Management of giant paraesophageal hernia

A retrospective review was performed of 51 patients operated on for giant paraesophageal hiatal hernia to compare the transthoracic and transabdominal approaches and to assess the value of a concomitant fundoplication. Operative repair was performed using open transthoracic, transabdominal, and thoracoabdominal approaches. Laparoscopic techniques were used in one patient. Fundoplication was performed in 45 patients. There was no operative mortality, but early postoperative complications occurred in 29% of patients. The presence of commonly associated symptoms was used to derive preoperative and postoperative symptom scores. Follow-up was available in 48 patients. Excellent results were reported in 69% of patients and 17% had good results. The symptom score improved significantly regardless of the operative approach selected or whether a fundoplication was performed. We conclude that outcome after open paraesophageal hiatal hernia repair is satisfactory in most patients, irrespective of the route chosen or techniques used for repair.