Surgical Endoscopy

, Volume 22, Issue 4, pp 1107–1111 | Cite as

Do recurrences after paraesophageal hernia repair matter?

Ten-year follow-up after laparoscopic repair
  • B. C. WhiteEmail author
  • L. O. Jeansonne
  • C. B. Morgenthal
  • S. Zagorski
  • S. S. Davis
  • C. D. Smith
  • E. Lin



The recurrence rate for paraesophageal hernias (PEH) can be as high as 30% following laparoscopic repair. The aim of this study was to determine the severity of symptoms in patients with recurrences and the need for reoperation 10 years after surgery.

Methods and Procedures

Consecutive laparoscopic paraesophageal cases performed at a single institution between 1993 and 1996 were identified from the institution’s foregut database. Patients were asked about the presence and severity of symptoms (heartburn, chest pain, regurgitation, and dysphagia). Patients were also asked whether they had (1) been diagnosed with hernia recurrence or (2) undergone repeat surgical intervention.


Complete follow-up was obtainable in 31 of the total of 52 patients (60%). The proportion of patients reporting moderate/severe symptoms was less at 10 years than preoperatively: heartburn 12% versus 54% (p < 0.001), chest pain 9% versus 36% (p = 0.01), regurgitation 6% versus 50% (p < 0.001), and dysphagia 3% versus 30% (p = 0.001). Two patients underwent repeat surgical intervention for symptomatic recurrences within the first postoperative year. Eight more patients have been diagnosed with hernia recurrences on either contrast esophagram or upper endoscopy but had not required reoperation. At ten years, more patients with hernia recurrence had heartburn than those who did not have recurrences (60% versus 14%; p < 0.05).


Despite a hiatal hernia recurrence rate of 32% 10 years after surgery, laparoscopic PEH was a successful procedure in the majority of patients; most remained symptomatically improved and required no further intervention 10 years after surgery.


Paraesophageal hernia hernia recurrence laparoscopic hernia repair 


  1. 1.
    Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagne DJ, Caushaj PF, Landreneau RJ, Keenan RJ (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation. Surg Endosc 18:444–447PubMedCrossRefGoogle Scholar
  2. 2.
    Champion JK, Rock D (2003) Laparoscopic mesh cruroplasty for large paraesophageal hernias. Surg Endosc 17:551–553PubMedCrossRefGoogle Scholar
  3. 3.
    Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 72:1125–1129PubMedCrossRefGoogle Scholar
  4. 4.
    Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7:59–66; discussion 66–57PubMedCrossRefGoogle Scholar
  5. 5.
    Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19:4–8PubMedCrossRefGoogle Scholar
  6. 6.
    Granderath FA, Carlson MA, Champion JK, Szold A, Basso N, Pointner R, Frantzides CT (2006) Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 20:367–379PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson JM, Carbonell AM, Carmody BJ, Jamal MK, Maher JW, Kellum JM, DeMaria EJ (2006) Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplications: a critical analysis of the available literature. Surg Endosc 20:362–366PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson JM, Carmody BJ, Jamal MK, DeMaria EJ (2005) Onlay hiatal reinforcement utilizing human acellular dermal matrix: three case series. Surg Innov 12:239–241PubMedCrossRefGoogle Scholar
  9. 9.
    Keidar A, Szold A (2003) Laparoscopic repair of paraesophageal hernia with selective use of mesh. Surg Laparosc Endosc Percutan Tech 13:149–154PubMedCrossRefGoogle Scholar
  10. 10.
    Khaitan L, Houston H, Sharp K, Holzman M, Richards W (2002) Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate. Am Surg 68:546–551; discussion 551–542PubMedGoogle Scholar
  11. 11.
    Mattar SG, Bowers SP, Galloway KD, Hunter JG, Smith CD (2002) Long-term outcome of laparoscopic repair of paraesophageal hernia. Surg Endosc 16:745–749PubMedCrossRefGoogle Scholar
  12. 12.
    Mehta S, Boddy A, Rhodes M (2006) Review of outcome after laparoscopic paraesophageal hiatal hernia repair. Surg Laparosc Endosc Percutan Tech 16:301–306PubMedCrossRefGoogle Scholar
  13. 13.
    Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244:481–490PubMedGoogle Scholar
  14. 14.
    Strange PS (2003) Small intestinal submucosa for laparoscopic repair of large paraesophageal hiatal hernias: a preliminary report. Surg Technol Int 11:141–143PubMedGoogle Scholar
  15. 15.
    Swanstrom LL, Jobe BA, Kinzie LR, Horvath KD (1999) Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg 177:359–363PubMedCrossRefGoogle Scholar
  16. 16.
    Targarona EM, Novell J, Vela S, Cerdan G, Bendahan G, Torrubia S, Kobus C, Rebasa P, Balague C, Garriga J, Trias M (2004) Midterm analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia. Surg Endosc 18:1045–1050PubMedCrossRefGoogle Scholar
  17. 17.
    Tsuboi K, Tsukada K, Nakabayashi T, Kato H, Miyazaki T, Masuda N, Kuwano H (2002) Paraesophageal hiatus hernia, which has progressed for 8 years: report of a case. Hepatogastroenterology 49:992–994PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • B. C. White
    • 1
    Email author
  • L. O. Jeansonne
    • 1
  • C. B. Morgenthal
    • 1
  • S. Zagorski
    • 1
  • S. S. Davis
    • 1
  • C. D. Smith
    • 2
  • E. Lin
    • 1
  1. 1.Emory Endosurgery Unit, Department of SurgeryEmory School of MedicineAtlantaGeorgia
  2. 2.Mayo School of Medicine and ClinicJacksonvilleFlorida

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