Controversies and advancement of laparoscopic repair of large hiatal hernia / 中华胸心血管外科杂志

ABSTRACT

Large Hiatal Hernia(LHH)is a special type of hiatal hernia,usually defined as more than 1/3 of stomach mi-gration with or without other organs or diameter of esophageal hiatus more than 5 cm.Operation is the only therapeutic method. With the development of laparoscopic surgery, laparoscopic repair of large hiatal hernia(LRLHH)is the standard technique for repair of large hiatal hernias.However LRLHH still is a kind of complexity, difficulty, high risk and recurrence to some extent. Moreover, there is still no consensus amongst surgeons about what is the optimal technique for LRLHH .Currently, controver-sies and advancement of LRLHH mainly concentrated on completely dissection and reduction of the sac from the mediastinum , suture cruroplasty with or without mesh, deal with short esophagus and gastroesophageal reflux.Modified LRLHH achieves completely dissection hiatal hernia sac , which is more convenient and more helpful for suture cruroplasty and reduce the ten-sion.The use of mesh effectively reduces the anatomical recurrence rate and may lead to complications such as esophageal ero-sion or extensive fibrosis with troublesome dysphagia .LRLHH with mesh or without mesh should be individualized .Optimal technique for LRLHH needs continual improvement and high-quality randomized controlled trials to obtain the most effective and safe mesh in the long term.In this paper, the controversy and progress of laparoscopic huge esophageal hiatal hernia repair will be summarized.