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A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair.
Surgery. 2000 Oct; 128(4):623-30.S

Abstract

BACKGROUND

Giant paraesophageal hiatal hernia (GPEH) presents a risk of catastrophic complications that include massive bleeding, strangulation, and perforation and should be repaired. Controversy persists as to the surgical approach and whether an antireflux repair is required.

METHODS

This study reviews the experience with 100 patients with GPEH who underwent surgical repair between 1967 and 1999. Eighty patients underwent an elective operation, and 20 patients underwent an emergency procedure for complications of GPEH. The gastroesophageal junction was above the hiatus ("combined" hernia with sliding component) in 23 patients and in the abdomen in 77 patients, including 3 patients with a true parahiatal hernia.

RESULTS

A thoracic approach was used in 18 patients, mostly early in our experience; postoperative gastric volvulus requiring transabdominal repair developed in 2 patients. The remaining 82 patients underwent an abdominal repair, with temporary gastrostomy to prevent gastric displacement in 75 patients; the hernial sac was resected, and the hiatus was reconstructed in all of the patients. Thirty-five patients with reflux on preoperative work up underwent a fundoplication, with gastroplasty in 2 patients because of a short esophagus. No patient has experienced hernia recurrence. Whereas symptomatic relief was excellent in all patients with elective repair, mild reflux was present in 2 patients after emergency operation. There were no deaths among the patients who underwent elective operation; there were 2 hospital deaths among those patients who underwent emergency operation (10%).

CONCLUSIONS

GPEH should be repaired soon after recognition. Reflux should be evaluated before the operation, and if present, fundoplication should be part of the repair along with the reduction of the hernia, excision of the sac, gastropexy, and crural closure. These are best achieved with an abdominal approach.

Authors+Show Affiliations

Division of Cardiothoracic Surgery, The University of Illinois at Chicago, Chicago, Ill. 60612, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11015096

Citation

Geha, A S., et al. "A 32-year Experience in 100 Patients With Giant Paraesophageal Hernia: the Case for Abdominal Approach and Selective Antireflux Repair." Surgery, vol. 128, no. 4, 2000, pp. 623-30.
Geha AS, Massad MG, Snow NJ, et al. A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery. 2000;128(4):623-30.
Geha, A. S., Massad, M. G., Snow, N. J., & Baue, A. E. (2000). A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery, 128(4), 623-30.
Geha AS, et al. A 32-year Experience in 100 Patients With Giant Paraesophageal Hernia: the Case for Abdominal Approach and Selective Antireflux Repair. Surgery. 2000;128(4):623-30. PubMed PMID: 11015096.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. AU - Geha,A S, AU - Massad,M G, AU - Snow,N J, AU - Baue,A E, PY - 2000/10/3/pubmed PY - 2001/2/28/medline PY - 2000/10/3/entrez SP - 623 EP - 30 JF - Surgery JO - Surgery VL - 128 IS - 4 N2 - BACKGROUND: Giant paraesophageal hiatal hernia (GPEH) presents a risk of catastrophic complications that include massive bleeding, strangulation, and perforation and should be repaired. Controversy persists as to the surgical approach and whether an antireflux repair is required. METHODS: This study reviews the experience with 100 patients with GPEH who underwent surgical repair between 1967 and 1999. Eighty patients underwent an elective operation, and 20 patients underwent an emergency procedure for complications of GPEH. The gastroesophageal junction was above the hiatus ("combined" hernia with sliding component) in 23 patients and in the abdomen in 77 patients, including 3 patients with a true parahiatal hernia. RESULTS: A thoracic approach was used in 18 patients, mostly early in our experience; postoperative gastric volvulus requiring transabdominal repair developed in 2 patients. The remaining 82 patients underwent an abdominal repair, with temporary gastrostomy to prevent gastric displacement in 75 patients; the hernial sac was resected, and the hiatus was reconstructed in all of the patients. Thirty-five patients with reflux on preoperative work up underwent a fundoplication, with gastroplasty in 2 patients because of a short esophagus. No patient has experienced hernia recurrence. Whereas symptomatic relief was excellent in all patients with elective repair, mild reflux was present in 2 patients after emergency operation. There were no deaths among the patients who underwent elective operation; there were 2 hospital deaths among those patients who underwent emergency operation (10%). CONCLUSIONS: GPEH should be repaired soon after recognition. Reflux should be evaluated before the operation, and if present, fundoplication should be part of the repair along with the reduction of the hernia, excision of the sac, gastropexy, and crural closure. These are best achieved with an abdominal approach. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/11015096/A_32_year_experience_in_100_patients_with_giant_paraesophageal_hernia:_the_case_for_abdominal_approach_and_selective_antireflux_repair_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039-6060(00)53851-3 DB - PRIME DP - Unbound Medicine ER -