Paraesophageal hiatal hernia. Open vs. laparoscopic surgery.
BACKGROUND
paraesophageal hiatal hernia represents 5-10% of hiatal hernias. Its importance is based on the severe complications it may have, including gastric volvulus, and surgical treatment is recommended when a diagnosis is established.


METHODS
a retrospective study of all patients who underwent surgery for paresophageal hernia between 1985 and 2007.


RESULTS
we studied 90 cases, 68 females and 22 males with a median age of 67.6 years (37-96). Forty-five patients reported pyrosis, 34 epigastric postprandial pain, and 15 dysphagia; eight patients were diagnosed with gastric volvulus. Eighty-one patients underwent elective surgery and 9 emergency surgery. Forty-seven cases underwent an open procedure and 43 a laparoscopic one; 5 (11.6%) of them required conversion. The techniques performed were D Or fundoplication in 35 cases, Nissen in 35, Toupet in 14, simple hiatal closure in 2, Narbona in 1, and Lortat-Jakob in 1; in 10 patients a mesh was placed. The complication rate for open procedure was 10.6 and 9.5% for the laparoscopic one (p > 0.05). Median hospital stay was 9.1 days for the open procedure and 3.4 for the laparoscopic one (p < 0.05). As follow-up, we analyzed 84 patients. After a median follow-up of 12 years (1-19), 15 patients were still symptomatic (17.8%), with recurrence in 8 cases (5 required reoperation). The satisfaction rate was 95.5%.


CONCLUSIONS
equivalent results were observed after laparoscopic and open surgery and a significant shorter hospital stay in the laparoscopic one. Therefore, we think that laparoscopic surgery should be considered as the election procedure for paraesophageal hiatal hernia.
Díez Tabernilla
M
M
Service of General Surgery and Digestive Diseases, University Hospital Ramón y Cajal, C/Padre Francisco Palau y Quer 7, Madrid, Spain. mariadieztabernilla@gmail.com
Ruiz-Tovar
J
J
Grajal Marino
R
R
Calero García
P
P
Pina Hernández
J D
JD
Chames Vaisman
A
A
Morales Castiñeiras
V
V
Sanjuanbenito Dehesa
A
A
Martínez Molina
E
E
Fresneda Moreno
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies