Redo Hiatal Hernia Surgery Advanced Techniques – Dr Tarun Mittal at WALS 2025 скачать в хорошем качестве

Redo Hiatal Hernia Surgery Advanced Techniques – Dr Tarun Mittal at WALS 2025

Introduction Hiatal hernia surgery aims to repair the protrusion of the stomach through the diaphragm into the chest cavity, often alleviating symptoms like gastroesophageal reflux disease (GERD). However, recurrences or complications from prior surgeries may necessitate redo hiatal hernia surgery, a complex procedure requiring advanced techniques. At the World Association of Laparoscopic Surgeons (WALS) 2025 conference, Dr. Tarun Mittal, a renowned laparoscopic surgeon from Sir Ganga Ram Hospital, Delhi, presented groundbreaking approaches to redo hiatal hernia surgery, emphasizing robotic precision and innovative fixation methods. Challenges in Redo Hiatal Hernia Surgery Redo hiatal hernia surgery is technically demanding due to: Scarred Anatomy: Previous surgeries often leave adhesions and altered tissue planes, complicating dissection. Recurrence Factors: Improper hiatal closure, excessive crural tension, or missed esophageal dysmotility can lead to hernia recurrence. Mesh-Related Complications: Prior use of mesh may cause infections or esophageal erosion, requiring careful removal. Patient Factors: Elderly patients or those with comorbidities face higher morbidity risks. Dr. Mittal’s presentation at WALS 2025 addressed these challenges with a focus on minimally invasive solutions tailored to complex cases. Advanced Techniques Highlighted by Dr. Tarun Mittal Dr. Mittal showcased several cutting-edge techniques that are revolutionizing redo hiatal hernia surgery: 1. Robotic-Assisted Laparoscopic Approach Enhanced Precision: Robotic systems provide superior visualization and dexterity, aiding in delicate dissection around scarred tissues. Dr. Mittal emphasized the use of robotic arms for mediastinal dissection and hiatal reconstruction, reducing the risk of damage to the esophagus or stomach. Tension-Free Closure: By leveraging robotic assistance, Dr. Mittal demonstrated techniques to achieve tension-free hiatal approximation, such as inducing a controlled left pneumothorax to relax the diaphragm. Outcomes: Studies cited by Dr. Mittal indicate that robotic approaches result in lower perioperative complications compared to traditional laparoscopic methods, particularly in redo cases. 2. Innovative 3-Point Fixation Technique Dr. Mittal introduced a novel 3-point fixation technique for redo hiatal hernia repair, designed to enhance the durability of the repair. Mechanism: This method involves fixing the stomach to the abdominal wall at three strategic points to prevent mediastinal migration of the stomach or wrap. It combines laparoscopic reduction with targeted fixation, inspired by gastropexy principles. Benefits: The technique minimizes recurrence by stabilizing the stomach’s position, particularly in patients with large or recurrent hernias. It is especially useful for high-risk patients unsuitable for extensive surgery. WALS 2025 Impact: Dr. Mittal’s live demonstration of this technique was a highlight, showcasing its applicability in complex redo scenarios. 3. Selective Mesh Use and Alternatives Minimizing Mesh Complications: Dr. Mittal advocated for avoiding mesh whenever possible due to risks like infection or erosion. When mesh is necessary, he prefers bioabsorbable or composite meshes to reduce long-term complications. Relaxing Incisions: To address crural tension, Dr. Mittal employs relaxing incisions on the diaphragm, closed with sutures or minimal mesh, ensuring a robust repair without excessive foreign material. Smart Materials: He also discussed emerging smart materials, such as 3D-printed scaffolds and hydrogels, which offer biocompatibility and may replace traditional meshes in the future. 4. Tailored Fundoplication Personalized Wrap Construction: Dr. Mittal stressed the importance of customizing fundoplication based on esophageal motility. For patients without dysmotility, a floppy Nissen fundoplication is preferred, while a Toupet or Dor is considered for those with motility issues. Avoiding Common Errors: He highlighted pitfalls like overly tight wraps or using the gastric body instead of the fundus, which can cause dysphagia or pain. Robotic Precision: The robotic platform aids in constructing a precise, floppy wrap, reducing postoperative complications. https://www.laparoscopyhospital.com/S... Contact us: World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi, INDIA Phone/WhatsApp: +919811416838, +919999677788 World Laparoscopy Training Institute Bld. No: 27, DHCC, Dubai, UAE Phone: +971525857874 World Laparoscopy Training Institute 8320 Inv Dr, Tallahassee, Florida, USA Phone: +1 321 250 765