Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene

Background: Several studies have shown that large hiatal hernias are associated with a high recurrence rate. Despite the problem of recurrence, the technique of hiatal hernior-rhaphy has not changed appreciably since its inception. In this 3-year study we have evaluated laparoscopic hiatal her-nia repair in individuals with a hernia defect greater than 8 cm in diameter. Methods: A series of 35 patients with sliding or paraesopha-geal hiatal hernias was prospectively randomized to hiatal hernia repair with (n 4 17) or without (n 4 18) polytet-rafluoroethylene (PTFE). All patients had an endoscopic and radiographic diagnosis of large hiatal hernia. Both re-pairs were performed by using interrupted stitches to ap-proximate the crurae. In the group randomized to repair with prosthesis, PTFE mesh with a 3-cm “keyhole ” was posi-tioned around the gastroesophageal junction with the esophagus through the keyhole. The PTFE was stapled to the diaphragm and crura with a hernia stapler. Results: Patients were followed with EGD and esophago-gram at 3 months postoperatively, and with esophagogram every 6 months thereafter. Individuals with PTFE had a longer operation time, but the 2-day hospital stay was the same in both groups. The cost of the repair was $1050 ± $135 more in the group with the prosthesis. There were two complications (1 pneumonia, 1 urinary retention) in the group repaired with PTFE and one complication (pneumo-thorax) in the group without prosthesis. The group without PTFE was notable for three (16.7%) recurrences within the first 6 months of surgery. Conclusion: On the basis of these preliminary results it appears that repair with PTFE may confer an advantage, with lower rates of recurrence in patients with large hiatal hernia defects