A case of paraesophageal hernia repaired by laparoscopic approach

Paraesophageal hernia comprises only 2 approximately 5% of all hiatal hernias but is prone to incarceration and strangulation. For this reason they must be recognized and repaired as expeditiously as possible. The laparoscopic approach has already been successfully applied to the repair of the more common sliding hiatal hernia and it seems reasonable to propose that the paraesophageal hernia, provided it is not complicated, might also be repaired by the laparoscopic technique. We present here a case of paraesophageal hernia which has been successfully repaired by the laparoscopic approach. A 73-year-old female suffering from postprandial fullness in the retrosternal area was diagnosed preoperatively with paraesophageal hiatal hernia with gastroesophageal acid reflux and was submitted for laparoscopic repair. The procedure entailed reduction of the hernia, mobilization of the esophagogastric junction with crural repair and partial fundoplication. At the 9th-month follow-up, the patient had remained asymptomatic and follow-up studies revealed no evidence of hernia or acid reflux. As a result of this favorable experience with minimal morbidity, early hospital discharge, and effective control of symptoms without adverse sequalae, laparoscopic repair can be considered as the curative and minimal invasive method in the management of paraesophageal hernia.