Background. Failures occur in approximately 25% of laparoscopic procedures.
Aim of the study was to perform comprehensive analysis of failures of laparoscopic repairs of hiatal hernias, based on long-term outcomes and laparoscopic redo procedures.
Results. Laparoscopic redo procedures were necessary in 2% of operated patients. The main reasons for redo procedures were anatomical recurrences (86.6%). 85% of them were in combination with reflux recurrences. Pure reflux recurrences were reasons for redo procedures in 6.7% of cases, and oesophageal strictures — in 6.7% of cases. A new classification of failures was created and discribed. This classification system unifies definitions and indications for distinct treatment of each variant of failures. Recommendations about diagnostics and tips of laparoscopic redo procedures were also given.
Conclusions. 1. Small hiatal hernias require primary crural repair, large and giant ones require mesh repair.
2. Universal classification of failures defines distinct indications for redo procedures.
3. Redo laparoscopic procedures are feasible and may be highly effective in experienced centers.