Laparoscopic treatment of paraesophageal and large mixed hiatal hernias

BACKGROUND. Laparoscopic treatment of large mixed hiatal hernias was attempted in eight patients. METHODS. One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the abdomen resulting from a shortened esophagus. One left pleural tear occurred intraoperatively and was repaired without further consequence. Median duration of the operation was 150 min (range 120-300 min). RESULTS. No postoperative complications were recorded. All patients are asymptomatic after a median follow-up of 14 months (range 7-15 months). Correct repositioning of the stomach was confirmed by radiological evaluation 1 month after surgery. Early functional results are good. (One asymptomatic gastroesophageal reflux was detected and medical treatment was undertaken). CONCLUSIONS. Laparoscopic crural repair and fundoplication are feasible even in paraesophageal and large mixed hiatal hernias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay. Nevertheless, long-term assessment is required to confirm the effectiveness of the laparoscopic approach in patients with large mixed hiatal hernias.