Laparoscopic tension-free repair of large paraesophageal hernias

Abstract

The paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with life-threatening mechanical problems. Elective repair is recommended at the time the condition is diagnosed, and open surgery can be accomplished with a low incidence of complications. The option of performing these repairs through a laparoscopic approach may further reduce morbidity and recovery time associated with surgical intervention. The purpose of this report was to review available options for laparoscopic repair and to present our experience with a tension-free technique for large paraesophageal hernias. Three patients with large diaphragmatic defects had laparoscopic repairs using an expanded polytetrafluorethylene (PTFE) patch secured with intracorporeal suturing techniques. One of these patients also underwent laparoscopic Toupet fundoplication in conjunction with repair of the hernia. In the other two patients, the fundus was secured to the right diaphragmatic crus to reduce the potential for recurrence and minimize postoperative reflux symptoms. All patients underwent successful repair without perioperative complications and had excellent long-term results. Laparoscopic repair of paraesophageal hernias can be accomplished by a number of different reported techniques. The use of a tension-free repair with PTFE may be particularly suitable for large diaphragmatic defects. An antireflux operation may be added selectively depending on clinical circumstances.

Surgical Management of Paraesophageal Hernias: Outcome and Quality of Life Analysis / with Invited Commentary

“…These include mandatory versus selective use of fundoplications [28, 29, 30, 31], the use of prosthetic mesh in crural repair [3, 32], and when and if Collis gastroplasty should be used for esophageal lengthening [11, 17]. Our experience supports that of others who suggest that patients with PEH are at increased risk of postoperative GERD without fundoplication.…”

Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair

“…Several authors have advocated the use of mesh to close the crural defects in a paraesophageal hernia [3,22,31]. In contrast to inguinal or ventral hernias, the diaphragmatic hiatus contains a nonserosalized hollow viscous that risks erosions or stricturing as a results of the fibrotic response to mesh.…”

Laparoscopic mesh cruroplasty for large paraesophageal hernias

“…A number of authors have advocated the use of prosthetic material for crural reinforcement [2,7,8,11,13,14]. However, the choice of prosthetic material and the shape, location, and placement of the material vary widely.…”