LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA

Objective The purpose of this report is to describe the authors' techn ique for the laparoscopic repair of paraesophageal hernias and the out come in their series of patients. Methods Thirty patients underwent el ective laparoscopic repair of paraesophageal hernias. Ail were pure ty pe II paraesophageal hernias as defined by upper gastrointestinal cont rast studies. All operations were performed by a single surgeon (JKE) assisted by five different chief surgical residents. The authors have used various prototypes of a laparoscopic utility beitto reduce the ph ysician requirement to the surgeon and a first assistant. The operativ e setup and specific techniques of the repair are described and illust rated. A concomitant anti-reflux procedure was performed in the last 2 3 patients. Results Satisfactory repair using video-iaparoscopic techn iques was achieved in all cases. There were no deaths. Complications o ccurred in 8 of 30 patients. Postoperative gastroesophageal reflux dev eloped in three of the first seven patients in whom fundoplication was not performed. Three consecutive patients had left lower lobe atelect asis believed to be related to endotracheal tube displacement during t he passage of the bougie. One patient had postoperative dysphagia. The re was one case of major deep venous thrombosis with pulmonary embolis m. Twenty-eight of 30 patients were discharged home by postoperative d ay 3. Twenty-four of 30 patients had returned to normal activity by th e time of their first postoperative office visit 1 week after surgery.