Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation

J. J. Andujar, P. K. Papasavas, T. Birdas, J. Robke, Y. Raftopoulos, D. J. Gagné, P. F. Caushaj, R. J. Landreneau, R. J. Keenan

Research output: Contribution to journalReview articlepeer-review

125 Scopus citations

Abstract

Background: Laparoscopic repair of paraesophageal hernia (LRPEH) is a feasible and effective technique. There have been some recent concerns regarding possible high recurrence rates following laparoscopic repair. Methods: We reviewed our experience with LRPEH from 5/1996 to 8/2002. Large paraesophageal hernia (PEH) was defined by the presence of more than one-third of the stomach in the thoracic cavity. Principles of repair included reduction of the hernia, excision of the sac, approximation of the crura, and fundoplication. Pre- and postoperative symptoms were evaluated utilizing visual analogue scores (VAS) on a scale ranging from 0 to 10. Patients were followed with VAS and barium esophagram studies. Statistical analysis was performed using two-tailed Student's t-test. Results: A total of 166 patients with a mean age of 68 years underwent LRPEH. PEH were type II (n = 43), type III (n = 104), and type IV (n = 19). Mean operative time was 160 min. Fundoplications were Nissen (127), Toupet (23), Dor (1), and Nissen-Collis (1). Fourteen patients underwent a gastropexy. One patient required early reoperation to repair an esophageal leak. Mean hospital stay was 3.9 days. At 24 months postoperatively there was statistically significant improvement in the mean symptom scores: heartburn from 6.8 to 0.5, regurgitation from 5.9 to 0.3, dysphagia from 4.0 to 0.5, chest pain from 3.7 to 0.3. Radiographic surveillance was obtained in 120 patients (72%) at a mean of 15 months postoperatively. Six patients (5%) had radiographic evidence of a recurrent paraesophageal hernia (two required surgery), 24 patients (20%) had a sliding hernia (two required surgery), and four patients (3.3%) had wrap failure (all four required surgery). Reoperation was required in 10 patients (6%); two for symptomatic recurrent PEH (1.2%), four for recurrent reflux symptoms (2.4%), and four for dysphagia (2.4%). Patients with abnormal postoperative barium esophagram studies who did not require reoperation have remained asymptomatic at a mean follow up of 14 months. Conclusion: LPEHR is a safe and effective treatment for PEH. Postoperative radiographic abnormalities, such as a small sliding hernia, are often seen. The clinical importance of these findings is questionable, since only a small percentage of patients require reoperation. True PEH recurrences are uncommon and frequently asymptomatic.

Original languageEnglish (US)
Pages (from-to)444-447
Number of pages4
JournalSurgical Endoscopy and Other Interventional Techniques
Volume18
Issue number3
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

Keywords

  • Hernia recurrence
  • Laparoscopic hernia repair
  • Paraesophageal hernia

ASJC Scopus subject areas

  • Surgery

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