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lüll Laparoscopic mesh-augmented hiatoplasty without fundoplication as a method to treat large hiatal hernias Linke GR; Gehrig T; Hogg LV; Gohl A; Kenngott H; Schafer F; Fischer L; Gutt CN; Muller-Stich BPSurg Today 2014[May]; 44 (5): 820-6PURPOSE: Laparoscopic hiatal hernia repair with additional fundoplication is a commonly recommended standard surgical treatment for symptomatic large hiatal hernias with paraesophageal involvement (PEH). However, due to the risk of persistent side effects, this method remains controversial. Laparoscopic mesh-augmented hiatoplasty without fundoplication (LMAH), which combines hiatal repair and mesh reinforcement, might therefore be an alternative. METHODS: In this retrospective study of 55 (25 male, 30 female) consecutive PEH patients, the perioperative course and symptomatic outcomes were analyzed after a mean follow-up of 72 months. RESULTS: The mean DeMeester symptom score decreased from 5.1 to 1.8 (P < 0.001) and the gas bloating value decreased from 1.2 to 0.5 (P = 0.001). The dysphagia value was 0.7 before surgery and 0.6 (P = 0.379) after surgery. The majority of the patients were able to belch and vomit (96 and 92 %, respectively). Acid-suppressive therapy on a regular basis was discontinued in 68 % of patients. In 4 % of patients, reoperation was necessary due to recurrent or persistent reflux. A mesh-related stenosis that required endoscopic dilatation occurred in 2 % of patients. CONCLUSIONS: LMAH is feasible, safe and provides an anti-reflux effect, even without fundoplication. As operation-related side effects seem to be rare, LMAH is a potential treatment option for large hiatal hernias with paraesophageal involvement.|*Surgical Mesh[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Fundoplication[MESH]|Gastroesophageal Reflux/epidemiology/prevention & control[MESH]|Hernia, Hiatal/*surgery[MESH]|Herniorrhaphy/*methods[MESH]|Humans[MESH]|Laparoscopy/*methods[MESH]|Male[MESH]|Middle Aged[MESH]|Reoperation/statistics & numerical data[MESH]|Retrospective Studies[MESH]|Time Factors[MESH]|Treatment Outcome[MESH] |