Falciform Ligament plug in Laparoscopic Hiatus Hernia repair
Objectives: Laparoscopic repair of a para-esophageal hiatal hernia is a challenging procedure. Several methods have been developed in efforts to achieve tension-free reconstruction of the esophageal hiatus. The falciform ligament is used as an autologous onlay flap to achieve tension-free closure of the crural defect of a para-esophageal hernia (PEH). Aim of the work: To assess the use of falciform ligament for hiatus hernia repair and to evaluate the results. Methods: Hernias were diagnosed with esophago-gastroscopy and esophageal manometry and barium contrast X-ray study. Results: Fifty patients underwent falciform ligament plug repair while eight patients underwent crural approximation and fundoplication repairs. The classical traditional practice period for repairs was significantly (p=0.004) longer in duration. Period of stays in the hospital, average contraction amplitudes, and lower esophageal sphincter pressure during the rest were non-significantly different among the groups. Discussion: The well-established benefits of laparoscopic hiatal hernia repair include shorter period of hospitalization, less pain; and rapid recovery rate, but with high failure rates than in open repairs of patients. Conclusion: Different data were recorded about demographic distribution, steps of operation and symptoms pre-and post-operation. Application of the falciform ligament for induction of vascularization on lay flap is effective and safe. The technique was used for adequate closing of the crural anomaly of para-esophageal hiatus hernia. The recommended instructions for the position of the falciform ligament is that, it must be mobilized freely in the region of anterior abdominal wall to avoid lateral pressure on the flap, in the same time avoiding induction of devascularization. For fixing the falciform ligament to the left and right hiatal crura, interrupted vertical mattress sutures should be done.
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