Laparoscopic paraesophageal hernia repair

Abstract

Influential studies published by Belsey in 1967 and Hill in 1973 convinced surgeons for many years that all paraesophageal hernias should be repaired when identified, regardless of symptomatology [1, 2]. The rationale for this approach was prophylactic, based largely on a concern for life-threatening hernia-related complications such as strangulation and gastric ischemia. This notion has been challenged in recent years and now many asymptomatic hernias are managed expectantly [3]. When a hernia becomes more than mildly symptomatic, it should be repaired in most cases. Typical symptoms related to a paraesophageal hernia can include dysphagia, early satiety, epigastric pain, and even dyspnea. Some patients may suffer from significant medically refractory gastroesophageal reflux disease necessitating repair. Cameron's ulcers can develop from chronic mucosal ischemia and mechanical irritation from twisting of the stomach, typically at the hiatus. These ulcers may lead to chronic insidious blood loss with resultant anemia or less commonly frank hematemesis. Operative correction should be considered in these patients, as well. © Springer-Verlag London Limited 2010.