Tags

Type your tag names separated by a space and hit enter

Laparoscopic repair of paraesophageal hiatal hernias.
J Am Coll Surg. 1998 Apr; 186(4):428-32; discussion 432-3.JA

Abstract

BACKGROUND

Regardless of symptoms, paraesophageal hiatal hernias should be repaired in order to prevent complications. This study reports the University of California San Francisco experience with laparoscopic repair of paraesophageal hiatal hernias, emphasizing the technical steps essential for good results.

PATIENTS AND METHODS

From May 1993 to September 1997, 55 patients, 27 women and 28 men, with a mean age of 67 years (range, 35-102 years) underwent laparoscopic repair of paraesophageal hernias at the University of California San Francisco. Symptoms, which had been present an average of 85 months before surgery, consisted mainly of pain (55%), heartburn (52%), dysphagia (45%), and regurgitation (41%). Of the four patients who presented with acute illness, two had gastric obstruction, one had severe dyspnea, and one had gastric bleeding. Endoscopy demonstrated esophagitis in 25 (69%) of 36 patients, and 24-hour pH-monitoring demonstrated acid reflux in 22 (67%) of 33 patients. Manometry detected severely impaired distal esophageal peristalsis in 17 (52%) of 33 patients. The preferred operation consisted of reduction of the hernia, excision of the sack and the gastric fat pad, closure of the enlarged hiatus without mesh, and construction of a fundoplication anchored by sutures within the abdomen.

RESULTS

Of the 55 patients, the operations of 49 were completed laparoscopically using the following reconstructions: Guarner (270-degree) fundoplication (30 patients); Nissen fundoplication (10 patients); and gastropexy (9 patients). Five (9%) operations were converted to laparotomies. The average operating time was 219 minutes; the average blood loss was less than 25 mL; resumption of an unrestricted diet, 27 hours; and mean hospital stay, 58 hours. Intraoperative technical complications occurred in five (9%) patients. One patient died during surgery from a sudden pulmonary embolus. Two (4%) patients required a second operation for recurrent paraesophageal hernias.

CONCLUSIONS

Laparoscopic repair of paraesophageal hiatal hernias is safe and effective, but the operation is difficult and good results hinge on details of the operative technique and the surgeon's experience. In this series, the crus could always be closed securely without using mesh. We realized early that a fundoplication should be a routine step, because it corrects reflux and is the best method to secure the gastroesophageal junction in the abdomen.

Authors+Show Affiliations

Department of Surgery, University of California, San Francisco, 94143-0475, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9544957

Citation

Gantert, W A., et al. "Laparoscopic Repair of Paraesophageal Hiatal Hernias." Journal of the American College of Surgeons, vol. 186, no. 4, 1998, pp. 428-32; discussion 432-3.
Gantert WA, Patti MG, Arcerito M, et al. Laparoscopic repair of paraesophageal hiatal hernias. J Am Coll Surg. 1998;186(4):428-32; discussion 432-3.
Gantert, W. A., Patti, M. G., Arcerito, M., Feo, C., Stewart, L., DePinto, M., Bhoyrul, S., Rangel, S., Tyrrell, D., Fujino, Y., Mulvihill, S. J., & Way, L. W. (1998). Laparoscopic repair of paraesophageal hiatal hernias. Journal of the American College of Surgeons, 186(4), 428-32; discussion 432-3.
Gantert WA, et al. Laparoscopic Repair of Paraesophageal Hiatal Hernias. J Am Coll Surg. 1998;186(4):428-32; discussion 432-3. PubMed PMID: 9544957.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic repair of paraesophageal hiatal hernias. AU - Gantert,W A, AU - Patti,M G, AU - Arcerito,M, AU - Feo,C, AU - Stewart,L, AU - DePinto,M, AU - Bhoyrul,S, AU - Rangel,S, AU - Tyrrell,D, AU - Fujino,Y, AU - Mulvihill,S J, AU - Way,L W, PY - 1998/4/17/pubmed PY - 1998/4/17/medline PY - 1998/4/17/entrez SP - 428-32; discussion 432-3 JF - Journal of the American College of Surgeons JO - J Am Coll Surg VL - 186 IS - 4 N2 - BACKGROUND: Regardless of symptoms, paraesophageal hiatal hernias should be repaired in order to prevent complications. This study reports the University of California San Francisco experience with laparoscopic repair of paraesophageal hiatal hernias, emphasizing the technical steps essential for good results. PATIENTS AND METHODS: From May 1993 to September 1997, 55 patients, 27 women and 28 men, with a mean age of 67 years (range, 35-102 years) underwent laparoscopic repair of paraesophageal hernias at the University of California San Francisco. Symptoms, which had been present an average of 85 months before surgery, consisted mainly of pain (55%), heartburn (52%), dysphagia (45%), and regurgitation (41%). Of the four patients who presented with acute illness, two had gastric obstruction, one had severe dyspnea, and one had gastric bleeding. Endoscopy demonstrated esophagitis in 25 (69%) of 36 patients, and 24-hour pH-monitoring demonstrated acid reflux in 22 (67%) of 33 patients. Manometry detected severely impaired distal esophageal peristalsis in 17 (52%) of 33 patients. The preferred operation consisted of reduction of the hernia, excision of the sack and the gastric fat pad, closure of the enlarged hiatus without mesh, and construction of a fundoplication anchored by sutures within the abdomen. RESULTS: Of the 55 patients, the operations of 49 were completed laparoscopically using the following reconstructions: Guarner (270-degree) fundoplication (30 patients); Nissen fundoplication (10 patients); and gastropexy (9 patients). Five (9%) operations were converted to laparotomies. The average operating time was 219 minutes; the average blood loss was less than 25 mL; resumption of an unrestricted diet, 27 hours; and mean hospital stay, 58 hours. Intraoperative technical complications occurred in five (9%) patients. One patient died during surgery from a sudden pulmonary embolus. Two (4%) patients required a second operation for recurrent paraesophageal hernias. CONCLUSIONS: Laparoscopic repair of paraesophageal hiatal hernias is safe and effective, but the operation is difficult and good results hinge on details of the operative technique and the surgeon's experience. In this series, the crus could always be closed securely without using mesh. We realized early that a fundoplication should be a routine step, because it corrects reflux and is the best method to secure the gastroesophageal junction in the abdomen. SN - 1072-7515 UR - https://www.unboundmedicine.com/medline/citation/9544957/Laparoscopic_repair_of_paraesophageal_hiatal_hernias_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1072751598000611 DB - PRIME DP - Unbound Medicine ER -