title: [Report of 12 years experience in the surgical treatment of 286 paraesophageal hernias].
abstract: BACKGROUND
  In contrast to axial hiatus hernias, paraesophageal hernias are rare but can lead to chronic iron deficiency anemia and severe acute complications. Treatment is manifold and consistent standards are lacking.
  
  
  OBJECTIVE
  The aim of this study was to describe our experiences of 286 patients with paraesophageal hernias, who underwent surgery from 2003 to 2014 at a tertiary referral center. The study was particularly concerned with morbidity, mortality, quality of life and recurrence rates.
  
  
  METHODS
  In 12 years a total of 286 paraesophageal hernias were surgically treated, 255 with a minimally invasive procedure and 31 with an open approach. In 138 patients (48 %) the suture-based hiatoplasty was reinforced by means of a lightweight mesh, which was fixed with fibrin glue in 90 cases. Abdominal fixation of the stomach consisted of a gastropexy and anterior (n = 244) or posterior (n = 42) fundoplication.
  
  
  RESULTS
  Complications arose in 8.4 % of the patients. The mean hospital stay was 5.3 (± 2.8) days for elective surgery and 24.7 (± 17.8) days for emergency operations. The gastrointestinal quality of life index according to Eypasch significantly increased from mean preoperative values of 92.8 (± 22.5) to 109.6 (± 20.2) in the postoperative course (p < 0.001). Of the patients 20 (7 %) suffered a recurrence requiring surgery, including 7 early and 13 late recurrences. During the immediate postoperative period radiographically detected recurrences were promptly revised. The strategy of late recurrences in the long-term course was based on patient symptoms and asymptomatic hernias were treated conservatively while symptomatic hernias were surgically treated. Symptomatic late recurrences developed in 4.6 % of the patients, including 7.4 % (11 out of 148) without and 1.4 % (2 out of 138) with primary mesh repair.
  
  
  CONCLUSIONS
  The repair of paraesophageal hernias in 286 patients provided excellent patient satisfaction and symptom improvement with low perioperative morbidity and mortality. Mesh reinforcement reduced the recurrence rate. The quality of life index is a suitable clinical course parameter for evaluation of paraesophageal hernias.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland. bernd.geissler@klinikum-augsburg.de.
authors.forename: B
authors.initials: B
authors.lastname: Geißler
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
authors.forename: E
authors.initials: E
authors.lastname: Birk
authors.affiliation: Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Anthuber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D059485:Gastropexy / Q000379:methods; D006551:Hernia, Hiatal / Q000401:mortality / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D013526:Surgical Mesh; D016019:Survival Analysis
keywords: Laparoscopy; Paraesophageal hiatal hernia; Quality of life; Recurrence; Surgical mesh