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Successful Laparoscopic Repair of Paraesophageal Hernia
David E. Pitcher, MD;
Myriam J. Curet, MD;
Daniel T. Martin, MD;
Diana M. Vogt, MD;
MAJ John Mason, MC, USAF;
Karl A. Zucker, MD
Arch Surg. 1995;130(6):590-596.
Abstract
Objective
To evaluate prospectively the safety and efficacy of laparoscopic surgical techniques in the repair of types II and III paraesophageal hernias.
Design
Case series.
Setting
Tertiary-care, university-affiliated hospitals.
Patients
Twelve consecutive patients undergoing elective laparoscopic repair of type II or type III paraesophageal hernias. Patients were available for follow-up for I to 17 months postoperatively.
Interventions
All patients underwent laparoscopic paraesophageal hernia reduction and repair. Eight patients with gastroesophageal reflux disease underwent concurrent laparoscopic Nissen fundoplication.
Main Outcome Measures
Operative times, operative complications, and estimated blood loss were recorded. Postoperative outcome measurements included length of hospital stay, postoperative complications, postoperative gastrointestinal tract symptoms, and patient satisfaction.
Results
All patients had successful completion of paraesophageal hernia repair laparoscopically with no recurrences, and with an overall minor morbidity rate of 25%, major morbidity rate of 8%, and no deaths. Eight of 12 patients with concomitant reflux disease underwent successful laparoscopic Nissen fundoplication with complete control of reflux symptoms. The average hospital stay for patients with uncomplicated courses was 2.5 days. Long-term (>6 weeks) postfundoplication symptoms occurred in 13% of those patients who underwent fundoplication. Eleven (92%) of 12 patients described good to excellent results with complete or near complete control of all preoperative symptoms.
Conclusions
Laparoscopic repair of types II and III paraesophageal hernias can be performed under elective circumstances by experienced laparoscopic surgeons, with acceptable morbidity and comparable short-term efficacy. Addition of a concomitant antireflux procedure should be reserved for those patients with clear preoperative evidence of reflux disease secondary to a mechanically defective lower esophageal sphincter. Patients with a normal lower esophageal antireflux barrier do not need a concomitant antireflux procedure.
(Arch Surg. 1995;130:590-596)
Author Affiliations
From The University of New Mexico School of Medicine, Albuquerque (Drs Pitcher, Curt, Martin, Vogt, and Zucker), and the Albuquerque Federal Regional Medical Center (Drs Pitcher, Curet, Martin, Mason, and Zucker).
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