Laparoscopic Repair of Paraesophageal Hernia
- 1 February 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 253 (2), 291-296
- https://doi.org/10.1097/sla.0b013e3181ff44c0
Abstract
The purpose of this report is to evaluate and compare the long-term objective and subjective outcome after laparoscopic paraesophageal hernia repair (LPHR). Short-term symptomatic results of LPHR are often excellent. However, a high recurrence rate is detected at objective radiographic follow-up. Retrospective review of a prospectively gathered database of consecutive patients undergoing LPHR with and without reinforced crural repair at a single institution. Subjective and objective outcomes were assessed by using a structured symptoms questionnaire, Gastrointestinal Quality-of-Life Index, satisfaction score, and barium esophagogram. From September 1991 to September 2005, LPHR was performed in 85 patients (median age, 66 years) with (25 patients) and without (60 patients) reinforced crural repair. Two patients (3%) underwent laparoscopic reoperation, for severe dysphagia and for symptomatic recurrence, respectively. Subjective outcome, available for 64 patients (75%), improved significantly at median follow-up of 118 months with a postoperative median Gastrointestinal Quality-of-Life Index score of 116. Radiographic recurrence (median follow-up, 99 months) occurred in 23 (66%) of the 35 patients, independently of age at operation, type of paresophageal hiatal hernias, and crural reinforcement, and showed no impact on quality of life. Although providing excellent symptomatic results, long-term objective evaluation of LPHR reveals a high recurrence rate even with reinforced cruroplasty. A tailored, lengthening gastroplasty and reinforced cruroplasty based on objective intraoperative evaluation, and not only on surgeon's personal judgment, may be the answer to recurrences.Keywords
This publication has 32 references indexed in Scilit:
- Fatal complications of adult paraesophageal hernia: A population-based studyThe Journal of Thoracic and Cardiovascular Surgery, 2009
- Do recurrences after paraesophageal hernia repair matter?Surgical Endoscopy, 2007
- Laparoscopic mesh hiatoplasty for paraesophageal hernias and fundoplicationsSurgical Endoscopy, 2006
- Controversies in paraesophageal hernia repair; a review of literatureSurgical Endoscopy, 2005
- Long-term outcome of laparoscopic repair of paraesophageal herniaSurgical Endoscopy, 2002
- Laparoscopic Management of Giant Type III Hiatal Hernia and Short EsophagusJournal of Gastrointestinal Surgery, 2002
- Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair.Surgical Endoscopy, 1999
- Gastrointestinal Quality of Life Index: Development, validation and application of a new instrumentBritish Journal of Surgery, 1995
- Surgical management of large paraesophageal hernia with complete intrathoracic stomachWorld Journal of Surgery, 1988
- Surgical management of esophageal reflux and hiatus herniaThe Journal of Thoracic and Cardiovascular Surgery, 1967