[Our experiences during laparoscopic giant paraesophageal hernia repair (1993-2004)].
BACKGROUND
Following both open and laparoscopic surgery for large hiatus hernias the recurrence rate is high. During the last decade we found that the correct indication and operation technique at primary operation should be prophylactic against recurrent hiatus hernia and postoperative dysphagia.


METHODS
Between 1993 and 2004 more than 350 antireflux procedures were performed in our department. In 35 patients direct crural reconstructions and onlay-mesh implantation was necessary because of extremely large hiatus hernias. The onlay-mesh implantation and tension-free hiatus reconstruction beside correct calibration of the lower esophageal sphincter (LES) decreases the chance of recurrence and postoperative dysphagia.


RESULTS
In the early period there were five recurrent hernias due to crural reconstruction with absorbable sutures, weak intracorporally knotted crural sutures and extremely large hiatus hernia. During laparoscopic reoperations reconstructions with onlay mesh implantation were performed successfully.


CONCLUSIONS
The mesh implantation with correct indication and intraoperatively calibrated wrap decrease recurrence and postoperative dysphagia. Laparoscopic reoperation is a safe procedure with good results in trained hands.
Hajdu
Zoltán
Z
Hajdú-Bihar Megyei Onkormányzat Kenézy Gyula Kórház-Rendelointézet, a Debreceni Egyetem Orvos- és Egészségtudományi Centrum Oktató Kórhaza, Altalános Sebészeti Osztály, Debrecen.
Bodnár
Zsolt
Z
Tóth
Dezso
D
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome