DURABILITY OF LAPAROSCOPIC REPAIR OF PARAESOPHAGEAL HERNIA

Objectives To define a method of primary repair that would minimize he rnia recurrence and to report medium-term follow-up of patients who un derwent laparoscopic repair of paraesophageal hernia to verify durabil ity of the repair and to assess the effect of inclusion of an antirefl ux procedure. Summary Background Data Primary paraesophageal hernia re pair was completed laparoscopically in 55 patients. There were five re currences within 6 months when the sac was not excised (20%), After in stitution of a technique of total sac excision in 30 subsequent repair s, no early recurrences were observed. Methods Inclusion of an antiref lux procedure, incidence of subsequent hernia recurrence, dysphagia, a nd gastroesophageal reflux symptoms were recorded in clinical follow-u p of patients who underwent a laparoscopic procedure. Results Mean len gth of follow-up was 29 months. Forty-nine patients were available for follow-up, and one patient had died of lung cancer. Mean age at surge ry was 68 years. The surgical morbidity rate in elderly patients was n o greater than in younger patients. Eleven patients (22%) had symptoms of mild to moderate reflux, and 15 were taking acid-reduction medicat ion for a variety of dyspeptic complaints. All but 2 of these 15 had u ndergone 360 degrees fundoplication at initial repair. Two patients (4 %) had late recurrent hernia, each small, demonstrated by esophagram o r endoscopy. Conclusions Laparoscopic repair in the medium term appear ed durable. The incidence of postsurgical reflux symptoms was unrelate d to inclusion of an antireflux procedure. In the absence of motility data, partial fundoplication was preferred, although dysphagia after f loppy 360 degrees wrap, was rare. With the low morbidity rate of this procedure, correction of symptomatic paraesophageal hernia appears ind icated in patients regardless of age.