proposed.

Tension-Free Techniques

One tension-free technique is anterior placement of a triangular piece of mesh, proposed by Paul et al52 (Figure 1). A triangular or semilunar polytef patch is placed to occlude the anterior segment of the hiatus and fixed with staples or stitches. The stomach is fixed to the abdomen and a fundoplication is added.

For posterior placement of a triangular piece of mesh (Figure 2), the aim is the same as in the technique for anterior placement. Kuster and Gilroy46 proposed a posterior segmental occlusion, occluding the base of the pillar overture, and placing the esophagus anteriorly, fixing the mesh with staples or stitches. Fixation to the abdominal wall or a gastrostomy is also performed.

A third technique involves onlay of a piece of mesh, with a hole facilitating the passage of the esophagus. The mesh covers the whole of the hiatal defect, and no attempt is made to close the hiatus (Figure 3). There are several shapes of mesh designed to allow the passage of the esophagus and to facilitate fixation (eg, U shape,22,53 A shape59) (Figure 4). Basso et al101 also proposed covering the mesh with autologous flaps of peritoneal tissue obtained from the hernia sac. Casaccia et al59 recently proposed a composite polytef-polypropylene A-shaped mesh. This mesh was designed according to the strength lines of the hiatus and produced good results after 8 months of follow-up.

A piece of mesh may be placed just covering the defect below the esophagus, overlapping both pillars laterally. This was described by Basso et al56 (Figure 5).

In another technique, after a standard closure of the hiatus, a relaxing incision lateral to the right crura is placed, and a patch is fixed with stitches or staples covering the diaphragmatic defect (Figure 6). Described by Huntington in 1997,51 it has been also proposed by Horgan et al.15

Non–Tension-Free Techniques

Simple crural closure with either simple stitches (Figure 7) or a continuous suture (Figure 8) is the most common method for hiatal closure. In 1992, Cuschieri et al102 described the first specific method for hiatal closure, using a continuous suture.

Other non–tension-free techniques are reinforcement of the crural closure, to avoid the cutting effect of the stitches; simple stitches with Teflon or Dacron pledgets18,29 (Figure 9); a polypropylene strip along the crura to hold the stitches (Figure 10); and a piece of polypropylene mesh covering both edges of the pillars. The stitches close the hiatus including the mesh and tissue, as proposed by Kamolz et al60 (Figure 11).

A buttress mesh technique has also been described. A long strip of mesh is placed below the esophagus, covering the pillar closure (Figure 12). The advantage is that it avoids the encircling of the esophagus, reducing the risk of dysphagia or erosion. Champion and Rock61 reported good results in a series of 52 cases, with a recurrence rate of 2%, although esophagography was performed in only 52% of cases.

Placement of onlay mesh around the esophagus with a hole in the middle, once the defect has been closed, has been used (Figure 13). There are also preshaped meshes designed to adapt anatomically to the characteristics of the anatomic area31,62 (Figure 4).

Other Maneuvers

Additional maneuvers for fixing the stomach in the abdominal cavity include a range of techniques, such as fixation of the fundoplication to the diaphragm, fixation of the gastric body to the abdominal wall, and gastrostomy.103,104 Fundoplication itself may have some fixation effect. Some authors have proposed that the Toupet technique may avoid recurrence because the posterior placement of the fundus covers the crural closure and fixes it to the diaphragm.1,3 However, there are no definitive data from randomized trials to support any of these measures.

REPAIR MATERIAL

The prostheses available for hiatal reinforcement are made of a range of materials. Most authors agree that the material used should be nonresorbable, because resorbable material (poly-glycolic acid) loses its mechanical properties as it is resorbed. Nonresorbable material may be made of polypropylene, polytef, or composite (polytef plus polypropylene; C. R. Bard, Inc, Murray Hill, NJ). Recently, a nonresorbable material of biological origin has been used (Surgisis; Cook Biotech Incorporated, West Lafayette, Ind).62 The crucial aspect of the material used to reinforce the hiatus is stiffness. The advantages of polytef are its softness and its lower capacity to induce adhesions. The different surfaces prevent tight adhesions to the visceral face of the mesh, and the texture of the free margin in near contact with the esophagus is potentially less dangerous. However, the handling and sewing of the mesh may be more difficult than when polypropylene is used. The main drawback of polypropylene is the stiffness of the margins and the possibility that the esophagus will be eroded. Experience with mixed mesh or with material of biological origin is scarce.

