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Laparoscopic management of giant paraesophageal herniation.
Ann Thorac Surg. 2001 Apr; 71(4):1080-6; discussion 1086-7.AT

Abstract

BACKGROUND

Many surgeons have found laparoscopic fundoplication effective management of medically recalcitrant gastroesophageal reflux disease (GERD) associated with sliding type I hiatal hernias. The anatomic distortion and technical difficulty inherent with repair has limited the use of laparoscopy for repair of "giant" paraesophageal hernias (gPH).

METHODS

Since July 1993, we have accomplished laparoscopic repair of paraesophageal hiatal hernias in 54 of 60 (90%) patients. Five patients had classic type II hernias with total intrathoracic stomachs, and 53 patients had large sliding/paraesophageal type III herniation. Two patients had true parahiatal hernias. None had gastric incarceration. Median age was 53 years and 28 of 60 (47%) were women. Chest pain and dysphagia were primary complaints from 39 of 60 (65%). Heartburn with or without regurgitation was present in 52 of 60 (85%). Preoperative manometry and prolonged pH testing were obtained on 43 of 60 (72%) and 44 of 60 (73%) patients, respectively. Principles of repair included reduction of the hernia, excision of the sac, crural approximation, and fundoplication over a 54F bougie (Nissen, 41; Dor, 1; Toupet, 18) to "pexy" the stomach within the abdomen and to control postoperative reflux.

RESULTS

Mean operative time was 202+/-81 minutes. Conversion to "open" repair was required in 6 patients (iatrogenic esophageal injury in 2 patients and difficult hernia sac dissection in 4 patients). One postoperative mortality occurred as a result of sepsis and multiorgan failure after an intraoperative esophageal perforation. Follow-up barium swallow performed in 44 of 60 patients demonstrated recurrent hiatal hernias in 3 patients. Preoperative symptoms have been relieved in all but 3 patients. Reoperation for recurrent paraesophageal herniation has been required in these latter 3 patients.

CONCLUSIONS

Although technically challenging, laparoscopic repair of paraesophageal hiatal hernias is a viable alternative to "open" surgical approaches. Control of the herniation and the patient's symptoms are equivalent and hospitalization and return to full activity are shorter.

Authors+Show Affiliations

Allegheny General Hospital Campus, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

11308140

Citation

Wiechmann, R J., et al. "Laparoscopic Management of Giant Paraesophageal Herniation." The Annals of Thoracic Surgery, vol. 71, no. 4, 2001, pp. 1080-6; discussion 1086-7.
Wiechmann RJ, Ferguson MK, Naunheim KS, et al. Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg. 2001;71(4):1080-6; discussion 1086-7.
Wiechmann, R. J., Ferguson, M. K., Naunheim, K. S., McKesey, P., Hazelrigg, S. J., Santucci, T. S., Macherey, R. S., & Landreneau, R. J. (2001). Laparoscopic management of giant paraesophageal herniation. The Annals of Thoracic Surgery, 71(4), 1080-6; discussion 1086-7.
Wiechmann RJ, et al. Laparoscopic Management of Giant Paraesophageal Herniation. Ann Thorac Surg. 2001;71(4):1080-6; discussion 1086-7. PubMed PMID: 11308140.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic management of giant paraesophageal herniation. AU - Wiechmann,R J, AU - Ferguson,M K, AU - Naunheim,K S, AU - McKesey,P, AU - Hazelrigg,S J, AU - Santucci,T S, AU - Macherey,R S, AU - Landreneau,R J, PY - 2001/4/20/pubmed PY - 2001/5/22/medline PY - 2001/4/20/entrez SP - 1080-6; discussion 1086-7 JF - The Annals of thoracic surgery JO - Ann Thorac Surg VL - 71 IS - 4 N2 - BACKGROUND: Many surgeons have found laparoscopic fundoplication effective management of medically recalcitrant gastroesophageal reflux disease (GERD) associated with sliding type I hiatal hernias. The anatomic distortion and technical difficulty inherent with repair has limited the use of laparoscopy for repair of "giant" paraesophageal hernias (gPH). METHODS: Since July 1993, we have accomplished laparoscopic repair of paraesophageal hiatal hernias in 54 of 60 (90%) patients. Five patients had classic type II hernias with total intrathoracic stomachs, and 53 patients had large sliding/paraesophageal type III herniation. Two patients had true parahiatal hernias. None had gastric incarceration. Median age was 53 years and 28 of 60 (47%) were women. Chest pain and dysphagia were primary complaints from 39 of 60 (65%). Heartburn with or without regurgitation was present in 52 of 60 (85%). Preoperative manometry and prolonged pH testing were obtained on 43 of 60 (72%) and 44 of 60 (73%) patients, respectively. Principles of repair included reduction of the hernia, excision of the sac, crural approximation, and fundoplication over a 54F bougie (Nissen, 41; Dor, 1; Toupet, 18) to "pexy" the stomach within the abdomen and to control postoperative reflux. RESULTS: Mean operative time was 202+/-81 minutes. Conversion to "open" repair was required in 6 patients (iatrogenic esophageal injury in 2 patients and difficult hernia sac dissection in 4 patients). One postoperative mortality occurred as a result of sepsis and multiorgan failure after an intraoperative esophageal perforation. Follow-up barium swallow performed in 44 of 60 patients demonstrated recurrent hiatal hernias in 3 patients. Preoperative symptoms have been relieved in all but 3 patients. Reoperation for recurrent paraesophageal herniation has been required in these latter 3 patients. CONCLUSIONS: Although technically challenging, laparoscopic repair of paraesophageal hiatal hernias is a viable alternative to "open" surgical approaches. Control of the herniation and the patient's symptoms are equivalent and hospitalization and return to full activity are shorter. SN - 0003-4975 UR - https://www.unboundmedicine.com/medline/citation/11308140/Laparoscopic_management_of_giant_paraesophageal_herniation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(00)01229-7 DB - PRIME DP - Unbound Medicine ER -