Repair of paraesophageal hernias

BACKGROUND: Three years ago we proposed the use of laparoscopy and systemat ic addition of an antireflux procedure to repair paraesophageal hernias. We now present an analysis of the outcome on patients and the evolution of th e technique proposed. METHODS: Symptoms and esophageal function were prospectively collected and followed in 41 consecutive patients treated over a 4-year period. Indicatio ns for repair included chronic anemia in 15 patients, and previous incarcer ation in 8. Twenty-two patients had symptoms of reflux. RESULTS: All operations were started laparoscopically, two were converted. Mean operating time was 210 minutes, and mean hospital stay was 4 days. Mea n follow-up was 3 years. The operation was effective; all symptoms had impr oved significantly at last follow-up. CONCLUSIONS: Laparoscopic repair of paraesophageal hernia with the addition of an antireflux procedure, although difficult, lengthy, and not totally w ithout risk, improves symptoms substantially, resolves anemia, and prevents incarceration in nearly all patients. Am J Surg. 1999;177:354-358. (C) 199 9 by Excerpta Medica, Inc.