LAPAROSCOPIC MANAGEMENT OF PARAESOPHAGEAL HERNIA - EARLY RESULTS

The objective was to review our early results with laparoscopic repair of paraesophageal hernias to determine the safety, technical feasibil ity, and short-term outcome of the operation, Twelve patients with a m ean age of 75 +/- 1 years underwent laparoscopic repair of a paraesoph ageal hernia, Principles of open repair, including sac excision, prima ry crural repair, and pexy, were accomplished laparoscopically in 83%, 83%, and 100% of patients, respectively, In two patients the diaphrag matic defect was closed with mesh, Fundoplication was also performed i n seven patients with symptoms of reflux disease, No laparoscopic proc edure was converted to an open repair; however, one patient required a postoperative celiotomy to control hemorrhage. Short-term evaluation of all patients postoperatively detected gastroesophageal reflux disea se (GERD) in five patients (42%), four of whom did not undergo fundopl ication, Two major complications were esophageal perforation and bleed ing. Minor complications included atrial fibrillation in two patients, meat impaction in one patient, and a small asymptomatic recurrence in a single patient. Overall patient satisfaction was high, Laparoscopic repair of paraesophageal hernias was safe and technically feasible an d warrants further investigation, The incidence of postoperative esoph ageal reflux, however, is high if an antireflux procedure is not perfo rmed, Extensive preoperative evaluation for reflux should objectively identify patients requiring fundoplication and decrease the incidence of postoperative GERD.