title: Laparoscopic management of large paraesophageal hiatal hernia.
abstract: BACKGROUND
  Large paraesophageal hernias (POHs) predominantly occur in the elderly population. Early repair is recommended to avoid the risks associated with gastric volvulus.
  
  
  METHODS
  Data were collected prospectively during an 8-year period. Laparoscopic repair of POHs initially included circumcision of the sac and mesh hiatal repair. Sac excision and suture hiatal repair were later adopted. A fundoplication was also included, initially as a selective procedure.
  
  
  RESULTS
  Fifty-three patients with large POHs were treated by one surgeon. All had attempted laparoscopic repair, with four conversions to an open procedure. Symptomatic hernia recurrence occurred in five patients (9%). The 21 patients who had sac excision, hiatal repair, and fundoplication have remained free of symptomatic recurrence. The postoperative morbidity rate was 13%, with one death.
  
  
  CONCLUSIONS
  Laparoscopic repair of large POHs remains feasible. We advocate complete sac excision, hiatal repair, fundoplication, and gastropexy to prevent early recurrence.
authors.affiliation: Royal Berkshire Hospital, London Road, Reading, RG1 5AN, United Kingdom.
authors.forename: P C
authors.initials: PC
authors.lastname: Leeder
authors.forename: G
authors.initials: G
authors.lastname: Smith
authors.forename: T C B
authors.initials: TC
authors.lastname: Dehn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006551:Hernia, Hiatal / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D012008:Recurrence; D013526:Surgical Mesh; D017792:Surgical Stapling
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors