2011, Number 4
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ABSTRACTParaesophageal hernias account for between 5 and 14% of hiatal hernias. Surgical management is complex and is currently one of the most debated subjects in surgery. Every symptomatic patient with a paraesophageal hernia and no contraindication for surgery should undergo repair. It is important to perform an evaluation that includes medical history, chest x-rays, barium swallow, upper endoscopy and manometry. Surgical approaches include open thoracic and abdominal access. Recently, laparoscopic surgery has become an option with less morbidity and mortality with results similar to open surgery. Essential technical aspects to improve results are reduction of the hernia sac, recognition and management of the short esophagus, hiatal closure and an antireflux procedure. Despite improving recurrence rates, use of synthetic mesh for hiatal closure has been associated with catastrophic complications; therefore, use of biologic mesh is preferred.
Schieman C, Grondin SC. Paraesophageal hernia: clinical presentation, evaluation, and management controversies. Thorac Surg Clin 2009;19:473-484.
Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR, et al. Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 2002;74:1909-1915; discussion 1915-1916.
Rogers ML, Duffy JP, Beggs FD, Salama FD, Knowles KR, Morgan WE. Surgical treatment of para-oesophageal hiatal hernia. Ann R Coll Surg Engl 2001;83:394-398.
Davis SS Jr. Current controversies in paraesophageal hernia repair. Surg Clin North Am 2008;88:959-978.
Mitiek MO, Andrade RS. Giant hiatal hernia. Ann Thorac Surg 2010;89:S2168-2173.
Stylopoulos N, Gazelle GS, Rattner DW. Paraesophageal hernias: operation or observation? Ann Surg 2002;236:492-500; discussion 500-501.
Wiechmann RJ, Ferguson MK, Naunheim KS, McKesey P, Hazelrigg SJ, Santucci TS, et al. Laparoscopic management of giant paraesophageal herniation. Ann Thorac Surg 2001;71:1080-1086; discussion 1086-1087.
Wolf PS, Oelschlager BK. Laparoscopic paraesophageal hernia repair. Adv Surg 2007;41:199-210.
Edye M, Salky B, Posner A, Fierer A. Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia. Surg Endosc 1998;12:1259-1263.
Rosen M, Ponsky J. Laparoscopic paraesophageal hernia repair. Oper Tech Gen Surg 2006;8:127-135.
Awais O, Luketich JD. Management of giant paraesophageal hernia. Minerva Chir 2009;64:159-168.
Hoang CD, Koh PS, Maddaus MA. Short esophagus and esophageal stricture. Surg Clin North Am 2005;85:433-451.
Horvath KD, Swanstrom LL, Jobe BA. The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery. Ann Surg 2000;232:630-640.
Luketich JD, Grondin SC, Pearson FG. Minimally invasive approaches to acquired shortening of the esophagus: laparoscopic Collis-Nissen gastroplasty. Semin Thorac Cardiovasc Surg 2000;12:173-178.
O’Rourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, et al. Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus. Arch Surg 2003;138:735-740.
Bochkarev V, Lee YK, Vitamvas M, Oleynikov D. Short esophagus: how much length can we get? Surg Endosc 2008;22:2123-2127.
Johnson AB, Oddsdottir M, Hunter JG. Laparoscopic collis gastroplasty and Nissen fundoplication. A new technique for the management of esophageal foreshortening. Surg Endosc 1998;12:1055-1060.
Whitson BA, Hoang CD, Boettcher AK, Dahlberg PS, Andrade RS, Maddaus MA. Wedge gastroplasty and reinforced crural repair: important components of laparoscopic giant or recurrent hiatal hernia repair. J Thorac Cardiovasc Surg 2006;132:1196-1202.
Morino M, Giaccone C, Pellegrino L, Rebecchi F. Laparoscopic management of giant hiatal hernia: factors influencing long-term outcome. Surg Endosc 2006;20:1011-1016.
Granderath FA, Carlson MA, Champion JK, Szold A, Basso N, Pointer R, et al. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc 2006;20:367-379.
Stadlhuber RJ, Sherif AE, Mittal SK, Fitzgibbons RJ, Michael Brunt L, Hunter J, et al. Mesh complications after prosthetic reinforcement of hiatal closure: a 28-case series. Surg Endosc 2009;23:1219-1226.
Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointer R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 2005;140:40-48.
Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 2006;244:481-490.
Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, et al. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 2010;139:395-404.