Background: We compared the incidence of early hernia recurrence in no
nrandomized but consecutive patients undergoing laparoscopic repair of
paraesophageal hernia (LRPH) without and with excision of the hernia
sac. Methods: LRPH was completed in 55 of 58 patients. In the first 25
patients, the sac was not excised. Total sac excision was performed i
n the subsequent 30 patients. All patients had crural repair with or w
ithout fundoplication, or gastropexy. Results: Mean age of patients wa
s 68 years (range, 34-95). Then were three conversions; one patient di
ed postoperatively. Mean operative time was 225 min in the first group
and 190 min in the sac excision group, Median length of stay was 2 da
ys (range, 1-15) for both groups. Conclusions: A precise method of tot
al sac excision simplified dissection. It also ensured complete reduct
ion of the hernia and availability of adequate esophageal length. Oper
ative time was not increased, and no subsequent early recurrences were
observed (p < 0.05).