RESULTS

Most of the clinical results of the use of mesh in the hiatus come from short series of patients, although the midterm follow-up is often adequate (up to 5 years). No long-term experience (up to 10 years) is available. Mesh has been used mostly in adults, although there is some experience in the pediatric setting as well. Overall results are plotted in Table 2; tolerance is good and the recurrence rate and morbidity are both low. Three comparative studies have been published (Table 3), but only 1 was a prospective randomized trial. In addition, 2 of the comparative trials included patients with all types of hiatal hernias, and only 1 focused on PEH hernia repair. Basso et al56 compared simple and tension-free closures using an onlay piece of polypropylene, dividing their personal series chronologically into 2 parts. Kamolz et al60 compared simple closure with a reinforcement procedure that put the stitches over a piece of polypropylene covering the hiatal closure. Neither study was randomized; they were merely comparisons of initial experiences without mesh with more recent experiences with mesh. They also counted hiatal repair of all types, including type I hernias or pure gastroesophageal reflux disease without hernia. Mesh placement was followed by reductions in the incidence of recurrences, without specific morbidity.

Frantzides et al65 showed the results of a prospective randomized trial comparing simple closure with polytef onlay reinforcement for PEH hernia repair, in cases with hiatus wider than 8 cm. Recurrences were significantly reduced after mesh placement (20% vs 0%; P<.001), without long-term sequel, after a 40-month follow-up period.

The main drawback with the use of mesh in the hiatus is the risk of local complications (fibrosis and adhesions, erosion, or perforation). Nonetheless, the incidence of mesh-related complications in the hiatus is currently less than 2%, although no reports on long-term outcome (>10 years) are available.

Mesh placed in the hiatus may induce complications because of the type of mesh or the device used for fixation. Some complications may be related to local fibrosis (dysphagia) or to the erosion of the digestive lumen. Others may be induced by the device applied to fix the mesh, especially when staples or tackers are used, and injury to the vital structures surrounding the hiatus may occur. Teflon pledgets may also erode the fundus or induce fibrous retraction and dysphagia. Table 6 shows the incidence of complications of this type in reports published to date.105108 Mesh has also been used in pediatric cases, without long-term problems.52,109

COMMENT

Surgical treatment of PEH and type III mixed hernias has been a challenging chapter in digestive surgery for the past 30 years (Table 4). The treatment used to be offered to a subset of elderly patients, some of them particularly frail and, in some cases, associated with urgent situations such as gastric volvulus or gastric incarceration. However, the results from centers with wide experience showed low morbidity and good long-term outcome after standard open transthoracic or transabdominal approaches, although in most series the results were merely assessed on the basis of the presence or absence of symptoms without any anatomic (radiologic) evaluation.110 The experience available shows the efficacy of the laparoscopic approach for treatment of PEH.111,112 Despite the increased intraoperative technical difficulty, and although there are no comparative randomized trials with the open approach to conclusively determine their relative merits, the immediate outcome clearly endorses this minimally invasive approach in a population that is typically at higher risk than conventional patients with GERD or small type I hiatal hernia. The large number of series published in recent years (20 series related to the open approach in 33 years, compared with 46 series in 12 years for the laparoscopic approach) bears witness to the success of, and the interest in, the application of laparoscopic techniques in PEH repair.

