Background and Study Aims: Surgical repair of paraesophageal hernia is mandatory,
due to the risk of severe complications, and it can be accomplished via the laparoscopic
route. This study presents the results of laparoscopic repair of paraesophageal hernia
combined with anterior hemifundoplication.
Patients and Methods: During a two-year period, ten consecutive patients with paraesophageal
hernia (six men, four women; mean age 73, range 55 - 82) underwent laparoscopic treatment.
Five patients presented with symptoms of gastroesophageal 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 all underwent esophagography, upper gastrointestinal endoscopy, stationary
manometry, and 24-hour ambulatory pH-metry, preoperatively and within three months
postoperatively. At laparoscopy, the hernia content was completely reduced, the sac
excised, and the diaphragmatic crura approximated. The operation was 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 were no
postoperative deaths. One patient developed atelectasis, and another had empyema of
the left pleura, treated with drainage and antibiotics. All patients but one were
discharged on the second or third postoperative day. At the three-month follow-up
examination, none of the patients had symptoms related to the paraesophageal hernia,
gastroesophageal reflux, or fundoplication. Esophagography demonstrated restoration
of normal anatomy at the gastroesophageal region, while esophageal motility was improved,
and esophageal pH-metry showed no gastroesophageal reflux.
Conclusion: Laparoscopic repair of paraesophageal hernias is a safe, technically feasible,
and well tolerated procedure, which offers rapid and total relief of symptoms. The
addition of an anterior hemifundoplication not only cures preexisting gastroesophageal
reflux, but also prevents the development of postoperative gastroesophageal reflux.
References
E-mail:exynos@med.uoc.gr
