Successful laparoscopic repair of paraesophageal hernia
D. E. Pitcher, M. J. Curet, D. T. Martin, D. M. Vogt, J. Mason and K. A. Zucker
University of New Mexico School of Medicine, Albuquerque, USA.
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 1 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.
