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A review of laparoscopic paraesophageal hernia repair

Laparoskopische Therapie der paraösophagealen Hernien

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Zusammenfassung

GRUNDLAGEN: Bei der Therapie der paraösophagealen Hernien (PEH) hat die laparoskopische Technik die offenen Operationen verdrängt. Gewisse Aspekte der operativen Therapie haben sich, unabhängig von der Methodik, bewährt. Andere wiederum werden weiterhin kontrovers diskutiert. METHODIK: Literaturanalyse. ERGEBNISSE: Die chirurgische Therapie der paraösophagealen Hernien (PEH) stellt den goldenen Standard bei symptomatischen Patienten dar. Bei asymptomatischen Patienten jedoch bleibt die Rolle der Chirurgie weiterhin unklar. In der Literatur liegen keine auf Evidenz basierenden Daten vor, die die Notwendigkeit einer routinemäßigen Durchführung einer Antirefluxmaßnahme bestätigen. Die Verwendung von Kunststoffnetzen bei großen Gewebedefekten wird in der Literatur sowohl empfohlen als auch als unnotwendig dargestellt. Die vorliegenden Daten bringen keine Klarheit darüber, ob die möglichen Vorteile oder das Risiko der Kunststoffnetz-bedingten Komplikationen überwiegen. Die Inzidenz und die klinische Signifikanz der Rezidive der PEH nach laparoskopischen Operationen sind unklar. Die publizierte Rezidivrate rangiert zwischen 0 und 42%. SCHLUSSFOLGERUNGEN: Die laparoskopische Therapie der paraösophagealen Hernien stellt unbestritten eine anspruchsvolle Technik dar, welche jedoch bei exakter Durchführung exzellente Resultate ergeben kann.

Summary

BACKGROUND: Laparoscopic repair of paraesophageal hernias (PEH) is replacing the open approach. Regardless of the technique, certain aspects of the repair have proven to be beneficial while others remain controversial. METHODS: Review of the literature. RESULTS: Surgical correction of paraesophageal hernias (PEH) is the gold standard for symptomatic patients, the role of surgery in asymptomatic patients is less clear. There is not good evidence-based data to support the routine addition of an antireflux procedure. Prosthetic repair of large defects has been both advocated and condemned in the literature. Conflicting data make it unclear whether the potential benefits outweigh the risk of mesh-related complications. The incidence and clinical significance of PEH recurrence after laparoscopic repair remain undefined. The recurrence rate in the literature after laparoscopic PEH repair ranges from 0 to 42%. CONCLUSIONS: Laparoscopic paraesophageal hernia repair is a challenging procedure, but with meticulous technique, provides excellent results.

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Authors and Affiliations

  1. Mount Sinai Medical Center, Division of Laparoscopic Surgery, Department of Surgery, New York, NY, USA

    D. Hazzan, E. H. Chin & B. Salky

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  1. D. Hazzan
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  2. E. H. Chin
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  3. B. Salky
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Correspondence to D. Hazzan.

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Hazzan, D., Chin, E. & Salky, B. A review of laparoscopic paraesophageal hernia repair. Eur Surg 39, 174–179 (2007). https://doi.org/10.1007/s10353-007-0325-5

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  • DOI: https://doi.org/10.1007/s10353-007-0325-5

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