Between 1971 and 1986, the author operated on 30 patients, 23 women and 7 men, with large paraesophageal (PE) hernias and complete intrathoracic stomach. The average age of the patients was 70 years. Thirteen patients required urgent repair because of incarceration causing complete obstruction, bleeding, and, in one instance, perforation. Only 2 patients had a prior history of esophageal reflux. Surgery, always transabdominal, included excision of the sac, closure of the defect with pledgetted sutures, and anterior gastropexy. Four extremely poor‐risk patients underwent anterior gastropexy alone under local anesthesia. Two other patients underwent anterior gastropexy alone for different reasons. There were no deaths or major complications and no recurrences. The author's experience suggests that: (a) an abdominal approach is preferable to a transthoracic repair; (b) ancillary antireflux surgery, such as fundoplication, should be used only when indicated on the basis of a prior history of reflux esophagitis, which was the case in only 2 of our patients; (c) because the symptoms and complications of PE hernias result from the gastric volvulus rather than from the hernia per se, formal repair of the defect is not always necessary. Thus, patients whose general condition does not permit a major abdominal operation under general anesthesia can be completely relieved of their symptoms by an anterior gastropexy done under local anesthesia; (d) a PE hernia is a life‐threatening condition and elective repair should be recommended once the diagnosis is made.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.