Paraesophageal hiatal hernia. Open vs. laparoscopic surgery

• Published in: Revista española de enfermedades digestivas Vol. 101; no. 10; pp. 706 - 711
• Main Authors: Díez Tabernilla, M, Ruiz-Tovar, J, Grajal Marino, R, Calero García, P, Pina Hernández, J D, Chames Vaisman, A, Morales Castiñeiras, V, Sanjuanbenito Dehesa, A, Martínez Molina, E, Fresneda Moreno, V
• Format: Journal Article
• Language: English
• Published: Spain Sociedad Española de Patología Digestiva 01-10-2009
• Subjects: Adult; Aged; Aged, 80 and over; Digestive System Surgical Procedures - methods; Female; Gastroenterology & Hepatology; Geriatrics & Gerontology; Hernia, Hiatal - surgery; Humans; Infectious Diseases; Laparoscopy; Male; Middle Aged; Oncology; Pathology; Pharmacology & Pharmacy; Radiology, Nuclear Medicine & Medical Imaging; Retrospective Studies; Surgery; Hernia hiatal; Hernia repair; Paraesophageal hernia; Hiatal hernia; Hernia paraesofágica; Laparoscopy; Reparación herniaria; Laparoscopia
• ISSN: 1130-0108; 1130-0108
• DOI: 10.4321/S1130-01082009001000005

paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established.
a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007.
we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%.
equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.