Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias
- 31 May 1996
- journal article
- Published by Elsevier BV in The American Journal of Surgery
- Vol. 171 (5), 485-489
- https://doi.org/10.1016/s0002-9610(97)89609-2
Abstract
Early surgical treatment has been recommended in patients with paraesophageal hiatal hernias. Recently, the laparoscopic approach has emerged as an ideal way to perform the operation. But whether or not an antireflux procedure should be done remains controversial.Four patients with type II and eleven with type III hiatal hernias were treated. Twelve of them manifested symptoms of reflux preoperatively. The operative technique consisted of resection of the sac, closure of the crura and gastric fundoplication, anchored to the diaphragm.All but two patients were completed laparoscopically. Mean operative time was 320 (+/-49 SD) minutes, and mean hospital stay was 3 (+/-1.2 SD) days. Early postoperative complications were subcutaneous emphysema (two patients) and atrial fibrillation (one patient). At one year all patients were asymptomatic without dysphagia, reflux, or recurrence of the hernia.The addition of fundoplication to paraesophageal hernia repair restores competency of the sphincter in patients with reflux associated to the hernia and prevents postoperative gastroesophageal reflux that results from the extensive dissection required. In addition, it provides an ideal means of fixing the stomach in the subdiaphragmatic position, decreasing the long term-risk of recurrence.Keywords
This publication has 17 references indexed in Scilit:
- Management of paraesophageal hernia with a selective approach to antireflux surgeryThe American Journal of Surgery, 1995
- Successful Laparoscopic Repair of Paraesophageal HerniaArchives of Surgery, 1995
- Laparoscopic repair of paraesophageal herniaSurgical Endoscopy, 1995
- Paraoesophageal hernia repair with and without concomitant fundoplicationBritish Journal of Surgery, 1994
- Paraesophageal hiatal hernia: Is an antireflux procedure necessary?The Annals of Thoracic Surgery, 1993
- Paraesophageal Hernia Causing Colonic ObstructionJournal of Clinical Gastroenterology, 1991
- Diaphragmatic hiatal herniasPostgraduate Medicine, 1990
- Incarcerated paraesophageal herniaThe American Journal of Emergency Medicine, 1990
- Incarcerated paraesophageal herniaThe American Journal of Surgery, 1973
- Surgical management of esophageal reflux and hiatus herniaThe Journal of Thoracic and Cardiovascular Surgery, 1967