Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation

Surg Endosc. 2004 Mar;18(3):444-7. doi: 10.1007/s00464-003-8823-4. Epub 2004 Feb 2.


Background: Laparoscopic repair of paraesophageal hernia (LRPEH) is a feasible and effective technique. There have been some recent concerns regarding possible high recurrence rates following laparoscopic repair.

Methods: We reviewed our experience with LRPEH from 5/1996 to 8/2002. Large paraesophageal hernia (PEH) was defined by the presence of more than one-third of the stomach in the thoracic cavity. Principles of repair included reduction of the hernia, excision of the sac, approximation of the crura, and fundoplication. Pre- and postoperative symptoms were evaluated utilizing visual analogue scores (VAS) on a scale ranging from 0 to 10. Patients were followed with VAS and barium esophagram studies. Statistical analysis was performed using two-tailed Student's t-test.

Results: A total of 166 patients with a mean age of 68 years underwent LRPEH. PEH were type II ( n = 43), type III ( n = 104), and type IV ( n = 19). Mean operative time was 160 min. Fundoplications were Nissen (127), Toupet (23), Dor (1), and Nissen-Collis (1). Fourteen patients underwent a gastropexy. One patient required early reoperation to repair an esophageal leak. Mean hospital stay was 3.9 days. At 24 months postoperatively there was statistically significant improvement in the mean symptom scores: heartburn from 6.8 to 0.5, regurgitation from 5.9 to 0.3, dysphagia from 4.0 to 0.5, chest pain from 3.7 to 0.3. Radiographic surveillance was obtained in 120 patients (72%) at a mean of 15 months postoperatively. Six patients (5%) had radiographic evidence of a recurrent paraesophageal hernia (two required surgery), 24 patients (20%) had a sliding hernia (two required surgery), and four patients (3.3%) had wrap failure (all four required surgery). Reoperation was required in 10 patients (6%); two for symptomatic recurrent PEH (1.2%), four for recurrent reflux symptoms (2.4%), and four for dysphagia (2.4%). Patients with abnormal postoperative barium esophagram studies who did not require reoperation have remained asymptomatic at a mean follow up of 14 months.

Conclusion: LPEHR is a safe and effective treatment for PEH. Postoperative radiographic abnormalities, such as a small sliding hernia, are often seen. The clinical importance of these findings is questionable, since only a small percentage of patients require reoperation. True PEH recurrences are uncommon and frequently asymptomatic.

Publication types

  • Multicenter Study
  • Review

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Barium
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Contrast Media
  • Databases, Factual
  • Female
  • Follow-Up Studies
  • Fundoplication / methods*
  • Fundoplication / statistics & numerical data
  • Gastroesophageal Reflux / epidemiology
  • Gastroesophageal Reflux / etiology
  • Hernia, Hiatal / complications
  • Hernia, Hiatal / diagnostic imaging
  • Hernia, Hiatal / epidemiology
  • Hernia, Hiatal / surgery*
  • Humans
  • Incidence
  • Laparoscopy / statistics & numerical data*
  • Male
  • Middle Aged
  • Pennsylvania
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Radiography
  • Recurrence
  • Reoperation / statistics & numerical data
  • Retrospective Studies


  • Contrast Media
  • Barium