Background. The choice of method of hiatal hernia repair is still controversial. Recurrences after repair of large and giant hiatal hernia reach 42%. Mesh repair may decrease failure rate but bears risk of oesophageal complications. Thus, development of optimal methods of hiatal closure for prevention of repair-related recurrences and dysphagia is a very actual question.
Aim of the study was to analyse long-term results (i. e. anatomical recurrences and repair-related dysphagia) of different types of laparoscopic hiatal repair depending on hiatal surface area (HSA).
Methods. Results from 787 procedures were analysed (fundoplication — Nissen only). Patients were divided into 3 groups according to HSA measured as described by Granderath et al. (2007). I group — 343 patients with HSA < 10 cm2 (small hernias) whom primary crural repair was performed. II group — 358 patients with HSA 10–20 cm2 (large hernias) whom primary crural repair (subgroup A) or mesh repair (Subgroup B) was performed. Among the latter subgroup, on-lay fixation of polypropylene mesh ProleneТМ or the original technique of sub-lay repair by lightweight partially absorbable mesh UltraproТМ was used. III group — 86 patients with HSA > 20 cm2 (giant hernias) whom mesh repair was performed. Similarly to II group, they were divided into 2 subgroups based on method of repair.
Results. In I group there were 3.5% recurrence and 1.9% dysphagia rates. In II group there were 7.1% recurrence and 6.5% dysphagia rates. In II group subgroup A there were 11.9% recurrence and 2.2% dysphagia rates. In II group subgroup B there were 5.2% recurrence and 8.2% dysphagia rates. Comparing recurrence rates I group vs II group subgroup A, we obtained statistically significant difference in favor of I group. Comparing recurrence rates of II group subgroup A vs subgroup B, we obtained difference in favor of subgroup B. Original method of sub-lay lightweight partially absorbable mesh repair provides similar dysphagia rate as primary repair. In III group there were 19% recurrence and 8.8% dysphagia rates. Comparisons between subgroups of III group provided similar results as for II group.
Conclusions. 1. We advice to routinely measure HSA and use relative classification. 2. Optimal repair for small hernias is primary suturing. 3. For large hernias, original technique of sub-lay lightweight partially absorbable mesh repair seems to be the best. 4. For giant hernias original technique provides results corresponding to the literature, although these results require improvement.