Most accepted technical rules for the surgical treatment of PEH include stomach reduction, sac excision, and closure of the hiatal defect—on occasion more than 8 cm wide—with or without the addition of some type of fixation. The controversy arises after the definitive observation of a variable recurrence rate (up to 42%) when a routine radiologic follow-up is done. Some authors have suggested that alternative approaches (open or thoracic) may be better for this disease. Arguments put forward to account for this unacceptably high recurrence rate include the learning curve due to the technical difficulty of the procedure, poor technical crural closure, or a short esophagus. The learning curve for a difficult laparoscopic procedure undoubtedly plays a role, and it has been observed in several large series that the recurrence rate falls as surgeons gain experience. The significance of a short esophagus continues to be a controversial issue. It has been considered as a potential cause of failure, but most patients with PEH do not have advanced gastroesophageal reflux disease with esophageal scarring. The need to perform a Collis gastroplasty to lengthen the esophagus varied from 0% to 70% in the series analyzed, and as yet there is no clear agreement on whether this technical step is needed during PEH repair.

Clearly, as with other abdominal wall defects, the aim is to achieve adequate closure. In contrast to the accepted standard concept for inguinal or ventral hernia, which is tension free, the most widely supported approach is to close the hiatus under tension, with the obvious risk of disruption. The rationale for this judgment is that, unlike the abdomen or groin, in which the aim of repair is to achieve passive containment, the cardial region including the hiatus and the gastroesophageal junction is a highly dynamic anatomic area and so anatomic repair is justified. However, since PEH repair causes wide-ranging anatomic distortion and the risk of disruption is high, reinforcement with mesh is a logical forward step. Hiatal closure is occasionally difficult. Surgeons who are in general against the placement of mesh in the hiatus are sometimes obliged to use the procedure to correct the defect, because of either the size of the defect or the technical impossibility of proceeding otherwise.

There are no clear reasons for the differences in outcome after open or laparoscopic approach to PEH. Possibly the final results of laparoscopic repair are not as good because the laparoscopic approach is more technically demanding. However, systematic evaluation with radiologic esophagogram, including asymptomatic patients, has shown a higher number of recurrences. Haas et al75 found an anatomic recurrence rate of 42% after systematic radiologic evaluation. This suggests that the problem may also have been evident in the open-procedure era, but has only become relevant today since the increase in laparoscopic procedures and the possibility of more detailed study.

One of the main arguments against mesh placement has been the emergence of complications due mainly to visceral erosion, a risk that is intrinsically related to the existence of a foreign body. On the basis of this rationale, many surgeons consider routine placement contraindicated. However, there are clear differences between the placement of mesh and insertion of an Angelchik device or bands used for gastric banding in obese patients. The latter devices are placed directly over the cardia, maintaining a sustained and continued tension and favoring potential erosion; in contrast, mesh in the hiatus for reinforcement of the diaphragmatic closure is placed outside the esophagus and direct contact is avoided. Although several serious complications have been reported, the morbidity rate associated with mesh placement is low (Table 6).

No objective information is available to guide the choice of material. Most authors prefer soft materials with less intense fibrotic response such as polytef rather than polypropylene, but no comparative trials of the materials have been performed. Complications have been reported with the use of both types of mesh. No long-term follow-up data on this issue are available; experience with other types of material such as combined mesh types or biomaterials is limited, and the follow-up periods are short.

Another controversial point is whether the use of mesh for hiatal repair in PEH should be routine or selective. The local conditions of the hiatus after sac excision may cause differences in the results, and sometimes, although the hernia sac is large, the pillars are of good quality and can be approached without difficulty. There are no studies investigating predictive factors for recurrence after laparoscopic repair of PEH, which may involve the anatomic features of the hiatus (such as the size of the gap, tension, or diaphragmatic weakness), the type of repair (single stitches, pledget, etc), additional fixation maneuvers (Toupet, fixation, gastrostomy, etc), and patient characteristics (heavy work, constipation, chronic cough, etc). Some authors recommend a tailored approach, placing a mesh in cases at major risk of recurrence, and its use seems more advisable in the case of reoperations. However, the decision clearly depends on the experience of the surgeon.

The final answers to our questions should come from analysis of the long-term follow-up over 5 years of series of patients in whom mesh has been placed, and randomized trials of suitable design to provide answers regarding the controversial technical aspects (type of mesh, location, selective vs routine, additional maneuvers [fixation], Collis esophageal lengthening, etc).

