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 @entity354 . However, a relatively high incidence (7-11%) of intrathoracic Nissen valve @entity357 following laparoscopic fundoplication has recently been reported. METHODS: Between November 1992 and August 1995, 65 consecutive @entity1 with severe @entity354 and/or @entity357 underwent laparoscopic 360 degrees fundoplication. In nine of these 65 (13.8%) @entity1 , an intrathoracic Nissen valve migration had occurred within 4 months. Six of these @entity1 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 @entity7502 mesh (3 x 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 degrees fundoplication, was used for 67 @entity1 with @entity354 . At mean follow-up of 22.5 months (range, 1-30), there was no evidence of postoperative @entity357 related to the use of the mesh. CONCLUSIONS: This tension-free hiatoplasty seems to be an effective solution to prevent postoperative @entity357 in patients undergoing antireflux laparoscopic surgery. However, longer follow-up is still needed.

360 degrees laparoscopic fundoplication with tension-free hiatoplasty in the treatment of symptomatic XXXX .

@entity357 :: ('MESH:D006551', 'Disease') :: ['paraesophageal hernia or complications', 'paraesophageal hernia', 'migration/paraesophageal hernia', 'hiatal hernia'] @entity1 :: ('9606', 'Species') :: ['patients'] @entity7502 :: ('MESH:D011126', 'Chemical') :: ['polypropylene'] @entity354 :: ('MESH:D005764', 'Disease') :: ['gastroesophageal reflux disease (GERD) and/or hiatal hernia', 'GERD']
@entity354 :: (MESH:D005764,Disease) :: ['gastroesophageal reflux disease']
