Laparoscopic repair of paraesophageal hernia

After developing experience performing laparoscopic foregut surgery we combined laparoscopic access with traditional surgical techniques to treat patients with paraesophageal hernia. Five adults, four males and one female, with type II or III paraesophageal hernias underwent laparoscopic repair between October 1997 and April 1998 at our hospital. The average age of the patients was 60.4 years (range 41-71). Using five ports (two 10-mm and three 5-mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with interrupted sutures. In addition, all patients had a Nissen fundoplication performed and one patient had cholecystectomy for gall stone. The procedure was completed laparoscopically in all five cases and the median operating time was 270 min (range 160-310). Two minor complications occurred, subcutaneous emphysema in one patient, and an acute gouty arthritis attack in another. All patients were discharged on the 3rd or 4th postoperative day. No patients had longterm dysphagia worse than their preoperative condition. Preoperative symptoms of chest pain, esophageal obstruction and reflux were resolved in all patients. This study indicated that paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard techniques.