At present, the information available shows that the use of a mesh for hiatal repair after laparoscopic repair of PEH is safe and prevents hernia recurrence. However, information on the long-term results is lacking; severe complications may arise, albeit infrequently. A selective use based on clinical experience is recommended, as the technique appears to be safe, and the fears expressed at earlier stages of its development have not been confirmed.

Back to top
Article Information

Correspondence: Eduardo M. Targarona, MD, PhD, Service of Surgery, Hospital de Sant Pau, Padre Claret 167, 08025 Barcelona, Spain (etargarona@hsp.santpau.es).

Accepted for Publication: January 19, 2004.

Acknowledgment: Isabel Salgado drew the illustrations for the figures in this article.

References
1.
Cuesta  MAPeet  DLKlinkerberg-Knol  EC Laparoscopic treatment of large hiatal hernias. Semin Laparosc Surg 1999;6213- 223
PubMed
2.
Floch  N Paraesophageal hernias: current concepts. J Clin Gastroenterol 1999;296- 7
PubMedArticle
3.
Hashemi  MSillin  LFPeters  JH Current concepts in the management of paraesophageal hiatal hernia. J Clin Gastroenterol 1999;298- 13
PubMedArticle
4.
Buenaventura  POSchauer  PRKeena  RJLuketich  JD Laparoscopic repair of giant paraesophageal hernia. Semin Thorac Cardiovasc Surg 2000;12179- 185
PubMed
5.
Freeman  MEHinder  RA Laparoscopic paraesophageal hernia repair. Semin Laparosc Surg 2001;8240- 245
PubMedArticle
6.
Landrenau  RJ Surgical management of paraesophageal herniation. Nyhus  LMBaker  RJFischer  JEMastery of Surgery. 3rd ed. Boston, Mass Little Brown & Co Inc1997;694- 707
7.
Litle  VRBuenaventura  POLuketich  JD Laparoscopic repair of giant paraesophageal hernia. Adv Surg 2001;3521- 38
PubMed
8.
Oelschlager  BKPellegrini  CA Paraesophageal hernias: open, laparoscopic, or thoracic repair. Chest Surg Clin N Am 2001;11589- 603
PubMed
9.
Huntington  TR Short-term outcomes of laparoscopic paraesophageal hernia repair: a case series of 58 consecutive patients. Surg Endosc 1997;11894- 898
PubMedArticle
10.
Perdikis  GHinder  RAFilipi  CJ  et al.  Laparoscopic paraesophageal hernia repair. Arch Surg 1997;132586- 590
PubMedArticle
11.
Edye  MBCanin-Endres  JGattorno  FSalky  BA Durability of laparoscopic repair of paraesophageal hernia. Ann Surg 1998;228528- 535
PubMedArticle
12.
Gantert  WAPatti  MGArcerito  M  et al.  Laparoscopic repair of paraesophageal hiatal hernias. J Am Coll Surg 1998;186428- 433
PubMedArticle
13.
Watson  DIDavies  NDevitt  PGJamieson  GG Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 1999;1341069- 1073
PubMedArticle
14.
Wu  JSDunnegan  DLSoper  NJ Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 1999;13497- 502
PubMedArticle
15.
Horgan  SEubanks  TRJacobsen  GOmelanczuk  PPellegrini  CA Repair of paraesophageal hernias. Am J Surg 1999;177354- 358
PubMedArticle
16.
Swanstrom  LLJobe  BAKinzie  LRHorvath  KD Oesophageal motility and outcome following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 1999;177359- 363
PubMedArticle
17.
Hashemi  MPeters  JHDeMeester  TR  et al.  Laparoscopic repair of large type III hiatal hernia: objective follow up reveals high recurrence rate. J Am Coll Surg 2000;190553- 561
PubMedArticle
18.
Peet  DLKlinkerberg-Knol  ECAlonso  ASietses  CEijsbouts  QAJCuesta  MA Laparoscopic treatment of large paraesophageal hernias. Surg Endosc 2000;141015- 1018
PubMedArticle
19.
Dahlberg  PSDeschamps  CMiller  DLAllen  MSNichols  FCPairolero  PC Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 2001;721125- 1129
