Surgical treatment of para-oesophageal hiatal hernia

The development of laparoscopic antireflux surgery has stimulated interest in laparoscopic para-oesophageal hiatal hernia repair. This review of our p ractice over 10 years using a standard transthoracic technique was undertak en to establish the safety and effectiveness of the open technique to allow comparison. Sixty patients with para-oesophageal hiatal hernia were operat ed on between 1989 and 1999. There were 38 women and 22 men with a median a ge of 69.5 years. There were 47 elective and 13 emergency presentations. Op eration consisted of a left thoracotomy, hernia reduction and crural repair . An antireflux procedure was added in selected patients. There were no dea ths among the elective cases and one among the emergency cases. Median foll ow-up time was 19 months. There was one recurrence (1.5%). Seven patients ( 12%) required a single oesophagoscopy and dilatation up to 2 years postoper atively but have been asymptomatic since. Two patients (3%) developed sympt omatic reflux which has been well controlled on proton-pump inhibitors. Tra nsthoracic para-oesophageal hernia repair can be safely performed with mini mal recurrence.