Journal of Gastrointestinal Surgery

, Volume 16, Issue 7, pp 1406–1411 | Cite as

How I Do It: Laparoscopic Paraesophageal Hernia Repair

How I do it

Abstract

Introduction

Paraesophageal hernias are usually complex anatomic abnormalities of the upper gastrointestinal tract capable of causing symptoms and complications including death. Furthermore, they affect patients who are usually older and have other comorbidities. Preferred treatment approach has evolved over time, with laparoscopic repair being the current preferred technique as it causes less hemodynamic changes and is better tolerated than open repairs.

Technique

In this report, we describe our technique for laparoscopic paraesophageal hernia repair. The most salient technical aspects of this procedure include reduction of the stomach below the diaphragm, circumferential dissection and excision of the hernia sac, closure of the crural defect with our without the addition of mesh, and fundoplication to prevent reflux.

Conclusion

While this procedure has a low morbidity risk and short hospital stay, anatomic recurrence is frequent even when performed by experienced surgeons.

Keywords

Paraesophageal hernia repair Hiatal hernia Antireflux procedure Biologic mesh Esophageal lengthening 

References

  1. 1.
    Bowditch HI. A treatise on diaphragmatic hernia. Buffalo: Jewett, Thomas & Co.; 1853.Google Scholar
  2. 2.
    Stylopoulos N, Rattner DW. The history of hiatal hernia surgery. Ann Surg 2005; 241: 185–193.PubMedGoogle Scholar
  3. 3.
    Stylopoulos N, Gazelle S, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg 2002; 236(4): 492–501.PubMedCrossRefGoogle Scholar
  4. 4.
    Edye M, Salky B, Posner A, Fierer A. Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia. Surg Endosc 1998; 12(10): 1259–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Watson DL, Davies N, Devitt PG, Jamieson GG. Importance of dissection of the hernia sac in laparoscopic surgery for large hiatal hernias. Ann Surg 1999; 134:1069–1073.Google Scholar
  6. 6.
    Casabella F, Sinanan M, Horgan S, Pellegrini CA. Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias. Am J Surg 1996; 171(5):485–489.PubMedCrossRefGoogle Scholar
  7. 7.
    Horgan S, Eubanks TR, Jacobsen G, Omelanczuk P, Pellegrini CA. Repair of paraesophageal hernias. Am J Surg 1999; 177(5):354–358.PubMedCrossRefGoogle Scholar
  8. 8.
    Gangopadhyay N, Perrone JM, Soper NJ, Matthews BD, Eagon JC, Klingensmith ME, Frisella MM, Brunt LM. Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery 2006; 140:491–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Mattar SG, Bowers SP, Galloway KD, Hunter JG, Smith CD. Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 2002; 16:745–9.PubMedCrossRefGoogle Scholar
  10. 10.
    Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR, et al. Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thor Surg 2002; 74:1909–15.CrossRefGoogle Scholar
  11. 11.
    Oelschlager BK, Pellegrini CA, Hunter JG, Soper NJ, Brunt ML, Sheppard BC, Jobe B, Polissar NL, Mitsumori LM, Nelson J, Swanstrom LL. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006; 244:481–490.PubMedGoogle Scholar
  12. 12.
    Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. JACS 2011; 213:461–468.Google Scholar
  13. 13.
    Tatum RP, Shalhub S, Oelschlager BK, Pellegrini CA. Complications of PTFE mesh at the diaphragmatic hiatus. J Gastrointest Surg 2008; 12:953–957.PubMedCrossRefGoogle Scholar
  14. 14.
    Swanstrom LL, Marcus DR, Galloway GQ. Laparoscopic Collis gastroplasty is the treatment of choice for the shortened esophagus. Am J Surg 1996; 171(5): 477–81.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Rourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, Swanstrom LL. Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 2003; 138(7): 735–40.PubMedCrossRefGoogle Scholar
  16. 16.
    Oelschlager BK, Yamamoto K, Woltman T, Pellegrini C. Vagotomy during hiatal hernia repair: a benign esophageal lengthening procedure. J Gastrointest Surg 2008; 12: 1155–1162.PubMedCrossRefGoogle Scholar
  17. 17.
    Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 2010; 139(2): 395–404.PubMedCrossRefGoogle Scholar
  18. 18.
    Zehetner J, DeMeester SR, Ayazi S, Kilday P, Augustin F, Hagen JA, Lipham JC, Sohn HJ, DeMeester TR. Laparoscopic versus open repair of paraesophageal hernia: the second decade. JACS 2011; 212:813–820.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2012

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA

Personalised recommendations