LAPAROSCOPIC TREATMENT OF PARAESOPHAGEAL AND LARGE MIXED HIATAL-HERNIAS

Background: Laparoscopic treatment of large mixed hiatal hernias was a ttempted in eight patients. Methods: One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the a bdomen resulting from a shortened esophagus. One left pleural tear occ urred intraoperatively and was repaired without further consequence. M edian duration of the operation was 150 min (range 120-300 min). Resul ts: No postoperative complications were recorded. All patients are asy mptomatic after a median follow-up of 14 months (range 7-15 months). C orrect repositioning of the stomach was confirmed by radiological eval uation 1 month after surgery, Early functional results are good, (One asymptomatic gastroesophageal reflux was detected and medical treatmen t was undertaken). Conclusions: Laparoscopic crural repair and fundopl ication are feasible even in paraesophageal and large mixed hiatal her nias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay, Neverth eless, long-term assessment is required to confirm the effectiveness o f the laparoscopic approach in patients with large mixed hiatal hernia s.