Laparoscopic Lortat-Jacob Procedure for Hiatal Hernia Repair

Introduction: Hiatal hernia, together with its related complications (GERD, Barett’s esophagus, malignant dysplasia, anemia, upper GI bleeding, perforation, etc.), is one of the most common diseases of the upper GI tract. Despite the rich pharmacological variety of PPI, prokinetic agents, etc., the operative treatment proves to be the only reliable method of treatment. Numerous and controversial statistics and recommendations for the choice of an operative technique are found in the related medical literature.Materials and Methods: From November, 2014 until June, 2016, 32 hiatal hernia repairs have been performed at our surgery department. Twenty patients underwent the laparoscopic Lortat-Jacob procedure. Fourteen patients underwent an open hernia repair. All the patients have been followed up clinically and by means of radiological contrast upper GI imaging at the end of the second month after the surgery. Emergency (present or absent), patients’ general condition, concomitant diseases, perioperative risk and the surgeon’s experience were the determining criteria for the choice of the procedure. Results: No clinical or radiological data of recurrent hiatal hernia or GER have been found at the patient’s follow-up. The anemia was resolved completely without the need of oral administration of iron salts. Conclusions: The laparoscopic Lortat-Jacob procedure is a reliable method of hiatal hernia elective surgery. It has been proved effective and with a low complication rate. In case of emergency and severe heart diseases, the open approach is preferred.