Large paraesophageal hernias are generally repaired by reduction of the stomach into the abdomen, sac excision, crural closure, and gastropexy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combined laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias.
Ten adults, six males and four females, with type III paraesophageal hernias underwent laparoscopic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38–81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplication performed and one patient had a diaphragmatic gastropexy.
The procedure was completed laparoscopically in all ten cases and the median operating time was 282 min (range 165–430). Two complications occurred, an intraoperative gastric laceration, and a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative day. Eight of nine patients were asymptomatic at last follow-up (mean 8.9 months postop). One patient has mild dysphagia and heartburn from partial migration of the fundoplication into the chest. One patient died 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard surgical techniques.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Almond DJ, Bancewicz J (1988) Case report: paraesophageal hernia: the potential for disaster. Br J Hosp Med 40: 221–222
Brolin RE (1993) Morbid obesity. In: Levine BA, et al. (eds) Current practice of surgery XIII-8. Churchill Livingstone, New York
Bueno R, Brooks DC (1993) Laparoscopic repair of paraesophageal hernias: preliminary results (abstract). Surg Endosc 7(2): 128
Congrave DP (1992) Laparoscopic paraesophageal hernia repair. J Laparoendosc Surg 2: 45–48
DeMeester TR, Crookes PF (1993) Benign and malignant diseaes of the esophagus. In: Levine BA, et al. (eds) Current practice of surgery XIII-5. Churchill Livingstone, New York
Ellis FH (1989) Paraesophageal hiatus hernia: a surgical disease. Surg Rounds April: 28–39
Harris DR, Graham TR, Galea M, Salama FD (1992) Paraesophageal hiatal hernias: when to operate. J R Coll Surg Edinb 37: 97–98
Koger KE, Stone JM (1993) Laparoscopic reduction of acute gastric volvulus. Am Surg 59: 325–328
Kuster GG, Gilroy S (1993) Laparoscopic technique for repair of paraesophageal hiatal hernias. J Laparoendosc Surg 3: 331–338
Landreneau RJ, Johnson JA, Marshall JB, Hazelrigg SR, Boley TM, Curtis JJ (1992) Clinical spectrum of paraesophageal herniation. Dig Dis Sci 37: 537–544
Menguy R (1988) Surgical management of large paraesophageal hernia with complete intrathoracic stomach. World J Surg 12: 415–422
Naunheim KS, Baue AE (1994) Paraesophageal hiatal hernia. In: Shields TW (ed) General thoracic surgery, 4th ed, vol 1. Williams & Wilkins, Philadelphia, pp 644–651
Pairolero PC, Trastek VF, Payne WS Esophagus and diaphragmatic hernias. In: Schwartz, Shires, Spencer (eds) Principles of surgery, 5th ed. McGraw-Hill, New York, pp 1103–1156
Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia: Long term results with 1030 patients. J Thorac Cardiovasc Surg 53: 33–54
Vitelli CE, Jaffe BM, Kahng KU (1989) Paraesophageal hernia. NY State J Med 89: 654–657
Walther B, DeMeester TR, Lafontaine E, Courtney JV, Little AG, Skinner DB (1984) Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy. Am J Surg 147: 111–116
Williamson WA, Ellis FH, Streitz JM, Shahian DM (1993) Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56: 447–452
About this article
Cite this article
Oddsdottir, M., Franco, A.L., Laycock, W.S. et al. Laparoscopic repair of paraesophageal hernia. Surg Endosc 9, 164–168 (1995). https://doi.org/10.1007/BF00191959
- Paraesophageal hernia
- Nissen fundoplication
- Sliding hiatal hernia