Skip to main content
SpringerLink
Log in

Controversies in paraesophageal hernia repair; a review of literature

  • Review/metaanalysis article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

The surgical repair of paraesophageal hiatal hernias (PHH) can be performed by endoscopic means, but the procedure is not standardized and results have not been evaluated systematically so far. The aim of this review article was to clarify controversial subjects on the surgical approach and technique, i.e., recurrence rate after conventional versus laparoscopic PHH treatment, results of mesh reinforcement of the cruroplasty, the necessity for additional antireflux surgery, and indications for an esophageal lengthening procedure.

Methods

An electronic Medline search was performed to identify all publications reporting on laparoscopic and conventional PHH surgery. The computer search was followed by additional hand searches in books, journals, and related articles. All types of publications were evaluated because of a lack of high-level evidence studies such as randomized controlled trials. Critical analysis followed for all articles describing a study population of >10 patients and those reporting postoperative outcome.

Results

A total of 32 publications were reviewed. Randomized controlled trials comparing laparoscopic and open techniques could not be identified. Nineteen of the publications described the results of retrospective series. