Utility of falciform ligament flap for hiatal hernia repair: a systematic review.

Introduction: Surgical repair of hiatal hernia (HH) is plagued by high recurrence rates. Hiatoplasty failure has been identified as a major determinant of recurrent symptoms and HH, but there is no consensus on the optimal surgical approach to minimize this complication and hiatal mesh reinforcement remains controversial. The use of the falciform ligament as an autologous rotational flap to support crural repair has been proposed as a potential solution. This review aims to evaluate the safety and efficacy of the falciform ligament flap (FLF) as an adjunct in HH repair.

Evidence acquisition: Searches were conducted on Google, Google Scholar, PubMed, Scopus, Web of Science, and Cochrane through May 2024. The primary study outcome was HH recurrence rate. Secondary outcomes included 30-day mortality rate, postoperative morbidity, and length of hospital stay. Descriptive statistics were used to analyze the data.

Evidence synthesis: Twelve studies comprising 469 patients undergoing FLF augmentation during primary or revisional HH repair were included. The majority (80.7%) of patients had HH types III-IV. Crural suture hiatoplasty was performed in all cases, and adjunctive mesh reinforcement was reported in two studies. Postoperative morbidity was 4.6%, and there was no mortality. The overall HH recurrence rate was 5.8% (range 0-15.4%).

Conclusions: Our study seems to suggest that FLF may reduce postoperative HH recurrence. Well designed and comparative studies with long-term follow-up are required to confirm these preliminary data.