LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA - NEW ACCESS, OLD TECHNIQUE

Large paraesophageal hernias are generally repaired by reduction of th e stomach into the abdomen, sac excision, crural closure, and gastrope xy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combine d laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias. Ten adults, six males an d four females, with type III paraesophageal hernias underwent laparos copic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38-81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplicat ion performed and one patient had a diaphragmatic gastropexy. The proc edure was completed laparoscopically in all ten cases and the median o perating time was 282 min (range 165-430). Two complications occurred, an intraoperative gastric laceration, an a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative d ay. Eight of nine patients were asymptomatic at last follow-up (mean 8 .9 months postop). One patient has mild dysphagia and heartburn from p artial migration of the fundoplication into the chest. One patient die d 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using stan dard surgical techniques.