An Overview on Laparoscopic Cruroplasty

Abstract

Hiatal hernia occurs when contents of the abdominal cavity protrude through the esophageal hiatus of the diaphragm. Factors that contribute to its development include enlargement of the hiatus, increased abdominal thoracic pressure gradient, depletion of elastic fibers in the phrenoesophageal membrane with aging and deterioration of the crura muscle fibers. In addition, changes in spinal curvature may be an important pathogenic factors. The stomach is the most commonly involved viscera and pathologic gastroesophageal reflux disease (GERD) may be associated. Laparoscopic hiatal hernia repair with fundoplication has been shown to be a valuable option in symptomatic patients. Reconstruction of the diaphragmatic crura cannot exempt from a careful evaluation of the complex anatomical conformation of the esophageal hiatus. Different techniques have been described for posterior cruroplasty ranging from simple suture repair to simple suture buttressed with mesh. However, these techniques are not standardized and left to the surgeons’ preference and “feeling” of weak crura.