Abstract
Introduction
Laparoscopic paraesophageal hernia repair continues to be one of the most challenging procedures facing the minimally invasive surgeon.
Discussion
A thorough understanding of the tenets of the operation and advanced skills in minimally invasive laparoscopy are needed for long-term freedom from symptomatic and anatomic recurrence. These include complete reduction of the hernia sac from the mediastinum back into the abdomen with careful preservation of the integrity of muscle and peritoneal lining of the crura, aggressive and complete mobilization of the esophagus to the level of the inferior pulmonary vein, vagal preservation, clear identification of the gastroesophageal junction to allow accurate assessment of the intraabdominal esophageal length, and use of Collis gastroplasty when esophageal lengthening is required for a tension-free intraabdominal repair. Liberal mobilization of the phrenosplenic and phrenogastric attachments substantially increases the mobility of the left limb of the crura, allowing for a tension-free primary closure in a large percentage of patients.
Conclusion
The following describes our current approach to laparoscopic paraesophageal hernia repair following a decade of refinement in a high-volume center.
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References
Collis JL. An operation for hiatus hernia with short esophagus. J Thorac Surg. 1957;34(6):768–773; discussion 774–768.
Hakanson BS, Thor KB, Thorell A, Ljungqvist O. Open vs laparoscopic partial posterior fundoplication. A prospective randomized trial. Surg Endosc. 2007;21(2):289–298.
Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KK, Schraut WH, Luketich JD. Comparison of laparoscopic versus open repair of paraesophageal hernia. Am J Surg. Dec 1998;176(6):659–665.
Altorki NK, Yankelevitz D, Skinner DB. Massive hiatal hernias: the anatomic basis of repair. J Thorac Cardiovasc Surg. Apr 1998;115(4):828–835.
Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg. 1998;115(1):53–60; discussion 61–52.
Luketich JD, Raja S, Fernando HC, Campbell W, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Schauer PR. Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg. Oct 2000;232(4):608–618.
Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR, Schauer PR. Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg. Dec 2002;74(6):1909–1915; discussion 1915–1906.
Pitcher DE, Curet MJ, Martin DT, Vogt DM, Mason J, Zucker KA. Successful laparoscopic repair of paraesophageal hernia. Arch Surg. Jun 1995;130(6):590–596.
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, 404 e391.
Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM. Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc. Jan 2005;19(1):4–8.
Nason KS, Luketich JD, Qureshi I, Keeley S, Trainor S, Awais O, Shende M, Landreneau RJ, Jobe BA, Pennathur A. Laparoscopic repair of giant paraesophageal hernia results in long-term patient satisfaction and a durable repair. J Gastrointest Surg. 2008;12(12):2066–2075; discussion 2075–2067.
Zurawska U, Parasuraman S, Goldhaber SZ. Prevention of pulmonary embolism in general surgery patients. Circulation. Mar 6 2007;115(9):e302-307.
Zollinger RJ, Zollinger RS. Cholesystectomy, Hasson Open Technique, Laparoscopic. In: Jr ZR, Sr ZR, eds. Zollinger's Atlas of Surgical Operations, 8th edn. New York: The McGraw-Hill Companies, Inc; 2003.
Whitson BA, Hoang CD, Boettcher AK, Dahlberg PS, Andrade RS, Maddaus MA. Wedge gastroplasty and reinforced crural repair: important components of laparoscopic giant or recurrent hiatal hernia repair. J Thorac Cardiovasc Surg. 2006;132(5):1196–1202 e1193.
Davis RE, Awad ZT, Filipi CJ. Technical factors in the creation of a "floppy" Nissen fundoplication. Am J Surg. Jun 2004;187(6):724–727.
O'Reilly MJ, Mullins SG, Saye WB, Pinto SE, Falkner PT. Laparoscopic posterior partial fundoplication: analysis of 100 consecutive cases. J Laparoendosc Surg. Jun 1996;6(3):141–150.
el-Sherif AE, Adusumilli PS, Pettiford BL, d’Amato TA, Schuchert MJ, Clark A, DiRenzo C, Landreneau JP, Luketich JD, Landreneau RJ. Laparoscopic clam shell partial fundoplication achieves effective reflux control with reduced postoperative dysphagia and gas bloating. Ann Thorac Surg. 2007;84(5):1704–1709.
Velanovich V, Vallance SR, Gusz JR, Tapia FV, Harkabus MA. Quality of life scale for gastroesophageal reflux disease. J Am Coll Surg. Sep 1996;183(3):217–224.
Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.
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Nason, K.S., Luketich, J.D., Witteman, B.P. et al. The Laparoscopic Approach to Paraesophageal Hernia Repair. J Gastrointest Surg 16, 417–426 (2012). https://doi.org/10.1007/s11605-011-1690-8
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DOI: https://doi.org/10.1007/s11605-011-1690-8