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Updated: Jul 5, 2026
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Large paraesophageal hernias in children. Early experience with laparoscopic repair
M Bettolli1, S Z Rubin, A Gutauskas
1Division of Pediatric General Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Large paraesophageal hernias (LPEH) in children, often a complication of prior surgery, can be managed with laparoscopic repair. This technically demanding but feasible approach shows promising results in initial pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Minimally Invasive Surgery
Background:
- Large paraesophageal hernias (LPEH) are rare in children.
- LPEH in pediatric patients is frequently associated with previous fundoplication procedures.
- This study addresses the management and laparoscopic repair of LPEH in children.
Purpose of the Study:
- To report the management strategies for large paraesophageal hernias in pediatric patients.
- To present initial experiences and outcomes of laparoscopic repair for LPEH in children.
- To evaluate the feasibility and safety of the laparoscopic approach for pediatric LPEH.
Main Methods:
- Retrospective analysis of four pediatric patients (aged 4-17 years) undergoing laparoscopic repair of LPEH.
- Inclusion of patients with prior fundoplications and gastrostomies.
- Hiatal defect closure using crural sutures and prosthetic materials (mesh or submucosal patch).
Main Results:
- Operative times ranged from 300-540 minutes.
- One conversion to open surgery and two mediastinal pleural tears occurred.
- Postoperative imaging confirmed no recurrent hernia or air, with a median hospital stay of 3 days.
Conclusions:
- LPEH in children often results from prior fundoplication.
- Laparoscopic repair of pediatric LPEH is technically challenging yet achievable.
- Effective crural repair with mesh may decrease recurrence rates; multicenter studies are recommended.
Background:
Large paraesophageal hernias (LPEH) in children are unusual. The aim of this study is to report the management of LPEH and our initial experience with the laparoscopic approach.
Methods:
Since September 2005, four children aged 4-17 years underwent laparoscopic repair of LPEH at the Children's Hospital of Eastern Ontario. Three children had previous fundoplications and two of these had a gastrostomy. Closure of the hiatal defect included crural sutures and prosthetic material, either polytetrafluoroethylene-polypropylene mesh or porcine small intestinal submucosal patch. The charts were retrospectively analyzed.
Results:
The operative time was 300-540 minutes, with one conversion and two mediastinal pleural tears. Postoperative chest X-ray showed neither mediastinal nor intrapleural air. The median hospital stay was 3 days. Contrast X-ray showed no recurrent hernia and an intact fundoplication.
Conclusion:
LPEH in children is usually a complication of previous fundoplication. Laparoscopic repair is technically demanding but feasible. Adequate crural repair using mesh may reduce the incidence of recurrence. In view of the rarity of LPEH in children, a combined multicenter study is needed to evaluate the results of laparoscopic repair.
