Many studies have confirmed the effectiveness of laparoscopic paraesophageal hernia repair, but there are reports of high recurrence rates after surgery. We have conducted a review of the literature to determine whether it is a safe and durable procedure. A literature search was performed to identify all papers relevant to laparoscopic paraesophageal hernia repair. Twenty studies met the inclusion criteria for this review. In total, 1415 patients underwent attempted repair (mean age 65.7 y) of which 94% underwent an antireflux procedure. There were 70 (5.3%) episodes of operative morbidity and 173 (12.7%) patients experienced postoperative complications. In 10 studies, radiologic follow-up was offered after a mean of 16.5 months. Of those undergoing contrast swallow 26.9% had evidence of anatomic recurrence. In conclusion, recurrence rates after laparoscopic repair seem to be high compared with earlier studies of open repair. The long-term consequences of anatomic recurrence are currently uncertain.

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Adhesion formation is a long-term complication of laparoscopic inguinal hernia surgery-particularly by the transabdominal preperitoneal technique; but it is not thought to occur after open repair. We describe a gentleman presenting with a recurrent hernia who had previously undergone an open mesh plug repair 4 years earlier. At laparoscopy he was found to have considerable adhesions associated with the plug. These were successfully divided before repair. This case illustrates the possibility of intra-abdominal adhesions developing even after open hernia surgery.