SUCCESSFUL LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA

Objective: To evaluate prospectively the safety and efficacy of laparo scopic surgical techniques in the repair of types II and III paraesoph ageal hernias. Design: Case series. Setting: Tertiary-care, university -affiliated hospitals. Patients: Twelve consecutive patients undergoin g elective laparoscopic repair of type II or type III paraesophageal h ernias. Patients were available for follow-up for 1 to 17 months posto peratively. Interventions: All patients underwent laparoscopic paraeso phageal hernia reduction and repair. Eight patients with gastroesophag eal reflux disease underwent concurrent laparoscopic Nissen fundoplica tion. Main Outcome Measures: Operative times, operative complications, and estimated blood loss were recorded. Postoperative outcome measure ments included length of hospital stay, postoperative complications, p ostoperative gastrointestinal tract symptoms, and patient satisfaction . Results: All patients had successful completion of paraesophageal he rnia repair laparoscopically with no recurrences, and with an overall minor morbidity rate of 25%, major morbidity rate of 8%, and no deaths . Eight of 12 patients with concomitant reflux disease underwent succe ssful laparoscopic Nissen fundoplication with complete control of refl ux symptoms. The average hospital stay for patients with uncomplicated courses was 2.5 days. Long-term (>6 weeks) postfundoplication symptom s occurred in 13% of those patients who underwent fundoplication. Elev en (92%) of 12 patients described good to excellent results with compl ete or near complete control of all preoperative symptoms. Conclusions : Laparoscopic repair of types II and III paraesophageal hernias can b e performed under elective circumstances by experienced laparoscopic s urgeons, with acceptable morbidity and comparable short-term efficacy. Addition of a concomitant antireflux procedure should be reserved for those patients with clear preoperative evidence of reflux disease sec ondary to a mechanically defective lower esophageal sphincter. Patient s with a normal lower esophageal antireflux barrier do not need a conc omitant antireflux procedure.