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Repair of Large Hiatus Hernias - Recent Advances and Controversies

Repair of Large Hiatus Hernias - Recent Advances and Controversies

20 Aug 2021 15:24 15:36
(12 mins)
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Although the indications and techniques for laparoscopic anti-reflux surgery for patients with small or no hiatus hernias is now well established, there is still lack of consensus on how to best manage patients who have large or giant hiatus hernias. They pose a surgical challenge especially as they are often more elderly and can present acutely with obstruction or volvulus. Mr.Toh will present his 20yr experience of dealing with these patients in a large volume centre, and discuss the merits of surgical techniques proposed to deal with the large defect and/or shortened oesophagus, including the use of releasing incisions in the diaphragm and oesophageal lengthening procedures. In particular, he will discuss the controversy of mesh repairs, the evidence for and against them and why we need to continue to study the use of mesh in this location as the outcome for suture only repair appears suboptimal. He will present early evidence of use of a permanent circumferential PVDF mesh in recurrent hernias that seems promising, and is currently being investigated in his RCT (Dynamic Trial). Short videos of surgical techniques will be included.

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