Laparoscopic Repair of Paraesophageal Hernias: the Last Ten Years

Michael Latzko, MD, Frank Borao, MD FACS, Anthony Squillaro, MD FACS, Jonas Mansson, MD, William Barker, MD, Thomas Baker. Monmouth Medical Center

Background: Laparoscopy has quickly become the standard surgical approach to repair paraesophageal hernias (PEH). Although many centers routinely perform this procedure, relatively high recurrence rates have led many to question this approach. We sought to evaluate outcomes in our cohort of patients with emphasis on recurrence rates, symptom improvement and its correlation with true radiologic recurrence seen on contrast imaging.
Methods: We retrospectively identified 126 consecutive patients who underwent laparoscopic repair of a large PEH between 2000 and 2010. Clinical outcomes were reviewed, and data was collected regarding operative details, peri-operative and post-operative complications, symptoms, and follow-up imaging. Radiologic evidence of any size hiatal hernia of was considered to be a recurrence.
Results: There were 95 female and 31 male patients with a mean (± SD) age of 71 ± 14 years. Laparoscopic repair was completed successfully in 120/126 patients with 6 operations converted to open procedures. 126  patients (79%) received crural re-inforcement with mesh, and 13 patients (11%) had a Collis gastroplasty performed. Fundoplications were performed in 113 patients (89%); Nissen (111), Dor (1), and Toupet (1). Radiographic surveillance was available for 89 patients (71%), obtained at mean time interval of 23 months post-operatively. Radiographic evidence of a recurrence was present in 19/81 patients (21%) with available imaging. Re-operation was necessary in six patients (5%); five for symptomatic recurrence (4%), and one for dysphagia (1%). Median length of stay was 4 days.
Conclusion: Laparoscopic PEH repair results in excellent outcome with short length of stay when performed at an experienced center. Radiologic recurrence is observed relatively frequently with routine surveillance, however many of these recurrences are small and few patients require correction of the recurrence. Furthermore, these small recurrent hernias are often asymptomatic and do not seem to be associated with the same risk for developing severe complications as the initial PEH.
 

View Poster