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Complications of laparoscopic paraesophageal hernia repair


The complications of laparoscopic paraesophageal hernia repair at two institutions were reviewed to determine the rate and type of complications. A total of 76 patients underwent laparoscopic paraesophageal hernia repair between December 1992 and April 1996. Seventy-one of them had fundoplication (6 required a Collis-Nissen procedure). Five patients underwent hernia reduction and gastropexy only. There was one conversion to laparotomy. Traumatic visceral injury occurred in eight patients (11%) (gastric lacerations in 3, esophageal lacerations in 2, and bougie dilator perforations in 3). All lacerations were repaired intraoperatively except for one that was not recognized until postoperative day 2. Vagus nerve injuries occurred in at least three patients. Three delayed perforations occurred in the postoperative period (4%) (2 gastric and 1 esophageal). Two patients had pulmonary complications, two had gastroparesis, and one had fever of unknown origin. Seven patients required reoperation for gastroparesis (n=2), dysphagia after mesh hiatal closure of the hiatus (n=1), or recurrent herniation (n=4). There were two deaths (3%): one from septic complications and one from myocardial infarction. Paraesophageal hernia repair took significantly longer (3.7 hours) than standard fundoplication (2.5 hours) in a concurrent series (P<0.05). Laparoscopic paraesophageal hernia repair is feasible but challenging. The overall complication rate, although significant, is lower than that for nonsurgically managed paraesophageal hernia.

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  1. 1.

    Wo JM, Branum GD, Hunter JG, et al. Clinical features of type III (mixed) paraesophageal hernia. Am J Gastroenterol 1996;91:914–916.

    PubMed  CAS  Google Scholar 

  2. 2.

    Oddsdottir M, Franco AL, Laycock WS, et al. Laparoscopic repair of paraesophageal hernia: new access, old technique. Surg Endocs 1995;9:164–168.

    CAS  Google Scholar 

  3. 3.

    Kroger KE, Stone JM. Laparoscopic reduction of acute gastric volvulus. Am Surg 1993;59:325–328.

    Google Scholar 

  4. 4.

    Congreve DP. Laparoscopic paraesophageal hernia repair. J Laparoendosc Surg 1992;2:45–48.

    PubMed  CAS  Google Scholar 

  5. 5.

    Kuster GGR, Gilray PA-C. Laparoscopic technique of repair of paraesophageal hiatal hernias. J Laparoendosc Surg 1993; 3:331–338.

    PubMed  CAS  Google Scholar 

  6. 6.

    Hunter JG, Trus TL, Branum GD, et al. A physiologic approach to laparoscopic fundoplication for gastroesophageal reflux disease. Ann Surg 1996;223:673–687.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Trus TL, Hunter JG. Laparoscopic surgery of the esophagus and stomach. Am J Surg (in press).

  8. 8.

    Skinner DB, Belsey RHR. Surgical management of esophageal reflux and hiatus hernia: Long-term results with 1,030 patients. J Thorac Cardiovasc Surg 1967;53:33–54.

    PubMed  CAS  Google Scholar 

  9. 9.

    Walther B, DeMeester TR, Lafontaine E, et al. Effect of paraesophageal hernia on sphincter function and its implication in surgical therapy. Am J Surg 1984;147:111–116.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Patti MG, Goldberg HI, Arcerito M, et al. Hiatal hernia size affects lower esophageal sphincter function, esophageal acid exposure, and the degree of mucosal injury. Am J Surg 1996; 171:182–186.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Swanstrom L, Marcus D, Galloway G. Laparoscopic Collis gastroplasty is the treatment of choice for the shortened esophagus. Am J Surg 1996;171:477–481.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Menguy R. Surgical management of large paraesophageal hernia with complete intrathoracic stomach. World J Surg 1988;12:415–422.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Harriss DR, Graham TR, Galea M, et al. Paraoesophageal hiatal hernias, when to operate. J R Coll Surg Edinb 1992;37: 97–98.

    PubMed  CAS  Google Scholar 

  14. 14.

    Williamson WA, Ellis FH, Streitz JM. Paraesophageal hiatal hernia: Is an antireflux procedure necessary? Ann Thorac Surg 1993;56:447–452.

    PubMed  CAS  Article  Google Scholar 

  15. 15.

    Myers GA, Horms BA, Starling JR. Management of paraesophageal hernia with a selective approach to antireflux surgery. Am J Surg 1995;170:375–380.

    PubMed  Article  CAS  Google Scholar 

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Correspondence to John G. Hunter M.D..

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Trus, T.L., Bax, T., Richardson, W.S. et al. Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1, 221–228 (1997).

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  • Hiatal Hernia
  • Antireflux Surgery
  • Esophageal Perforation
  • Laparoscopic Fundoplication
  • Paraesophageal Hernia