Laparoscopic technique for repair of paraesophageal hiatal hernias

Paraesophageal hernias represent a distinct group of hiatal hernias characterized by their potential for devastating complications. Between 1976 and 1992, a total of 270 surgeries were performed for hiatal hernias at Scripps Clinic, La Jolla, California, of which 33 were pure paraesophageal, without reflux. Starting in September 1991, a laparoscopic technique was used for repair of five out of six attempted cases of paraesophageal hiatal hernias. The closure of the hiatal defect was accomplished with mesh stapled to the edges of the hiatus in front of the esophagus. A gastropexy was added attaching the stomach to the diaphragm. This procedure proved to be technically easy and safe, and resulted in less discomfort and faster recovery of the patients when compared to the open procedure. This laparoscopic repair should be considered as a good alternative to the open techniques for paraesophageal hiatal hernias without reflux.