Paraesophageal herniation as a complication following laparoscopic antireflux surgery

Paraesophageal herniation of the stomach is a rare complication following l aparoscopic Nissen fundoplication. We retrospectively reviewed our experien ce with 720 patients undergoing laparoscopic Nissen fundoplications. Seven patients were found to have postoperative paraesophageal hernias requiring reoperation. The clinical presentation, diagnostic workup, operative treatm ent, and outcome were evaluated. There were no deaths or procedure-related complications. Clinical presentation was recurrent dysphagia in four, nonsp ecific abdominal symptoms in one, and acute abdomen in one. One additional patient was asymptomatic. Preoperatively the correct diagnosis was able to be confirmed in four of six patients by barium esophagogram Four patients u nderwent successful laparoscopic repair. Two patients had a thoracotomy inc luding one conversion from laparoscopy to thoracotomy. One patient had a la parotomy to reduce an intrathoracic gastric volvulus. At a mean follow-up o f 2.5 months no patient had further complications. Paraesophageal herniatio n is a rare complication following laparoscopic Nissen fundoplication and a definitive diagnosis is often difficult to establish. Early dysphagia afte r surgery should alert the surgeon to this complication. Redo laparoscopic surgery is feasible but an open procedure may be necessary.