Laparoscopic management of acute paraesophageal hernia

Objective: Acute paraesophageal hernia is a surgical emergency presenting with chest pain, abdominal pain, dysphagia, nausea and vomiting, retching or significant anemia. This can be due to gastric volvulus, incarceration, strangulation, severe bleeding or perforation. Traditionally this is treated with an open surgery. The purpose of this study is to evaluate the outcome of laparoscopic approach for these cases.
Methods: A retrospective chart review was performed for patients operated on for paraesophageal hernia at the Peter Lougheed Centre for 2004-2007. Patients admitted with acute symptoms requiring emergency surgery were selected for the study.
Results: Thirteen patients (11 women and 2 men) with a mean age of 71.5 years (50-91 years) were identified. Twelve patients underwent successful laparoscopic repair including reduction of the hernia content, excision of the sac, crural closure and fundoplication (anterior or Nissen). One patient was converted to open repair due to ischemic gastric perforation and peritoneal contamination. The mean operating time was 208 minutes (132-305 minutes), blood loss was minimal, and the mean postoperative hospital stay was 5.4 days (1-14 days). There were no significant perioperative complications. All patients were tolerating regular diet on short-term follow up.
Conclusions: Laparoscopic repair of acute paraesophageal hernia is safe and feasible with low morbidity and mortality. It affords all the benefits of minimally invasive surgery in a group of patients that are often elderly and suffer from multiple medical problems. Based on our experience we advocate the laparoscopic technique to repair acute paraesophageal hernias in patients with no obvious perforation.

Session: Podium Presentation

Program Number: S090

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