Intermediate-term results of laparoscopic repair of giant paraesophageal hernia: lack of follow-up esophagogram leads to detection bias.

Introduction: This retrospective study was performed to review the intermediate-term results of the laparoscopic repair of giant paraesophageal hernia (PEH) in the unit.
Methods: This retrospective 8-year case series involved 42 patients. The clinical records were retrieved, reviewed individually, and data were collected regarding symptoms, investigation, operative details, and follow-up.
Results: M:F ratio was 1:1.8 and median age was 64 years. Symptoms included epigastric/chest pain (69%), heartburn (42.8%), dysphagia (38%), vomiting (23.8%), gastric volvulus (19%), and upper GI bleed (16.6%). The repair included reduction, sac excision, esophageal mobilization, and cruroplasty. Fundoplication (anterior partial) was done in 18 (42.8%) patients with radiologically documented reflux. Median hospital stay was 3 days. The complications included esophageal perforation in 1 (2.3%), gas-forming mediastinal abscess in 1 (2.3%), small bowel obstruction in 1 (2.3%), and bilateral basal atelectasis in 3 (7.1%). One patient (2.3%) died due to duodenal perforation and myocardial infarction. Of the 38 (90.4%) patients followed up (median 18m), 20 (52.6%) had a follow-up investigation. One patient (2.6%) had postoperative dysphagia, and 3 (7.8%) had postoperative heartburn. Five (11.9%) had recurrence. Symptom outcome was Visick grades I/II (86.8%), III (10.5%), and IV (2.6%).
Conclusion: Laparoscopic repair of PEH resulted in a short length of stay, excellent outcome in almost 87% of patients, and an overall recurrence rate of 11.9%.