Laparoscopic Surgical Repair of a Giant Hiatal Hernia with Prothesis: How We Do It (with Video)

Abstract

Background: Giant hiatal hernias (GHH) account for 5-10% of all hiatal hernias. Most patients are asymptomatic, while others have debilitating and persistent symptoms affecting quality of life (QoL). GHHs are usually associated with chronic digestive and gastroesophageal reflux symptoms and acute severe complications may occur. Surgical treatment is usually indicated in cases of failure of optimal medical treatment in smaller hernias, symptomatic patients with large hernias and asymptomatic patients with high risk for complications. Surgery is the treatment of choice in symptomatic GHH, and laparoscopic repair is the standard approach and mesh reinforcement of crura repair remains is debatable. Hernia recurrence remains an important issue. Surgical Technique: We present a case of a 79-year-old male with a symptomatic GHH. Patient was submitted to laparoscopic GGH repair with mesh prothesis reinforcement. Discussion: Surgery is the only curative treatment for GHH, and laparoscopic repair, being safe and effective with low morbidity, is the standard approach for symptomatic patients. Hiatal hernia recurrences can occur and, even among experienced surgeons, they might be troublesome, especially in large hernias and obese patients. Mesh-repair techniques have been developed trying to respond to this issue. However, its use remains a source of disagreement. Controversy exists especially due to the potential mesh-related complications. A dual-sided synthetic mesh adapted to the anatomy of the diaphragmatic hiatus and its careful positioning can minimize potential complications. Further standardization of procedures and increased numbers in case series are required for drawing definitive conclusions regarding mesh reinforcement in GHH repair.