PubMedArticle
20.
Wiechmann  RJFerguson  MKNaunheim  KS  et al.  Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 2001;711080- 1087
PubMedArticle
21.
Velanovich  VKarmy-Jones  R Surgical management of paraesophageal hernias: outcome and quality of life analysis, with invited commentary. Dig Surg 2001;18432- 438
PubMedArticle
22.
Khaitan  LHouston  HSharp  KHolzman  MRichards  W Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg 2002;68546- 551
PubMed
23.
Pierre  AFLuketich  JDFernando  HC  et al.  Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 2002;741909- 1916
PubMedArticle
24.
Mattar  SGBowers  SPGalloway  KDHunter  CDSmith  CD Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 2002;16745- 749
PubMedArticle
25.
Diaz  SBrunt  MKlingensmith  MEFrisella  PMSoper  NJ Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 2003;759- 67
PubMedArticle
26.
Targarona  EMNovell  JVela  S  et al.  Mid-term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 2004;181045- 1050
PubMedArticle
27.
Leeder  PCSmith  GDehn  TCB Laparoscopic management of large paraesophageal hiatal hernia. Surg Endosc 2003;171372- 1375
PubMedArticle
28.
Ponsky  JRosen  MFanning  AMalm  J Anterior gastropexy may reduce the recurrence after laparoscopic paraesophageal hernia repair. Surg Endosc 2003;171029- 1035
PubMedArticle
29.
Jobe  BAAye  RWDeveney  CWDomreis  JSHill  LD Laparoscopic management of giant type III hiatal hernia and short oesophagus: objective follow up at three years. J Gastrointest Surg 2002;6181- 188
PubMedArticle
30.
Keidar  ASzold  A Laparoscopic repair of paraesophageal hernia with selective use of mesh. Surg Laparosc Endosc Percutan Tech 2003;13149- 154
PubMedArticle
31.
Athanasakis  HTzortzinis  ATsiaoussis  JVassilakis  JSXynos  E Laparoscopic repair of paraesophageal hernia. Endoscopy 2001;33590- 594
PubMedArticle
32.
Cloyd  DW Laparoscopic repair of incarcerated paraesophageal hernias. Surg Endosc 1994;8893- 897
PubMedArticle
33.
Coster  DD Laparoscopic paraesophageal hernia repair using Surgi-pro mesh [letter]. Surg Laparosc Endosc 1996;678- 79
PubMedArticle
34.
Johnson  PEPresuad  MMitchell  T Laparoscopic anterior gastropexy for treatment of paraesophageal hernias. Surg Laparosc Endosc 1994;4152- 154
PubMed
35.
Katkhouda  NMavor  EAchanta  K  et al.  Laparoscopic repair of chronic intrathoracic gastric volvulus. Surgery 2000;128784- 790
PubMedArticle
36.
Kercher  KWMatthews  BDPonsky  JL  et al.  Minimally invasive management of paraesophageal herniation in the high-risk surgical patient. Am J Surg 2001;182510- 514
PubMedArticle
37.
Koger  KEStone  JM Laparoscopic reduction of acute gastric volvulus. Am Surg 1993;59325- 328
PubMed
38.
Krahenbuhl  LSchafer  MFarhadi  JRenzulli  PSeiler  CBuchler  MW Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach. J Am Coll Surg 1998;187231- 237
PubMedArticle
39.
Luketich  JDRaja  SFernando  HC  et al.  Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 2000;232608- 618
PubMedArticle
40.
Medina  LPeetz  MRatzer  EFenoglio  M Laparoscopic paraesophageal hernia repair. JSLS 1998;2269- 272
PubMed
41.
Mosnier  HLeport  JAubert  AGuibert  LCaronia  F Videolaparoscopic treatment of paraesophageal hiatal hernia [in French]. Chirurgie 1998;123594- 599
PubMedArticle
42.
Rosati  RBona  SFumagalli  UChella  BPeracchia  A Laparoscopic treatment of paraesophageal and large mixed hiatal hernias. Surg Endosc 1996;10429- 431
PubMedArticle
43.
Tabet  JLacy  AMGrande  L  et al.  Paraesophageal hernias in elderly patients: an indication for laparoscopic surgery. Rev Esp Enferm Dig 1996;88801- 804
PubMed
44.
Luostarinen  MRantalainen  MHelve  OReinikainen  PIsolauri  J Late results of paraesophageal hiatus hernia repair with funduplication. Br J Surg 1998;85272- 275
PubMedArticle
45.
Carlson  MACondon  RELudwig  KASchulte  WJ Management of intrathoracic stomach with polypropylene mesh prosthesis reinforced transabdominal hiatus hernia repair. J Am Coll Surg 1998;187227- 230
PubMedArticle
46.
Kuster  GGGilroy  S Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 1993;3331- 338
PubMedArticle
47.
Edelman  DS Laparoscopic paraesophageal hernia repair with mesh. Surg Laparosc Endosc 1995;532- 37
PubMed
48.
Pitcher  DECuret  MJVogt  DMMason  JZucker  KA Successful repair of praesophageal hernia. Arch Surg 1995;130590- 596
PubMedArticle
49.
Oddsdottir  MFranco  ALLaycock  WAWaring  JPHunter  JG Laparoscopic repair of paraesophageal hernia: new access, old technique. Surg Endosc 1995;9164- 168
PubMedArticle
50.
Behrns  KESchlinkert  RT Laparoscopic management of paraesophageal hernia: early results. J Laparoendosc Surg 1996;6311- 317
PubMedArticle
51.
Huntington  TR Laparoscopic mesh repair of the oesophageal hiatus. J Am Coll Surg 1997;184399- 401
PubMed
52.
Paul  MGDe Rosa  RPPetrucci  PEPalmer  MLDanovitch  SH Laparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 1997;11303- 307
PubMedArticle
53.
Frantzides  CTCarlson  MA Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorraphy. Surg Endosc 1997;11769- 771
PubMedArticle
54.
Willekes  CLEdoga  JKFreeza  EE Laparoscopic repair of paraesophageal hernia. Ann Surg 1997;22531- 38
PubMedArticle
55.
Hawasli  AZonca  S Laparoscopic repair of paraesophageal hiatal hernia. Am Surg 1998;64703- 710
PubMed
56.
Basso  NDeLeo  AGenco  A  et al.  360 Degrees laparoscopic fundoplication with tension free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease. Surg Endosc 2000;14164- 169
PubMedArticle
57.
Lambert  AWHuddart  SN Mesh hiatal reinforcement in Nissen fundoplication. Pediatr Surg Int 2001;17491- 492
PubMedArticle
58.
Meyer  CBufffler  ARohr  SLima  MC Le traitement laparoscopique des hernies hiatales de gran taille avec mise en place d’une prothese: a propos de dix cas. Ann Chir 2002;127257- 261
PubMedArticle
59.
Casaccia  MTorelli  PPanaro  FCavaliere  DVentura  AValente  U Laparoscopic physiologic hiatoplasty for hiatal hernia: new composite “A”-shaped mesh. Surg Endosc 2002;161441- 1445
PubMedArticle
60.
Kamolz  TGranderath  FABasmmer  TPasiut  MPointner  R Dysphagia and quality of life after laparoscopic Nissen funduplication in patients with and without prosthetic reinforcement of the hiatal crura. Surg Endosc 2002;16572- 577
PubMedArticle
61.
Champion  JKRock  D Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 2003;17551- 553
PubMedArticle
62.
Oelschlager  BKBarreca  MChang  LPellegrini  CA The use of small intestine submucosa in the repair of paraesophageal hernias: initial observation of a new technique. Am J Surg 2003;1864- 8
PubMedArticle
63.
Granderath  FAKamolz  TSchweiger  UMPointner  R Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Arch Surg 2003;138902- 907
PubMedArticle
64.
Hui  TTDavid  TSpyrou  MPhillips  EH Mesh crural repair of large paraesophageal hiatal hernias. Am Surg 2001;671170- 1174
PubMed
65.
Frantzides  CTMadan  AKCarlson  MAStavropoulos  GP A prospective, randomised trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 2002;137649- 652
PubMedArticle
66.
Schauer  PRIkramuddin  SMcLaughlin  RH  et al.  Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg 1998;176659- 665
PubMedArticle
67.
Skinner  DBBelsey  RH Surgical management of esophageal reflux and hiatus: long-term results with 1030 patients. J Thorac Cardiovasc Surg 1967;5333- 54
PubMed
68.
Hill  LDTobias  JA Paraesophageal hernia. Arch Surg 1968;96735- 744
PubMedArticle
69.
Wichterman  KGeha  ASCahow  CEBaue  AE Giant paraesophageal hiatus hernia with intrathoracic stomach and colon: the case for early repair. Surgery 1979;86497- 506
PubMed
70.
Pearson  FGCooper  JDIlves  RTodd  TRJJamieson  WRE Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg 1983;3545- 51
PubMedArticle
71.
Ellis  FH  JrCrozier  REShea  JA Paraesophageal hiatus hernia. Arch Surg 1986;121416- 420
PubMedArticle
72.
Treacy  PJJamieson  GG An approach to the management of para-oesophageal hiatus hernias. Aust N Z J Surg 1987;57813- 817
PubMedArticle
73.
Menguy  R Surgical management of large paraesophageal hernia with complete intrathoracic stomach. World J Surg 1988;12415- 422
PubMedArticle
74.
Ackermann  CBally  HHarder  F Paraesophageal hiatal hernia—risks and surgical indications. Helv Chir Acta 1989;56159- 162
PubMed
75.
Haas  ORat  PChristophe  MFriedman  SFavre  JP Surgical results of intrathoracic gastric volvulus complicating hiatal hernia. Br J Surg 1990;771379- 1381
PubMedArticle
76.
Harriss  DRGraham  TRGalea  MSalama  FD Paraoesophageal hiatal hernias: when to operate. J R Coll Surg Edinb 1992;3797- 98
PubMed
77.
Allen  MSTrastek  VFDeschamps  CPairolero  PC Intrathoracic stomach: presentation and results of operation. J Thorac Cardiovasc Surg 1993;105253- 258
PubMed
78.
Williamson  WAEllis  FHStreitz  JMShahian  DM Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 1993;56447- 451
PubMedArticle
79.
Myers  GAHarms  BAStarling  JR Management of paraesophageal hernia with a selective approach to antireflux surgery. Am J Surg 1995;170375- 380
PubMedArticle
80.
Altorki  NKYankelevitz  DSkinner  DB Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg 1998;115828- 835
PubMedArticle
81.
Maziak  DETodd  TRPearson  FG Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg 1998;11553- 60
PubMedArticle
82.
Geha  ASMassad  MGSnow  NJBaue  AE A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 2000;128623- 630
PubMedArticle
83.
Rogers  MLDuffy  JPBeggs  FDSalama  FDKnowles  KRMorgan  WE Surgical treatment of para-oesophageal hiatal hernia. Ann R Coll Surg Engl 2001;83394- 398
PubMed
84.
Low  DESimchuk  EJ Effect of paraesophageal hernia repair on pulmonary function. Ann Thorac Surg 2002;74333- 337
PubMedArticle
85.
Carlson  MARichards  CGFrantzides  CT Laparoscopic prosthetic reinforcement of hiatal herniorraphy. Dig Surg 1999;16407- 410
PubMedArticle
86.
Willwerth  BM Gastric complications associated with paraesophageal herniation. Am Surg 1974;40366- 369
PubMed
87.
Wo  JMBranum  GDHunter  JGTrus  TNMauren  SJWaring  P Clinical features of type III (mixed) paraesophageal hernias. Am J Gastroenterol 1996;91914- 916
PubMed
88.
Ellis  FH Controversies regarding the management of hiatus hernia. Am J Surg 1980;139782- 788
PubMedArticle
89.
Boerema  I Hiatus hernia: repair by right-sided, subhepatic, anterior gastropexy. Surgery 1969;65884- 893
PubMed
90.
Carter  RBrewer  LDHinshaw  A Acute gastric volvulus. Am J Surg 1980;14099- 106
PubMedArticle
91.
