Laparoscopic management of paraesophageal hernia: early results

The objective was to review our early results with laparoscopic repair of paraesophageal hernias to determine the safety, technical feasibility, and short-term outcome of the operation. Twelve patients with a mean age of 75 +/- 1 years underwent laparoscopic repair of a paraesophageal hernia. Principles of open repair, including sac excision, primary crural repair, and pexy, were accomplished laparoscopically in 83%, 83%, and 100% of patients, respectively. In two patients the diaphragmatic defect was closed with mesh. Fundoplication was also performed in seven patients with symptoms of reflux disease. No laparoscopic procedure was converted to an open repair; however, one patient required a postoperative celiotomy to control hemorrhage. Short-term evaluation of all patients postoperatively detected gastroesophageal reflux disease (GERD) in five patients (42%), four of whom did not undergo fundoplication. Two major complications were esophageal perforation and bleeding. Minor complications included atrial fibrillation in two patients, meat impaction in one patient, and a small asymptomatic recurrence in a single patient. Overall patient satisfaction was high. Laparoscopic repair of paraesophageal hernias was safe and technically feasible and warrants further investigation. The incidence of postoperative esophageal reflux, however, is high if an antireflux procedure is not performed. Extensive preoperative evaluation for reflux should objectively identify patients requiring fundoplication and decrease the incidence of postoperative GERD.