Laparoscopic gastric fundus tamponade: a novel adaptation of the Toupet fundoplication for large paraesophageal hernia r
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and Other Interventional Techniques
Laparoscopic gastric fundus tamponade: a novel adaptation of the Toupet fundoplication for large paraesophageal hernia repair George Ferzli1 · Shinban Liu1 · Mazen Iskandar2 · Abe Fingerhut3,4 Received: 11 July 2019 / Accepted: 11 November 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Laparoscopic repair of large paraesophageal hiatal hernia with defects too large to close primarily or greater than 8 cm is technically challenging. The ideal repair remains unclear and is often debated. Utilizing the gastric fundus as an autologous patch to obliterate and tamponade large hiatal defects may offer a new solution. The aim of this study was to evaluate the short-term outcomes following partial posterior fundoplication with gastric fundus tamponade. Methods Retrospective chart review and prospective patient follow up was conducted on patients who underwent laparoscopic hiatal hernia repair between 2015 and 2019 by a single surgeon. Basic demographics, pre-operative diagnoses, operative technique, and clinical outcomes were recorded. Results Fifteen patients underwent the described technique for repair of large paraesophageal hiatal hernia. All procedures were completed laparoscopically with a short post-operative length of stay (mean of 3 days) and no 30-day readmissions. The majority of patients reported resolution of their pre-operative symptoms. Only one patient required surgery for emergent indications and the same patient was the only mortality in the study, which was secondary to respiratory failure, necrotizing pneumonia, and sepsis as a result of gastric volvulus and obstruction. Conclusion Utilizing the gastric fundus as an autologous patch to repair large hiatal hernia may be a safe and efficacious solution with good short-term outcomes. However, further studies should be conducted to elucidate long-term results. Keywords Paraesophageal hernia · Hiatal hernia · Gastric tamponade Hiatal hernias occur when the contents of the abdominal cavity herniate through the esophageal hiatus of the diaphragm. Under normal circumstances, the esophageal hiatal orifice facilitates the passage of the esophagus and vagus nerve into the abdominal cavity and acts as an interface between the abdominal and mediastinal cavities. Since the esophagus accommodates luminal contents and is generally mobile, the hiatus is not tightly filled and thus the integrity * Shinban Liu [email protected] 1
General Surgery, NYU Langone Health, 150 55th St, Brooklyn, NY 11220, USA
2
Mount Sinai Health System, 10 Union Square East, Suite 2N, New York City, NY 10003, USA
3
Section for Surgical Research, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
4
Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, China
of the hiatus relies on surrounding structures to support the space between the esophagus and crural diaphragm. Aside from the diaphragmati
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