Hallissey  MTRatliff  DATemple  JG Paraoesophageal hiatus hernia: surgery for all ages. Ann R Coll Surg Engl 1992;7423- 25
PubMed
92.
Hill  LD Incarcerated paraesophageal hernia: a surgical emergency. Am J Surg 1973;126286- 291
PubMedArticle
93.
Teague  WJAckroyd  RWatson  DIDevitt  PG Changing patterns in the management of gastric volvulus over 14 years. Br J Surg 2000;87358- 361
PubMedArticle
94.
Stylopoulos  NGazelle  GSRattner  DW Paraesophageal hernias: operation or observation? Ann Surg 2002;236492- 501
PubMedArticle
95.
Pros  ITargarona  EMAngás  J  et al.  Tratamiento quirúrgico del vólvulo gástrico. Cir Esp 1992;51449- 453
96.
Caskey  CIZerhouni  EAFishman  EKRahmouni  AD Aging of the diaphragm: a CT study. Radiology 1989;171385- 389
PubMed
97.
Purkiss  SFArgano  VAKuo  JLewis  CT Oesophageal erosion of an Angelchik prosthesis: surgical management using fundoplication. Eur J Cardiothorac Surg 1992;6517- 518
PubMedArticle
98.
Crookes  PFDeMeester  TR The Angelchik prosthesis: what have we learned in fifteen years? Ann Thorac Surg 1994;571385- 1386
PubMedArticle
99.
Benjamin  SBKerr  RCohen  DMotaparthy  VCastell  DO Complications of the Angelchik antireflux prosthesis. Ann Intern Med 1984;100570- 575
PubMedArticle
100.
Abu-Abeid  SKeidar  AGavert  NBlanc  ASzold  A The clinical spectrum of band erosion following laparoscopic adjustable silicone gastric banding for morbid obesity. Surg Endosc 2003;17861- 863
PubMedArticle
101.
Basso  NRosato  PDe Leo  AGenco  ARea  SNeri  T “Tension-free” hiatoplasty, gastrophrenic anchorage, and 360° fundoplication in the laparoscopic treatment of paraesophageal hernia. Surg Laparosc Endosc Percutan Tech 1999;9257- 262
PubMedArticle
102.
Cuschieri  AShimi  SNathanson  LK Laparoscopic reduction, crural repair and fundoplication of large hiatal hernia. Am J Surg 1992;163425- 430
PubMedArticle
103.
Agwunobi  AOBancewicz  JAttwood  SEA Simple laparoscopic gastropexy as the initial treatment of paraesophageal hiatal hernia. Br J Surg 1998;85604- 606
PubMedArticle
104.
Casabella  FSinanan  MHorgan  SPellegrini  CA Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 1996;171485- 489
PubMedArticle
105.
Trus  TLBax  TRichardson  WS  et al.  Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1997;1221- 228
PubMedArticle
106.
Kemppainen  EKiviluoto  T Fatal cardiac tamponade after emergency tension free repair of a large paraesophageal hernia. Surg Endosc 2000;14593
PubMed
107.
Baladas  HGSmith  GSRichardson  MADempsey  MBFalk  GL Esophagogastric fistula secondary to teflon pledget: a rare complication following laparoscopic fundoplication. Dis Esophagus 2000;1372- 74
PubMedArticle
108.
Arendt  TStuber  EMonig  HFolsch  URKatsoulis  S Dysphagia due to transmural migration of surgical material into the esophagus nine years after Nissen fundoplication. Gastrointest Endosc 2000;51607- 610
PubMedArticle
109.
Simpson  BRicketts  RRParker  PM Prosthetic patch stabilization of crural repair in antireflux surgery in children. Am Surg 1998;6467- 69
PubMed
110.
Ludemann  RWatson  DIJamieson  GG Influence of follow-up methodology and completeness on apparent clinical outcome of funduplication. Am J Surg 2003;186143- 147
PubMedArticle
111.
Terry  MSmith  CDBranum  GDGalloway  KWaring  JPHunter  JG Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 2001;15691- 699
PubMedArticle
112.
Trus  TLLaycock  WSWaring  JPBranum  GDHunter  JG Improvement in quality of life measures after laparoscopic antireflux surgery. Ann Surg 1999;229331- 336
PubMedArticle
×