New surgical approach for giant paraesophageal hernia repair: Closure of the esophageal hiatus anteriorly using the left triangular ligament

Omar Ghanem, Courtney Doyle, Raul Sebastian, Adrian Park

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Obtaining a tension-free repair for giant paraesophageal hernias (PEH) is often challenging. Many different techniques have been proposed, including laparoscopic posterior hiatoplasty with the use of prosthetic or biologic mesh as well as the use of autologous teres or falciform ligament flaps. In this report, we describe the use of the left triangular ligament as an onlay autologous vascularized flap to bridge the anterior residual defect after posterior cruroplasty. Methods: A novel technique of paraesophageal hiatal hernia repair is described. Posterior hiatoplasty is performed, including the approximation of the diaphragmatic crural fibers to the extent possible. The left triangular ligament is then mobilized and sutured to the right and left crural fibers lining the esophageal hiatus to seal the anterior residual diaphragmatic defect. Results: This technique has been performed in 4 patients with a mean age of 71 years and a 3:1 female to male ratio. The average hiatal defect size was 5.5 cm and the average length of operation was 122 min. There was no evidence of radiologic or clinical recurrence on follow-up. Conclusion: The use of the left triangular ligament flap is feasible and may be a valuable tool for closure of an anterior diaphragmatic defect in giant PEHs. Additional studies to validate its long-term function are needed.

Original languageEnglish (US)
Pages (from-to)124-128
Number of pages5
JournalDigestive Surgery
Volume32
Issue number2
DOIs
StatePublished - Apr 27 2015
Externally publishedYes

Keywords

  • Anterior hiatal closure
  • Paraesophageal hernia
  • Posterior hiatoplasty
  • Triangular ligament repair

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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