Laparoscopic paraesophageal hernia repair

Galen Perdifeis, Ronald A. Hinder, Charles Filipi, Tammara Walenz, Pamela J. McBride, Stephen L. Smith, Natsuya Katada, Paul J. Klingler

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)586-591
Number of pages6
JournalArchives of Surgery
Volume132
Issue number6
StatePublished - 1997

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Hiatal Hernia
Herniorrhaphy
Hernia
Stomach
Manometry
Barium
Length of Stay
Stomach Volvulus
Fundoplication
Lower Esophageal Sphincter
Reoperation
Surgical Instruments
Endoscopy
Dissection
Dilatation

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Perdifeis, G., Hinder, R. A., Filipi, C., Walenz, T., McBride, P. J., Smith, S. L., ... Klingler, P. J. (1997). Laparoscopic paraesophageal hernia repair. Archives of Surgery, 132(6), 586-591.

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 journalArticle

Perdifeis, G, Hinder, RA, Filipi, C, Walenz, T, McBride, PJ, Smith, SL, Katada, N & Klingler, PJ 1997, 'Laparoscopic paraesophageal hernia repair', Archives of Surgery, vol. 132, no. 6, pp. 586-591.
Perdifeis G, Hinder RA, Filipi C, Walenz T, McBride PJ, Smith SL et al. Laparoscopic paraesophageal hernia repair. Archives of Surgery. 1997;132(6):586-591.
Perdifeis, Galen ; Hinder, Ronald A. ; Filipi, Charles ; Walenz, Tammara ; McBride, Pamela J. ; Smith, Stephen L. ; Katada, Natsuya ; Klingler, Paul J. / Laparoscopic paraesophageal hernia repair. In: Archives of Surgery. 1997 ; Vol. 132, No. 6. pp. 586-591.
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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.",
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AU - Hinder, Ronald A.

AU - Filipi, Charles

AU - Walenz, Tammara

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AU - Smith, Stephen L.

AU - Katada, Natsuya

AU - Klingler, Paul J.

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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.

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