title: Laparoscopic repair of giant hiatal hernia. A single center experience.
abstract: BACKGROUND
  Giant hiatal hernia is a rare clinical entity with possibly serious complications, diagnosed mostly among older patients. The laparoscopic repair of such hernias is a therapeutic option, performed mostly in specialized centers by experienced surgeons.
  
  
  METHODS
  From 1997 to 2012 fifty-five patients with giant hiatal hernia (median age of 72) were primarily treated by laparoscopic surgery at the surgical department of the Catholic Clinic Oberhausen. Demographic data, operating times, conversion rate, morbidity and mortality were recorded prospectively. Follow-up was conducted by means of a mailed questionnaire.
  
  
  RESULTS
  Intraoperative complications occurred in 1,8% of the cases (n = 1). In this single case the procedure was converted to an open procedure due to technical difficulties imposed by hepatomegaly. The median operating time was 96 min (range, 30 to 350). Our rate of postoperative complications was 14,5% (n = 8). The median postoperative hospital stay was nine days. 14,5% (n = 8) of our patients underwent a redo-surgery for symptomatic recurrence. The median follow-up was 64 months by means of a self-designed questionnaire. 34,5% (19/55) of the questioned patients responded to our survey. The difference between pre- and postoperative symptom intensity was found to be significant for heartburn (p < 0,001) and retrosternal/epigastric pain (p = 0,028). The difference was not found to be statistically significant for dysphagia (p = 0,8) and bloating (p = 0,3). 85% of the questioned patients stated they would have the operation again, if necessary. 80% reported an improvement of their overall quality of life.
  
  
  CONCLUSIONS
  The laparoscopic repair of large hiatal hernias is a safe approach with an intraoperative complication rate of 1,8%, low post-operative morbidity (14,5%) and very low mortality (1,8%). There is a high patient satisfaction (85%) and a good postoperative quality of life (80%).
  
  
  CONCLUSIONS
  The laparoscopic approach for repair of large hiatal hernias is a relatively safe method with significant long-term efficacy in terms of symptom control and quality of life.
authors.affiliation: Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany. Electronic address: dimitrisprassas@yahoo.gr.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Prassas
authors.affiliation: Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany.
authors.forename: Thomas-Marten
authors.initials: TM
authors.lastname: Rolfs
authors.affiliation: Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany.
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Schumacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome
keywords: Giant hiatal hernia; Laparoscopic hiatal hernia repair; Large hiatal hernia; Upside-down stomach