Laparoscopic repair of paraesophageal hernia

Background and Study Aim: Surgical repair of paraesophageal hernia is manda tory, due to the risk of severe complications, and it can be accomplished v ia the laparoscopic route. This study presents the results of laparoscopic repair of paraesophageal hernia combined with anterior hemifundoplication. Patients mid Methods: During a two-year period, ten consecutive patients wi th paraesophageal hernia (six men, four women; mean age 73, range 55-82) un derwent laparoscopic treatment. Five patients presented with symptoms of ga stroesophageal reflux, while another four reported lower chest pain. There was one patient in whom the paraesophageal hernia was manifested with upper gastrointestinal bleeding. Six patients had type III hiatal hernia. They a ll underwent esophagography, upper gastrointestinal endoscopy, stationary m anometry, and 24-hour ambulatory pH-metry, preoperatively and within three months postoperatively. At laparoscopy, the hernia content was completely r educed, the sac excised, and the diaphragmatic crura approximated. The oper ation,vas completed with an anterior hemifundoplication. In three cases, a prosthetic mesh was applied to close the hiatal defect securely. Results: Operating times ranged from 75 min to 125 min (mean 90 min), There mere no postoperative deaths. One patient developed atelectasis, and anoth er had empyema of the left pleura, treated with drainage and antibiotics. A ll patients but one were discharged on the second or third postoperative da y. At the three-month follow-up examination, none of the patients had sympt oms related to the paraesophageal hernia, gastroesophageal reflux, or fundo plication. Esophagography demonstrated restoration of normal anatomy at the gastroesophageal region, while esophageal motility was improved, and esoph ageal pH-metry showed no gastroesophageal reflux. Conclusion: Laparoscopic: repair of paraesophageal hernias is a safe, techn ically feasible, and well tolerated procedure, which offers rapid and total relief of symptoms.. The addition of an anterior hemifundoplication not on ly cures preexisting gastroesophageal reflux, but also prevents the develop ment of postoperative gastroesophageal reflux.