title: Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment.
abstract: BACKGROUND
  We set out to evaluate the results of the laparoscopic treatment of large paraesophageal hernias in 22 patients.
  
  
  METHODS
  Between 1993 and 1998, we operated on 22 consecutive patients. Preoperative assessment consisted of endoscopy, barium esophagogram, 24-h pH testing, manometry, and gastric emptying times.
  
  
  RESULTS
  In the first three patients, the sac was not excised and gastropexy was not performed. Because of recurrences, we decided to change the technique in an attempt to avoid further complications. During middle- to long-term follow-up, only three recurrences were seen in the subsequent 19 patients. There were no deaths in this series.
  
  
  CONCLUSIONS
  Laparoscopic treatment of large paraesophageal hernias is feasible. Because recurrences may occur after successful laparoscopic treatment, both resection of the sac and some form of gastropexy are imperative.
authors: Department of Surgery, Vrije Universiteit Hospital, De Boelelaan 1117, Amsterdam, The Netherlands.
authors: D L
authors: DL
authors: van der Peet
authors: E C
authors: EC
authors: Klinkenberg-Knol
authors: A
authors: A
authors: Alonso Poza
authors: C
authors: C
authors: Sietses
authors: Q A
authors: QA
authors: Eijsbouts
authors: M A
authors: MA
authors: Cuesta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation