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Laparoscopic Paraesophageal Hernia Repair
Galen Perdikis, MD;
Ronald A. Hinder, MD, PhD;
Charles J. Filipi, MD;
Tammara Walenz, MD;
Pamela J. McBride, MD;
Stephen L. Smith, MD;
Natsuya Katada, MD;
Paul J. Klingler, MD
Arch Surg. 1997;132(6):586-590.
Abstract
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Background
Paraesophageal hernias require surgery to avoid potentially serious complications.
Objective
To evaluate paraesophageal hernia repair using the laparoscopic approach.
Design
Case series.
Setting
University hospital and foregut testing laboratory.
Subjects
Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram, endoscopy, esophageal manometry, and 24-hour pH monitoring.
Outcome Measures
Operative complications, postoperative morbidity, follow-up symptoms (53 patients; mean, 18 months; range, 2-54 months) and barium esophagogram (46 patients).
Results
Fifty-six patients (86%) had a type III hernia and 9 (14%) had a type II hernia. Twenty (65%) of 31 patients who underwent pH monitoring had a positive 24-hour pH score, and 24 (56%) of 43 patients who underwent manometry had an incompetent lower esophageal sphincter. Four patients had a gastric volvulus and 21 patients had more than 50% of their stomach in the chest. All patients underwent hernia reduction, crural repair, and fundoplication (64 Nissen procedures and 1 Toupet procedure). The average duration of surgery was 2 hours. There were 2 conversions: gastric perforation and a difficult dissection because of a large fibrotic sac. Other complications, all managed intraoperatively, were 2 gastric perforations and bleeding in 6 patients. Average length of hospital stay was 2 days (range, 1-23 days). Early reoperation was required in 3 patients: slipped Nissen; smallbowel obstruction due to trocar-site hernia; and organoaxial rotation with gastroduodenal obstruction. Four patients required esophageal dilatation after surgery. Forty-nine of 53 patients available for long-term follow-up were satisfied with the results of surgery. Time to full recovery was 3 weeks (range, I week to 2 months). Seven of 46 patients experienced small type I hernias observed on routine follow-up esophagograms.
Conclusions
Most paraesophageal hernias are type III. A concomitant antireflux procedure is recommended. Paraesophageal hernias can be managed successfully by the laparoscopic route with good outcome.
Arch Surg. 1997;132:586-590
Author Affiliations
From the Department of Surgery, Mayo Clinic, Jacksonville, Fla (Drs Hinder, Smith, and Klingler); and the Department of Surgery, Creighton University School of Medicine, Omaha, Neb (Drs Perdikis, Filipi, Walenz, McBride, and Katada).
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