STUDY OF SUTURE TENSION IN LAPAROSCOPIC CRUROPLASTY FOR PATIENTS WITH LARGE HIATAL HERNIAS
DOI:
https://doi.org/10.11603/2414-4533.2025.1.15172Keywords:
large hiatal hernia, tension-free, laparoscopic crurorhaphia, mesh implantAbstract
The aim of the work: to evaluate suture tension during laparoscopic cruroplasty and the impact of tension-reducing diaphragmatic incisions on surgical outcomes.
Materials and Methods. The study included 32 patients (23 women, 9 men; aged 49–74 years, mean age (62.8±4.6)) with large and giant hiatal hernias (types III-IV). Preoperative assessments included CT, contrast radiography, endoscopy, and pH monitoring. During laparoscopic cruroplasty, suture tension was measured using a dynamometer. For cases with tension >5 N, tension-reducing incisions of the diaphragmatic crura and dome were performed, followed by defect closure with self-fixating ProGrip mesh.
Results. Patients with suture tension >5 N exhibited higher recurrence risks and diaphragmatic tissue damage. Tension-reducing incisions decreased suture tension by 55–70 %, allowing tension-free closure. Recurrence occurred in 5.2 % of cases during a follow-up of 6–36 months. Complications included minor bleeding and pleural effusion, resolved without long-term effects.
Conclusions. Tension-reducing incisions during laparoscopic cruroplasty effectively decrease suture tension, minimizing recurrence risks and improving outcomes for large and giant hiatal hernias. This approach reduces reliance on synthetic implants and associated complications, providing a safer and more reliable surgical option.
References
Singhal VK, Md Suleman A, Senofer N, Singhal VV. Current Trends in the Management of Hiatal Hernia: A Literature Review of 10 Years of Data. Cureus. 2024 Oct 20; 16(10):e71921. DOI: 10.7759/cureus.71921. PMID: 39564064; PMCID: PMC11575107. DOI: https://doi.org/10.7759/cureus.71921
Latorre-Rodríguez AR, Rajan A, Mittal SK. Perioperative morbidity after primary hiatal hernia repair increases as hernia size increases. Dis Esophagus. 2025 Jan 7; 38(1):doae117. DOI: 10.1093/dote/doae117. PMID: 39722527. DOI: https://doi.org/10.1093/dote/doae117
Tarasov T, Markulan L. Paraesophageal hernia: the state of the problem and controversial issues. Review. ЗХ [Internet]. 2022 Dec. 30; (2):83-96. Available from: http://generalsurgery.com.ua/article/view/270980. DOI: https://doi.org/10.30978/GS-2022-2-83
Rajkomar K, Berney CR. Large hiatus hernia: time for a paradigm shift? BMC Surg. 2022 Jul 8; 22(1):264. DOI: 10.1186/s12893-022-01705-w. PMID: 35804332; PMCID: PMC9264491. DOI: https://doi.org/10.1186/s12893-022-01705-w
Omura N, Tsuboi K, Yano F. Minimally invasive surgery for large hiatal hernia. Ann Gastroenterol Surg. 2019 Jul 17; 3(5):487-95. DOI: 10.1002/ags3.12278. PMID: 31549008; PMCID: PMC6749952. DOI: https://doi.org/10.1002/ags3.12278
Sathasivam R, Bussa G, Viswanath Y, Obuobi RB, Gill T, Reddy A, Shanmugam V, Gilliam A, Thambi P. 'Mesh hiatal hernioplasty' versus 'suture cruroplasty' in laparoscopic para-oesophageal hernia surgery; a systematic review and meta-analysis. Asian J Surg. 2019 Jan; 42(1):53-60. DOI: 10.1016/j.asjsur.2018.05.001. Epub. 2018 Jun. 7. PMID: 29887394. DOI: https://doi.org/10.1016/j.asjsur.2018.05.001
Currie AC, Penney N, Kamocka A, Singh P, Abbassi-Ghadi N, Preston SR. Systematic review on reporting of components and outcomes in randomized clinical trials of paraoesophageal hernia mesh repair. Br J Surg. 2021 Apr 5; 108(3):256-64. DOI: 10.1093/bjs/znaa107. PMID: 33793727. DOI: https://doi.org/10.1093/bjs/znaa107
Guan L, Nie Y, Yuan X, Chen J, Yang H. Laparoscopic repair of giant hiatal hernia for elderly patients. Ann Transl Med. 2021 Apr; 9(8):704. DOI: 10.21037/atm-21-1495. PMID: 33987402; PMCID: PMC8106099. DOI: https://doi.org/10.21037/atm-21-1495
Armijo PR, Krause C, Xu T, Shostrom V, Oleynikov D. Surgical and clinical outcomes comparison of mesh usage in laparoscopic hiatal hernia repair. Surg Endosc. 2021 Jun; 35(6):2724-730. DOI: 10.1007/s00464-020-07703-4. Epub. 2020 Jun. 16. PMID: 32556757. DOI: https://doi.org/10.1007/s00464-020-07703-4
