Skip to main content
SpringerLink
Log in

Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Although laparoscopic repair of type 3 paraesophageal hernias is safe and results in symptomatic relief, recent data have questioned the anatomic integrity of the laparoscopic approach. The reports document an asymptomatic recurrence rate as high as 42% with radiologic follow-up evaluation for type 3 paraesophageal hernias repaired laparoscopically. This disturbingly high recurrence rate has prompted the addition of an anterior gastropexy to our standard laparoscopic paraesophageal hernia repair. Methods: A prospective series of 28 patients underwent laparoscopic repair of large type 3 hiatal hernias between July 2000 and January 2002 at the Cleveland Clinic Foundation by one surgeon. All the patients underwent reduction of the hernia, sac excision, crural repair, antireflux procedure, and anterior gastropexy. They all had a video esophagram 24 h after surgery, then at 3-, 6-, and 12-month follow-up visits and annually thereafter. Symptomatic outcomes were assessed with a standard questionnaire at each follow-up visit. Results: In this study, 21 women and 7 men with a mean age of 67 years (range, 35–82 years) underwent successful laparoscopic paraesophageal hernia repair. The mean operative time was 146 min (range, 101–186 min), and the average blood loss was 71 ml (range, 10–200 ml). One intraoperative complication occurred: A small esophageal mucosal tear occurred during esophageal dissection and was repaired laparoscopically. At 24 h, upper gastrointestinal examination identified no leaks. At this writing, all the patients have undergone video esophagram at a 3-month follow-up visit. All were asymptomatic and all examinations were normal. Of the 28 patients, 27 have undergone follow-up assessment at 6 months. At this writing, all the patients have undergone video esophagram at 3, 6, and 12 months follow up visits. All were asymptomatic and all examinations were normal. Ten patients have completed 2 year follow up barium swallows with no recurrences. Conclusions: With up to 2 years of follow-up evaluation, the addition of an anterior gastropexy to the laparoscopic repair of type 3 hiatal hernias resulted in no recurrences. These encouraging results necessitate further follow-up evaluation to document the long-term effects of anterior gastropexy in reducing postoperative recurrence after laparoscopic repair of paraesophageal hernias.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. MS Allen VF Trastek C Deschamps PC Pairolero (1993) ArticleTitleIntrathoracic stomach: presentation and results of operation. J Thorac Cardiovasc Surg 105 253–258 Occurrence Handle1:STN:280:ByyC2MnjtFc%3D Occurrence Handle8429652

    CAS  PubMed  Google Scholar 

  2. P Allison (1951) ArticleTitleReflux, esophagitis, sliding hiatal hernia, and the anatomy of repair. Surg Gynecol Obstet 92 419–431

    Google Scholar 

  3. KE Behrns RT Schlinkert (1996) ArticleTitleLaparoscopic management of paraesophageal hernia: early results. J Laparoendosc Surg 6 311–317 Occurrence Handle1:STN:280:ByiD2M3mtVM%3D Occurrence Handle8897241

    CAS  PubMed  Google Scholar 

  4. I Boerema (1969) ArticleTitleHiatus hernia: repair by right-sided, subhepatic, anterior gastropexy. Surgery 65 884–893 Occurrence Handle1:STN:280:CCaC1crls1Y%3D Occurrence Handle5769588

    CAS  PubMed  Google Scholar 

  5. DP Congreve (1992) ArticleTitleLaparoscopic paraesophageal hernia repair. J Laparoendosc Surg 2 45–48 Occurrence Handle1:STN:280:By2B2cfhs1Y%3D Occurrence Handle1533549

    CAS  PubMed  Google Scholar 

  6. PS Dahlberg C Deschamps DL Miller MS Allen FC Nichols PC Pairolero (2001) ArticleTitleLaparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72 1125–1129 Occurrence Handle10.1016/S0003-4975(01)02972-1 Occurrence Handle1:STN:280:DC%2BD3MrlslSmsA%3D%3D Occurrence Handle11603423

    Article  CAS  PubMed  Google Scholar 

  7. C Deschamps MS Allen VF Trastek JO Johnson PC Pairolero (1998) ArticleTitleEarly experience and learning curve associated with laparoscopic Nissen fundoplication. J Thorac Cardiovasc Surg 115 281–284, Occurrence Handle1:STN:280:DyaK1c7jtlKlug%3D%3D Occurrence Handle9475521

    CAS  PubMed  Google Scholar 

  8. MB Edye J Canin-Endres F Gattorno BA Salky (1998) ArticleTitleDurability of laparoscopic repair of paraesophageal hernia. Ann Surg 228 528–535 Occurrence Handle10.1097/00000658-199810000-00009 Occurrence Handle1:STN:280:DyaK1M%2FgsFSjsA%3D%3D Occurrence Handle9790342

    Article  CAS  PubMed  Google Scholar 

  9. FH Ellis Jr RE Crozier JA Shea (1986) ArticleTitleParaesophageal hiatus hernia. Arch Surg 121 416–420 Occurrence Handle1:STN:280:BimC2MfitlY%3D Occurrence Handle3954587

    CAS  PubMed  Google Scholar 

  10. C Frantzides A Madan M Carlson G Stavropoulous (2002) ArticleTitleA prospective randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137 649–651 Occurrence Handle10.1001/archsurg.137.6.649 Occurrence Handle12049534

    Article  PubMed  Google Scholar 

  11. M Hashemi JH Peters TR DeMeester JE Huprich M Quek JA Hagen PF Crookes J Theisen SR DeMeester LF Sillin CG Bremner (2000) ArticleTitleLaparoscopic repair of large type III hiatal hernia: objective follow-up reveals high recurrence rate. J Am Coll Surg 190 553–560 Occurrence Handle10.1016/S1072-7515(00)00260-X Occurrence Handle1:STN:280:DC%2BD3c3lvV2lsg%3D%3D Occurrence Handle10801022

    Article  CAS  PubMed  Google Scholar 

  12. A Hawasli S Zonca (1998) ArticleTitleLaparascopic repair of paraesophageal hiatal hernia. Am Surg 64 703–710 Occurrence Handle1:STN:280:DyaK1czmtFelsA%3D%3D Occurrence Handle9697897

    CAS  PubMed  Google Scholar 

  13. LD Hill JA Tobias (1968) ArticleTitleParaesophageal hernia. Arch Surg 96 735–744 Occurrence Handle1:STN:280:CCeB3s7ntVU%3D Occurrence Handle5647546

    CAS  PubMed  Google Scholar 

  14. PE Johnson M Persuad T Mitchell (1994) ArticleTitleLaparoscopic anterior gastropexy for treatment of paraesophageal hernias. Surg Laparosc Endosc 4 152–154 Occurrence Handle1:STN:280:ByuB3snjsVQ%3D Occurrence Handle8180770

    CAS  PubMed  Google Scholar 

  15. KW Kercher BD Matthews JL Ponsky SL Goldstein RT Yavorski RF Sing BT Heinford (2001) ArticleTitleMinimally invasive management of paraesophageal herniation in the high-risk surgical patient. Am J Surg 182 510–514 Occurrence Handle10.1016/S0002-9610(01)00760-7 Occurrence Handle1:STN:280:DC%2BD38%2FksVyhsg%3D%3D Occurrence Handle11754860

    Article  CAS  PubMed  Google Scholar 

  16. KE Koger JM Stone (1993) ArticleTitleLaparoscopic reduction of acute gastric volvulus. Am Surg 59 325–328 Occurrence Handle1:STN:280:ByyB2Mnjslw%3D Occurrence Handle8489104

    CAS  PubMed  Google Scholar 

  17. JD Luketich S Raja HC Fernando W Campbell NA Christie PO Buenaventura RJ Keenan PR Schauer (2000) ArticleTitleLaparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 232 608–618 Occurrence Handle10.1097/00000658-200010000-00016 Occurrence Handle1:STN:280:DC%2BD3M%2Fhs1ehtw%3D%3D Occurrence Handle10998659

    Article  CAS  PubMed  Google Scholar 

  18. DE Maziak TR Todd FG Pearson (1998) ArticleTitleMassive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg 115 53–60, Occurrence Handle1:STN:280:DyaK1c7ht1yktw%3D%3D Occurrence Handle9451045

    CAS  PubMed  Google Scholar 

  19. R Menguy (1988) ArticleTitleSurgical management of large paraesophageal hernia with complete intrathoracic stomach. World J Surg 12 415–422 Occurrence Handle1:STN:280:BieB1M7jvVM%3D Occurrence Handle3400251

    CAS  PubMed  Google Scholar 

  20. H Mosnier J Leport A Aubert R Kianmanesh MS Sbai Idrissi M Guivarc’h (1995) ArticleTitleA 270-degree laparoscopic posterior fundoplasty in the treatment of gastroesophageal reflux. J Am Coll Surg 181 220–224 Occurrence Handle1:STN:280:ByqH3c%2Fltlw%3D Occurrence Handle7670681

    CAS  PubMed  Google Scholar 

  21. R Nissen (1960) Repair of para-esophageal hiatal hernia by fixation to the abdominal wall. . Mulsohand (Eds) Current surgical management, 2nd ed. WB. Saunders Philadelphia 58–69

    Google Scholar 

  22. MG Paul RP DeRosa PE Petrucci ML Palmer SH Danovitch (1997) ArticleTitleLaparoscopic tension-free repair of large paraesophageal hernias. Surg Endosc 11 303–307 Occurrence Handle10.1007/s004649900351 Occurrence Handle1:STN:280:ByiB3snnsVE%3D Occurrence Handle9079617

    Article  CAS  PubMed  Google Scholar 

  23. FG Pearson JD Cooper R Ilves TR Todd WR Jamieson (1983) ArticleTitleMassive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg 35 45–51 Occurrence Handle1:STN:280:BiyD1MbktFw%3D Occurrence Handle6600388

    CAS  PubMed  Google Scholar 

  24. G Perdikis RA Hinder CJ Filipi T Walenz PJ McBride SL Smith N Katada PJ Klingler (1997) ArticleTitleLaparoscopic paraesophageal hernia repair. Arch Surg 132 586–558 Occurrence Handle1:STN:280:ByiA2c7lt1Y%3D Occurrence Handle9197849

    CAS  PubMed  Google Scholar 

  25. DB Skinner RH Belsey (1967) ArticleTitleSurgical management of esophageal reflux and hiatus hernia: long-term results with 1,030 patients. J Thorac Cardiovasc Surg 53 33–54 Occurrence Handle1:STN:280:CCiD2MjotlQ%3D Occurrence Handle5333620

    CAS  PubMed  Google Scholar 

  26. NJ Soper (1999) ArticleTitleLaparoscopic management of hiatal hernia and gastroesophageal reflux. Curr Probl Surg 36 765–838 Occurrence Handle1:STN:280:DyaK1MvlsFCltw%3D%3D Occurrence Handle10526545

    CAS  PubMed  Google Scholar 

  27. LL Swanstrom DR Marcus GQ Galloway (1996) ArticleTitleLaparascopic Collis gastroplasty is the treatment of choice for the shortened esophagus. Am J Surg 171 477–481 Occurrence Handle10.1016/S0002-9610(96)00008-6 Occurrence Handle1:STN:280:BymB2crhtVM%3D Occurrence Handle8651389

    Article  CAS  PubMed  Google Scholar 

  28. PJ Treacy GG Jamieson (1987) ArticleTitleAn approach to the management of paraoesophageal hiatus hernias. Aust N Z J Surg 57 813–817 Occurrence Handle1:STN:280:BieC2cbkt1E%3D Occurrence Handle3439921

    CAS  PubMed  Google Scholar 

  29. TL Trus T Bax WS Richardson GD Branum SJ Mauren L Swanstrom JG Hunter (1997) ArticleTitleComplications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1 221–228 Occurrence Handle10.1016/S1091-255X(97)80113-8 Occurrence Handle9834351

    Article  PubMed  Google Scholar 

  30. DI Watson N Davies PG Devitt GG Jamieson (1999) ArticleTitleImportance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 134 1069–1073 Occurrence Handle10.1001/archsurg.134.10.1069 Occurrence Handle1:STN:280:DyaK1MvltVKrsQ%3D%3D Occurrence Handle10522848

    Article  CAS  PubMed  Google Scholar 

  31. CL Willekes JK Edoga EE Frezza (1997) ArticleTitleLaparoscopic repair of paraesophageal hernia. Ann Surg 225 31–38 Occurrence Handle10.1097/00000658-199701000-00004 Occurrence Handle1:STN:280:ByiC2M3hvVI%3D Occurrence Handle8998118

    Article  CAS  PubMed  Google Scholar 

  32. WA Williamson FH Ellis Jr JM Streitz Jr DM Shahian (1993) ArticleTitleParaesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56 447–451 Occurrence Handle1:STN:280:ByyA1Mzis1Q%3D Occurrence Handle8379715

    CAS  PubMed  Google Scholar 

  33. JS Wu DL Dunnegan NJ Soper (1999) ArticleTitleClinical and radiologic assessment of laparoscopic paraesophageal hernia repair. Surg Endosc 13 497–502 Occurrence Handle10.1007/s004649901021 Occurrence Handle1:STN:280:DyaK1M3ksVOmtA%3D%3D Occurrence Handle10227951

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Minimally Invasive Surgery Center, Cleveland Clinic Foundation Desk, 9500 Euclid Avenue,A-80, Cleveland OH 44195, USA

    J. Ponsky, M. Rosen, A. Fanning & J. Malm

Authors
  1. J. Ponsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Fanning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Malm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Ponsky.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ponsky, J., Rosen, M., Fanning, A. et al. Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair . Surg Endosc 17, 1036–1041 (2003). https://doi.org/10.1007/s00464-002-8765-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-8765-2

Keywords

Search

Navigation