The treatment of para-esophageal hernia by the laparoscopic approach has been described by a number of authors. The lower morbidity of the laparoscopic approach compared with the open approach holds some attraction, however, reservations regarding the durability of laparoscopic repair exist. There is a paucity of objective follow-up data in the literature with regard to repair durability and symptomatic outcome. A review was undertaken of 94 patients over a 7 year period undergoing attempted laparoscopic repairs of para-esophageal hernia. Preoperative and operative data was collected and patients underwent postoperative interview and barium meal. Laparoscopic repair was successfully completed in 86 patients. Symptomatic reherniation occurred in 12% (10/86) of patients undergoing laparoscopic repair. These patients underwent open reoperative surgery. There were no symptomatic recurrences in patients undergoing initial open repair. Symptomatic outcome was assessed by interview in 78% (73/94) of patients at a median of 27 months (3-93 months) postoperatively. Ninety-seven percent (71/73) of patients were satisfied with their ultimate symptomatic outcome however, this group included seven patients who had required reoperative surgery for symptomatic recurrence and were therefore laparoscopic failures. In order to determine the asymptomatic recurrence rate patients were requested to undergo a barium meal. A further nine small asymptomatic recurrences were diagnosed in 42 patients having had laparoscopic repair. This represents an asymptomatic radiographic recurrence rate of 21%. Laparoscopic repair in this series was associated with a 12% symptomatic recurrence rate. The majority of patients with symptomatic recurrence underwent open reoperation with good results. Strategies for reducing recurrences should be examined in prospective series.

Blood is nonhomogeneous; hence, the relationship between light transmission and increasing concentration of dye in whole blood is never the perfect exponential curve predicted by Beer's law. Instead, as the concentration of indocyanine green is increased to high levels (40 mg/liter) the light transmission decreases exponentially toward an asymptote at 6–8% transmission for nearly monochromatic densitometers (half-band width: 13–20 mμ), but at 30–40% for densitometers using light of wide-band width. Consequently, following recording of a dilution curve, circulating background dye reduces the change in transmission per unit increase in dye concentration in subsequent curves. This decrease in sensitivity cannot be compensated for by a simple increase in the sensitivity of the densitometer or in the intensity of its light source. Compensation can be attained, however, if increasing densitometer sensitivity is associated with the automatic scale expansion provided when a suppressed zero point is used. At correct zero suppression, the deflection for zero output of the densitometer coincides with the asymptotic transmission value mentioned above. indicator-dilution in circulation; blood flow measurement; blood optical density; dye dilution technic; cardiac output measurement Submitted on April 15, 1963

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Esophageal leiomyoma are usually intramural and the most common minimally invasive approach is thoracoscopic excision leaving the mucosa intact. We report the case of a 58-year-old woman who underwent laparoscopic excision of a pedunculated esophageal leiomyoma.

In this animal model of large hiatus hernia repair, DualMesh showed optimal characteristics in terms of host tissue incorporation on the porous side and absence of adhesions on the visceral side of the prosthesis. The absence of adhesions and intraluminal erosion in this study may provide reassurance to surgeons using mesh at the hiatus.