LAPAROSCOPIC REPAIR OF A PARAESOPHAGEAL HIATUS-HERNIA WITHOUT FUNDOPLICATION

We treated a case of paraesophageal hiatus hernia by laparoscopic repa ir. The procedure included a reduction of the gastric fundus and duode nal bulbus, closure of the diaphragmatic defect, mesh wrapping of the closure, gastropexy to the diaphragm, and a gastrostomy, Preoperative monitoring of the pH for 24h showed no reflux. Intraoperative intralum inal manometry of the esophagus after hernia reduction showed the pres sure of the lower esophageal sphincter to be normal, and thus an antir eflux procedure was not deemed to be necessary. The patient was put on a soft diet from postoperative day 2. A postoperative upper gastroint estinal series showed no gastroesophageal reflux. No complications or recurrence of the hiatus hernia have been observed in the 12 months si nce the operation. Laparoscopic repair of a paraesophageal hiatus hern ia with normal pressure of the lower esophageal sphincter, so that fun doplication is not needed, is thus considered to be possible.