Abstract
Introduction:
Mesh application for pillar reinforcement in hiatal hernia is controversial. 1 There are several commercially available mesh types, each of them related to specific fixation difficulties or postoperative complications. 2,3 Lately, a tendency toward pillar reinforcement and decreased use of key-hole meshes are observed.
Video:
We present a video case (length 5:27 minutes) of a giant hiatal hernia treated with pillar reinforcement using a new type of mesh (a T-shaped mesh). The technical aspects of the procedure are described, as well as the mesh characteristics and the patient follow-up.
Patient:
A 47-year-old male patient was admitted to the emergency department of our hospital after a high-energy traffic accident. He was hemodynamically stable and referred a mild centrothoracic pain. Laboratory studies were normal. Computed tomography (CT) scan revealed a giant hiatal hernia containing the stomach and the transverse colon. Under the possibility of traumatic diaphragmatic hernia, a surgical management was indicated.
Treatment:
Using a standard laparoscopic approach, a giant chronic hiatal hernia with mediastinal localization of the stomach was found. The stomach was reduced to the abdominal cavity, and the hernial sac was excised. The pillars were closed and reinforced with a T-shaped mesh (Laparomesh). This mesh is composed of polypropylene net with a nonadherent silicone cover of the horizontal arm that could be placed in contact with the viscera. It was initially designed for prophylactic abdominal wall closure. 4 The procedure was completed with a 360° fundoplication (Nissen-Rossetti).
Results:
The postoperative period was uneventful. Within the 2 years of follow-up period, the patient remained asymptomatic. Control CT scan and barium meal confirmed the correct position of the stomach and the fundoplication.
Conclusion:
In case of giant hiatal hernias with good diaphragmatic pillar elasticity, the T-shaped mesh provides an excellent reinforcement option.
The authors have nothing to disclose.
Runtime of video: 5 mins 27 secs
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