Abstract
Background: Paraesophageal hernias require surgery to avoid potentially serious complications. Objectives: To evaluate paraesophageal hernia repair using the laparoscopic approach. Designs: Case series. Setting: University hospital and foregut testing laboratory. Subjects: Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram, endoscopy, esophageal manometry, and 24-hour pH monitoring. Outcome Measures: Operative complications, post-operative morbidity, follow-up symptoms (53 patients; mean, 18 months; range, 2-54 months) and barium esophagogram (46 patients). Results: Fifty-six patients (86%) had a type III hernia and 9 (14%) had a type II hernia. Twenty (65%) of 31 patients who underwent pH monitoring had a positive 24-hour pH score, and 24 (56%) of 43 patients who underwent manometry had an incompetent lower esophageal sphincter. Four patients had a gastric volvulus and 21 patients had more than 50% of their stomach in the chest. All patients underwent hernia reduction, crural repair, and fundoplication (64 Nissen procedures and 1 Toupet procedure). The average duration of surgery was 2 hours. There were 2 conversions: gastric perforation and a difficult dissection because of a large fibrotic sac. Other complications, all managed intraoperatively, were 2 gastric perforations anti bleeding in 6 patients. Average length of hospital stay was 2 days (range, 1-23 days). Early reoperation was required in 3 patients: slipped Nissen; small-bowel obstruction due to trocar-site hernia; and organoaxial rotation with gastroduodenal obstruction. Four patients required esophageal dilatation after surgery Forty-nine of 53 patients available tot long-term follow-up were satisfied with the results of surgery. Time to full recovery was 3 weeks (range, 1 week to 2 months). Seven of 46 patients experienced small type I hernias observed on routine follow-up esophagograms. Conclusions: Most paraesophageal hernias are type III. A concomitant antireflux procedure is recommended. Paraesophageal hernias can he managed successfully by the laparoscopic route with good outcome.
| Original language | English |
|---|---|
| Pages (from-to) | 586-591 |
| Number of pages | 6 |
| Journal | Archives of Surgery |
| Volume | 132 |
| Issue number | 6 |
| State | Published - 1997 |
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All Science Journal Classification (ASJC) codes
- Surgery
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Laparoscopic paraesophageal hernia repair. / Perdifeis, Galen; Hinder, Ronald A.; Filipi, Charles; Walenz, Tammara; McBride, Pamela J.; Smith, Stephen L.; Katada, Natsuya; Klingler, Paul J.
In: Archives of Surgery, Vol. 132, No. 6, 1997, p. 586-591.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Laparoscopic paraesophageal hernia repair
AU - Perdifeis, Galen
AU - Hinder, Ronald A.
AU - Filipi, Charles
AU - Walenz, Tammara
AU - McBride, Pamela J.
AU - Smith, Stephen L.
AU - Katada, Natsuya
AU - Klingler, Paul J.
PY - 1997
Y1 - 1997
N2 - Background: Paraesophageal hernias require surgery to avoid potentially serious complications. Objectives: To evaluate paraesophageal hernia repair using the laparoscopic approach. Designs: Case series. Setting: University hospital and foregut testing laboratory. Subjects: Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram, endoscopy, esophageal manometry, and 24-hour pH monitoring. Outcome Measures: Operative complications, post-operative morbidity, follow-up symptoms (53 patients; mean, 18 months; range, 2-54 months) and barium esophagogram (46 patients). Results: Fifty-six patients (86%) had a type III hernia and 9 (14%) had a type II hernia. Twenty (65%) of 31 patients who underwent pH monitoring had a positive 24-hour pH score, and 24 (56%) of 43 patients who underwent manometry had an incompetent lower esophageal sphincter. Four patients had a gastric volvulus and 21 patients had more than 50% of their stomach in the chest. All patients underwent hernia reduction, crural repair, and fundoplication (64 Nissen procedures and 1 Toupet procedure). The average duration of surgery was 2 hours. There were 2 conversions: gastric perforation and a difficult dissection because of a large fibrotic sac. Other complications, all managed intraoperatively, were 2 gastric perforations anti bleeding in 6 patients. Average length of hospital stay was 2 days (range, 1-23 days). Early reoperation was required in 3 patients: slipped Nissen; small-bowel obstruction due to trocar-site hernia; and organoaxial rotation with gastroduodenal obstruction. Four patients required esophageal dilatation after surgery Forty-nine of 53 patients available tot long-term follow-up were satisfied with the results of surgery. Time to full recovery was 3 weeks (range, 1 week to 2 months). Seven of 46 patients experienced small type I hernias observed on routine follow-up esophagograms. Conclusions: Most paraesophageal hernias are type III. A concomitant antireflux procedure is recommended. Paraesophageal hernias can he managed successfully by the laparoscopic route with good outcome.
AB - Background: Paraesophageal hernias require surgery to avoid potentially serious complications. Objectives: To evaluate paraesophageal hernia repair using the laparoscopic approach. Designs: Case series. Setting: University hospital and foregut testing laboratory. Subjects: Sixty-five consecutive patients (mean age, 63.6 years; range, 26-90 years). Preoperative evaluation included barium esophagogram, endoscopy, esophageal manometry, and 24-hour pH monitoring. Outcome Measures: Operative complications, post-operative morbidity, follow-up symptoms (53 patients; mean, 18 months; range, 2-54 months) and barium esophagogram (46 patients). Results: Fifty-six patients (86%) had a type III hernia and 9 (14%) had a type II hernia. Twenty (65%) of 31 patients who underwent pH monitoring had a positive 24-hour pH score, and 24 (56%) of 43 patients who underwent manometry had an incompetent lower esophageal sphincter. Four patients had a gastric volvulus and 21 patients had more than 50% of their stomach in the chest. All patients underwent hernia reduction, crural repair, and fundoplication (64 Nissen procedures and 1 Toupet procedure). The average duration of surgery was 2 hours. There were 2 conversions: gastric perforation and a difficult dissection because of a large fibrotic sac. Other complications, all managed intraoperatively, were 2 gastric perforations anti bleeding in 6 patients. Average length of hospital stay was 2 days (range, 1-23 days). Early reoperation was required in 3 patients: slipped Nissen; small-bowel obstruction due to trocar-site hernia; and organoaxial rotation with gastroduodenal obstruction. Four patients required esophageal dilatation after surgery Forty-nine of 53 patients available tot long-term follow-up were satisfied with the results of surgery. Time to full recovery was 3 weeks (range, 1 week to 2 months). Seven of 46 patients experienced small type I hernias observed on routine follow-up esophagograms. Conclusions: Most paraesophageal hernias are type III. A concomitant antireflux procedure is recommended. Paraesophageal hernias can he managed successfully by the laparoscopic route with good outcome.
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M3 - Article
VL - 132
SP - 586
EP - 591
JO - JAMA Surgery
JF - JAMA Surgery
SN - 2168-6254
IS - 6
ER -