title: Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia.
abstract: BACKGROUND
  We compared the incidence of early hernia recurrence in nonrandomized but consecutive patients undergoing laparoscopic repair of paraesophageal hernia (LRPH) without and with excision of the hernia sac.
  
  
  METHODS
  LRPH was completed in 55 of 58 patients. In the first 25 patients, the sac was not excised. Total sac excision was performed in the subsequent 30 patients. All patients had crural repair with or without fundoplication, or gastropexy.
  
  
  RESULTS
  Mean age of patients was 68 years (range, 34-95). There were three conversions; one patient died postoperatively. Mean operative time was 225 min in the first group and 190 min in the sac excision group. Median length of stay was 2 days (range, 1-15) for both groups.
  
  
  CONCLUSIONS
  A precise method of total sac excision simplified dissection. It also ensured complete reduction of the hernia and availability of adequate esophageal length. Operative time was not increased, and no subsequent early recurrences were observed (p < 0.05).
authors.affiliation: Division of Laparoscopic Surgery, The Mount Sinai Medical Center, 1 Gustave L. Levy Place, New York, NY 10029-6574, USA.
authors.forename: M
authors.initials: M
authors.lastname: Edye
authors.forename: B
authors.initials: B
authors.lastname: Salky
authors.forename: A
authors.initials: A
authors.lastname: Posner
authors.forename: A
authors.initials: A
authors.lastname: Fierer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003964:Diaphragm / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome