Management of patients with giant paraesophageal hernia

Paraesophageal herniation can cause massive bleeding, strangulation or perforation. This study reviews the experience with 24 patients (74.6 years, range 63-89 years, 20 males, 4 females) with a total or near-total intrathoracic stomach, managed at the Royal Lancaster Infirmary. All patients were symptomatic with 3/24 patients presenting as emergencies. Twenty-three of 24 patients underwent surgery: gastropexy alone-5, gastropexy and hiatal repair-17, gastropexy, hiatal repair and fundoplication 1. One of the emergency patients died prior to surgery. Median operative time was 50 min (range 35-65 min) and median hospital stay was 7 days (range 5 days-3 weeks). A splenectomy was necessary in 1/23 (4.4%) patients. Postoperative morbidity included: recurrent hernia requiring surgery-1, pleural effusion requiring chest tube-1, empyema-1, dysphagia requiring dilatation-1, reflux with stricturing-1. Elderly patients with a total or a near-total intrathoracic stomach can be managed by gastropexy and hiatal repair, with acceptable morbidity.