Videolaparoscopic treatment of paraesophageal hernia

6143 General Surgery
Videolaparoscopic Treatment of Paraesophageal Hernia
Roberta Gelmini, MD, Massimo Saviano, MD
Hiatal hernias are classified into 3 types: sliding hernia (type
I), paraesophageal hernia (type II), and mixed hernia (type
III), which is a combination of type I and II. The
paraesophageal and mixed hernias represent about 5% to 10% of surgically treated hiatal hernias. The surgical treat-
ment of the paraesophageal and mixed hernias is unavoid-
able because of the high risk of severe complications, and it
has to be considered in a high percentage of cases. The
most important technical difficulty in the videolaparoscopic
treatment is represented by the hugeness of the hernial defect
and by the challenging reduction of the stomach into the ab-
domen. A cautious dissection of the hernial sac and dia-
phragmatic cruses and a careful crural repair make the
videolaparoscopic procedure feasible. The operative times
are not prolonged, and the results are similar to those of the
open technique. In the literature, the incidence of complica-
tions, both intra- and postoperative, are not statistically sig-
nificantly different between the laparoscopic and open
technique. Because of the complexity of the laparoscopic
procedure, the minimally invasive access has to be reserved
for surgeons well trained in these techniques. We describe 2
cases: one paraesophageal and one mixed hernia video-
laparoscopically treated with the help, in the second case, of
a Gore-Tex mesh. In both cases, the technical results were
positive. Intra- and postoperative complications did not occur
and, one year after the surgical procedure, both patients
were in good health and recurrence free.