title: Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes.
abstract: The choice of the optimal surgical approach for repairing paraesophaeal hernias (PEH) is debated. Our objective is to evaluate the short-term outcomes of primary laparoscopic and open repairs of PEH performed in the Calgary Health Region. A retrospective review of all patients undergoing repair of PEH between October 1999 and February 2005 was performed. The outcome measures evaluated included intra-operative parameters and post-operative variables, mortality rates, recurrence rates and patient satisfaction. A total of 93 patients underwent either a laparoscopic (n = 46) or open (n = 47) primary PEH repair. The laparoscopic approach was associated with a longer mean operative time (3.1 +/- 1.2 hours vs. 2.5 +/- 0.7 hours, P = 0.005) but resulted in a shorter overall hospital stay (5 days [2-16 days]vs. 10 days [5-24 days]; P < 0.001), and fewer post-operative complications (10/46 [22%]vs. 25/47 [53%]P = 0.002). Although the follow-up was short (laparoscopic 16 months; open 18 months), a 9% recurrence rate was reported with both approaches. Patient satisfaction using the Gastroesophageal Disease Health-Related Quality Of Life questionnaire was similar in both groups (P = 0.861) with most patients reporting excellent outcomes (laparoscopic: 32/36 [89%]; open 27/35 [77%]). Our review suggests that the laparoscopic approach is safe with shorter hospital stay and recovery. Although early follow-up suggests that recurrence rates and patient satisfaction are similar, long-term follow-up is required to determine whether the laparoscopic approach will become the procedure of choice.
authors.affiliation: Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Karmali
authors.forename: S
authors.initials: S
authors.lastname: McFadden
authors.forename: P
authors.initials: P
authors.lastname: Mitchell
authors.forename: A
authors.initials: A
authors.lastname: Graham
authors.forename: E
authors.initials: E
authors.lastname: Debru
authors.forename: G
authors.initials: G
authors.lastname: Gelfand
authors.forename: J
authors.initials: J
authors.lastname: Graham
authors.forename: S
authors.initials: S
authors.lastname: Martin
authors.forename: C
authors.initials: C
authors.lastname: Tiruta
authors.forename: S
authors.initials: S
authors.lastname: Grondin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011788:Quality of Life; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors