Abstract
Background
Paraoesophageal hernias are an uncommon but important diaphragmatic defect due to a high prevalence of associated complications. The advent of laparoscopic surgery has popularised the surgical management of this condition, although the optimal technique has yet to be defined. The aim of this cohort study was to assess the necessity of an anti-reflux procedure in addition to the crural repair.
Methods
Details of all patients undergoing laparoscopic paraoesophageal hernia repair were collected prospectively paying particular attention to the details of the operative procedure and outcome, including the development of early complications. All patients were followed for six months and symptoms related to hernia recurrence or technical failure including dysphagia and reflux were noted.
Results
Twenty-three consecutive patients underwent laparoscopic paraoesophageal hernia repair. The first 11 patients (Group 1) routinely underwent an additional anti-reflux procedure, whereas the later cohort (Group 2) did not (chi-squared P < 0.05). At six months, nine of eleven patients in Group 1 reported dysphagia, in two cases requiring dilatation, but this complication was not seen in those in Group 2. Two patients reported reflux at six-month follow-up; this was controlled in both cases by a low dose of a proton pump inhibitor.
Conclusion
Laparoscopic repair of paraoesophageal hernias is an effective treatment with excellent short-term results and no recurrences. Our experience would suggest that an anti-reflux procedure is not always indicated and may indeed be detrimental to symptomatic outcome.
Similar content being viewed by others
References
Dahlberg PS, Deschamps C, Miller DC, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraoesophageal hiatus hernia. Ann Thorac Surg 72:1125–1129
Ellis FH Jr, Crozier RE, Shea JA (1986) Paraesophageal hiatus hernia. Arch Surg 121:416–420
Treacy PJ, Jamieson GG (1987) An approach to the management of para-oesophageal hiatus hernias. Aust NZ J Surg 57:813–817
Cuschieri A, Shimi S, Nathanson LK (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia. Am J Surg 163:425–430
Draaisma WA, Gooszen HG, Tiouronij E, Broeders AMJ (2005) Controversies in paraoesophageal hernia repair. Surg Endosc 19:1300–1308
Lal DR, Pellegrini CA, Oelschlager BK (2005) Laparoscopic repair of paraesophageal hernia. Surg Clin North Am 85:105–118
Williamson WA, Ellis FH Jr, Streitz JM Jr, Shahian DM (1993) Paraesophageal hiatus hernia: is an antireflux procedure necessary? Ann Thorac Surg 56:447–452
Ellis FH, Crozier RE, Shea JA (1986) Paraesophageal hernia. Arch Surg 121:416–420
Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernias: the case for abdominal approach and selective antireflux repair. Surgery 128:623–630
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Morris-Stiff, G., Hassn, A. Laparoscopic paraoesophageal hernia repair: fundoplication is not usually indicated. Hernia 12, 299–302 (2008). https://doi.org/10.1007/s10029-008-0332-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-008-0332-x