Watson DI, Thompson SK, Devitt PG, Aly A, Irvine T, Woods SD, Gan S, Game PA, Jamieson GG. Five Year Follow-up of a Randomized Controlled Trial of Laparoscopic Repair of Very Large Hiatus Hernia With Sutures Versus Absorbable Versus Nonabsorbable Mesh. Ann Surg. 2020 Aug; 272(2):241-47. DOI: 10.1097/SLA.0000000000003734. PMID: 32675536. DOI: https://doi.org/10.1097/SLA.0000000000003734
Abdelmoaty WF, Dunst CM, Filicori F, Zihni AM, Davila-Bradley D, Reavis KM, Swanstrom LL, DeMeester SR. Combination of Surgical Technique and Bioresorbable Mesh Reinforcement of the Crural Repair Leads to Low Early Hernia Recurrence Rates with Laparoscopic Paraesophageal Hernia Repair. J Gastrointest Surg. 2020 Jul; 24(7):1477-481. DOI: 10.1007/s11605-019-04358-y. Epub. 2019 Aug. 29. PMID: 31468330. DOI: https://doi.org/10.1007/s11605-019-04358-y
Olson MT, Mittal SK, Bremner RM. A Collective Review of Gore Bio-A Absorbable Synthetic Mesh in Cruroplasty Reinforcement. J Laparoendosc Adv Surg Tech A. 2021 Jan; 31(1):61-70. DOI: 10.1089/lap.2020.0343. Epub. 2020 Sep. 2. PMID: 32882152. DOI: https://doi.org/10.1089/lap.2020.0343
McKay SC, DeMeester SR, Sharata A, DeSouza ML, Bradley DD, Reavis KM, Dunst CM. Diaphragmatic relaxing incisions for complex hiatal reconstruction: longer-term follow-up confirms safety, efficacy and rare complications. Surg Endosc. 2023 Nov; 37(11):8636-643. DOI: 10.1007/s00464-023-10293-6. Epub. 2023 Jul. 26. PMID: 37495846. DOI: https://doi.org/10.1007/s00464-023-10293-6
Koch O, von Rahden BHA, Wykypiel H, Schoppmann SF, Függer R, Rosanelli G, Emmanuel K, Weitzendorfer M. Vorstellung einer prospektiv randomisierten Multicenterstudie zum Vergleich der Hiatusplastik mit Nähten vs. Nähte mit Pledgets vs. resorbierbares Netz bei großen Hiatushernien [Planning and Design of a Prospective Randomised Multi-Centre Trial on the Repair of Large Hiatal Hernias with Sutures vs. Pledgeted Sutures vs. Absorbable Mesh]. Zentralbl Chir. 2021 Apr; 146(2):204-09. DOI: 10.1055/a-1369-9694. Epub. 2021 Feb. 10. PMID: 33567462. German. DOI: https://doi.org/10.1055/a-1369-9694
Bradley DD, Louie BE, Farivar AS, Wilshire CL, Baik PU, Aye RW. Assessment and reduction of diaphragmatic tension during hiatal hernia repair. Surg Endosc. 2015 Apr; 29(4):796-804. DOI: 10.1007/s00464-014-3744-y. Epub. 2014 Jul. 24. PMID: 25055892. DOI: https://doi.org/10.1007/s00464-014-3744-y
Navaratne L, Ashrafian H, Martínez-Isla A. Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique. Surg Endosc. 2019 Sep; 33(9):3040-049. DOI: 10.1007/s00464-019-06843-6. Epub. 2019 May 28. PMID: 31140000. DOI: https://doi.org/10.1007/s00464-019-06843-6
Hrubnik VV, Hrubnik VV, Parfentʹyev RS. Vymiryuvannya syly natyahu shviv pry vykonanni laparoskopichnoyi krurorafiyi dlya vyznachennya pokazanʹ do vykorystannya sitchastykh implantativ [Measurement of suture tension force during laparoscopic crurorhaphy to determine indications for the use of mesh implants]. Odessa Medical Journal. 2021; 6(178):32-7. Available from: https://files.odmu.edu.ua/journal/OMJ_2021.06/m216_032.pdf. Ukrainian.
DeMeester SR, Bernard L, Schoppmann SF, Kloosterman R, Roth JS. Elective Laparoscopic Paraesophageal Hernia Repair Leads to an Increase in Life Expectancy Over Watchful Waiting in Asymptomatic Patients: An Updated Markov Analysis. Ann Surg. 2024 Feb 1; 279(2):267-75. DOI: 10.1097/SLA.0000000000006119. Epub. 2023 Oct. 11. PMID: 37818675.
Weyhe D, Uslar V, Kühne J, Kluge A. Hiatushernie: Standards und Kontroversen in Diagnostik und Therapie [Hiatus hernia: Standards and controversies in diagnostics and treatment]. Chirurg. 2019 Apr; 90(4):331-48. DOI: 10.1007/s00104-019-0932-2. PMID: 30903226. German. DOI: https://doi.org/10.1007/s00104-019-0932-2
WMA Declaration of Helsinki. Available from: https://www.wma.net/policies-post/wma-declaration-of-helsinki.
Statistica software. Available from: https://docs.tibco.com/products/tibco-statistica-14-0-0.
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