Journal article
Laparoscopic versus Open Repair of Paraesophageal Hernia: The Second Decade
Journal of the American College of Surgeons, v 212(5), pp 813-820
01 May 2011
PMID: 21435915
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Abstract
BACKGROUND: A decade ago we reported that laparoscopic repair of paraesophageal hernia (PEH) had an objective recurrence rate of 42% compared with 15% after open repair. Since that report we have modified our laparoscopic technique. The aim of this study was to determine if these modifications have reduced the rate of objective hernia recurrence.
STUDY DESIGN: We retrospectively identified all patients that had primary repair of a PEH with >= 50% of the stomach in the chest from May 1998 to January 2010 with objective follow-up by videoesophagram. The finding of any size of hernia was considered to be recurrence.
RESULTS: There were 73 laparoscopic and 73 open PEH repairs that met the study criteria. There were no significant differences in gender, body mass index, or prevalence of a comorbid condition between groups. The median follow-up was similar (12 months laparoscopic versus 16 months open; p = 0.11). In the laparoscopic group, 84% of patients had absorbable mesh reinforcement of the crural closure and 40% had a Collis gastroplasty, compared with 32% and 26%, respectively, in the open group. A recurrent hernia was identified in 27 patients (18%), 9 after laparoscopic repair and 18 after open repair (p = 0.09). The median size of a recurrent hernia was 3 cm, and the incidence of recurrence increased yearly in those with serial follow-up with no early peak or late plateau.
CONCLUSIONS: In our first decade of laparoscopic PEH repair, no mesh crural reinforcement was used, and no patient had a Collis gastroplasty. Evolution in the technique of laparoscopic PEH repair during the subsequent decade has reduced the hernia recurrence rate to that seen with an open approach. Reduced morbidity and shorter hospital stay make laparoscopy the preferred approach, but continued efforts to reduce hernia recurrence are warranted. (J Am Coll Surg 2011;212:813-820. (C) 2011 by the American College of Surgeons)
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Details
- Title
- Laparoscopic versus Open Repair of Paraesophageal Hernia: The Second Decade
- Creators
- Joerg Zehetner - College Station Medical CenterSteven R. DeMeester - American College of SurgeonsShahin Ayazi - University of Southern CaliforniaPatrick Kilday - University of Southern CaliforniaFlorian Augustin - University of Southern CaliforniaJeffrey A. Hagen - University of Southern CaliforniaJohn C. Lipham - University of Southern CaliforniaHelen J. Sohn - University of Southern CaliforniaTom R. DeMeester - University of Southern California
- Publication Details
- Journal of the American College of Surgeons, v 212(5), pp 813-820
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:000290956000009
- Scopus ID
- 2-s2.0-79955603061
- Other Identifier
- 991022048292004721
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- Surgery