caa a22 4500 475781635 CHVBK 20180406123646.0 cr unu---uuuuu 170329e20000201xx s 000 0 eng 10.1007/s004649900092 doi (NATIONALLICENCE)springer-10.1007/s004649900092 360° laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease [Elektronische Daten] [N. Basso, A. De Leo, A. Genco, P. Rosato, S. Rea, E. Spaziani, A. Primavera] Background: Since laparoscopic Nissen fundoplication was first described by Cuschieri in 1989 and later by Dallemagne in 1991, this procedure has been widely employed for the treatment of symptomatic gastroesophageal reflux disease (GERD) and/or hiatal hernia. However, a relatively high incidence (7-11%) of intrathoracic Nissen valve migration/paraesophageal hernia following laparoscopic fundoplication has recently been reported. Methods: Between November 1992 and August 1995, 65 consecutive patients with severe GERD and/or hiatal hernia underwent laparoscopic 360° fundoplication. In nine of these 65 (13.8%) patients, an intrathoracic Nissen valve migration had occurred within 4 months. Six of these patients were symptomatic and were again submitted to the laparoscopic intervention. Videotapes of both the first and second operation were reviewed. In all cases, it was apparent that, at the first operation, closure by stitches of the hiatus was under tension, and at the second operation, the muscle fibers of the right crus were disrupted, probably due to the tension between the suture margins during the inspiratory movements of the diaphragm. These findings prompted us to perform an effective tension-free closure of the hiatus. A polypropylene mesh (3 × 4 cm) was placed on the hiatus behind the esophagus and fixed with eight metallic agraphes (2 + 2 on the superior edge and 2 + 2 on the lateral sides of the right and left cruses). Results: Between August 1995 and February 1998, the technique, complete with 360° fundoplication, was used for 67 patients with GERD. At mean follow-up of 22.5 months (range, 1-30), there was no evidence of postoperative paraesophageal hernia or complications related to the use of the mesh. Conclusions: This tension-free hiatoplasty seems to be an effective solution to prevent postoperative paraesophageal hernia in patients undergoing antireflux laparoscopic surgery. However, longer follow-up is still needed. Springer-Verlag New York Inc., 2000 Key words: Gastroesophageal reflux disease — Hiatal hernia repair — Laparoscopic fundoplication — Prolene mesh nationallicence Basso N. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut De Leo A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Genco A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Rosato P. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Rea S. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Spaziani E. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Primavera A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut Surgical Endoscopy Springer-Verlag 14/2(2000-02-01), 164-169 0930-2794 14:2<164 2000 14 464 https://doi.org/10.1007/s004649900092 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004649900092 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Basso N. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- De Leo A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- Genco A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- Rosato P. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- Rea S. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- Spaziani E. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 700 1- Primavera A. II Clinica Chirurgica, Policlinico Umberto I, Università La Sapienza, Viale del Policlinico 155, 00161 Roma, Italy, Italy aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/2(2000-02-01), 164-169 0930-2794 14:2<164 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer