Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia

Abstract

The laparoscopic treatment of large paraesophageal and mixed hiatal hernias is not only feasible and safe but also offers a good quality of life on a midterm basis. However, the anatomic and functional recurrence rate is high. The next step is to identify the subset of patients who are at risk of failure and to establish technical alternatives that would ensure the durability of the repair.

Laparoscopic hiatal hernia repair

“…The perioperative results for our patients are consistent with published data [21]. However, no discrimination between irrelevant minor complications and major complications was undertaken in our series.…”

“…Concerning the symptomatic outcome, it is remarkable that only half of the patients with radiologic PEH recurrence were symptomatic, a fact that had already been shown by others [6,12,13,15,21]. This demonstrates that recurrence rates are underestimated if they are based only on symptomatic outcome, and that the clinical relevance of asymptomatic PEH recurrences after hiatal hernia repair remains unclear.…”

Controversies in paraesophageal hernia repair; a review of literature

“…In essence, no conventional options are available for the treatment of paraesophageal hernia, so surgical repair is recommended for relief of symptoms. Surgery with the objective of preventing complications in asymptomatic patients has been recommended, but scientific studies that compare peroperative morbidity to natural history are scarce [20,41,42,46,47].…”

Hiatus hernia and recurrence

“…Targarona et al [46] haben diese Ergebnisse anhand 46 eigener Patienten bestätigt und erstmals auch die Symptome der Patienten und deren Lebensqualität als Entscheidungskriterium für weitere chirurgische Schritte in die Diskussion eingebracht. Wie nicht anders zu erwarten, haben klinische Rezidive einen deutlich schlechteren Lebensqualitätsindex als nur radiologische, obwohl auch diese gegenüber den "normalen" postoperativen deutlich abfallen.…”