Laparoscopic repair of large hiatal hernia with polytetrafluoroethylene

Background: Several studies have shown that large hiatal hernias are associ ated with a high recurrence rate. Despite the problem of recurrence, the te chnique of hiatal herniorrhaphy has not changed appreciably since its incep tion. In this 3-year study we have evaluated laparoscopic hiatal hernia rep air in individuals with a hernia defect greater than 8 cm in diameter. Methods: A series of 35 patients with sliding or paraesophageal hiatal hern ias was prospectively randomized to hiatal hernia repair with (n = 17) or w ithout (n = 18) polytetrafluoroethylene (PTFE). All patients had an endosco pic and radiographic diagnosis of large hiatal hernia. Both repairs were pe rformed by using interrupted stitches to approximate the crurae. In the gro up randomized to repair with prosthesis, PTFE mesh with a 3-cm "keyhole" wa s positioned around the gastroesophageal junction with the esophagus throug h the keyhole. The PTFE was stapled to the diaphragm and crura with a herni a stapler. Results: Patients were followed with EGD and esophagogram at 3 months posto peratively, and with esophagogram every 6 months thereafter. Individuals wi th PTFE had a longer operation time, but the 2-day hospital stay was the sa me in both groups. The cost of the repair was $1050 +/- $135 more in the gr oup with the prosthesis. There were two complications (1 pneumonia, 1 urina ry retention) in the group repaired with PTFE and one complication (pneumot horax) 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 repai r with PTFE may confer an advantage, with lower rates of recurrence in pati ents with large hiatal hernia defects.