Authors: M G Paul R P DeRosa P E Petrucci M L Palmer S H Danovitch
Publish Date: 2014/03/19
Volume: 11, Issue: 3, Pages: 303-307
Abstract
The paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with lifethreatening 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 tensionfree 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 longterm results Laparoscopic repair of paraesophageal hernias can be accomplished by a number of different reported techniques The use of a tensionfree repair with PTFE may be particularly suitable for large diaphragmatic defects An antireflux operation may be added selectively depending on clinical circumstances
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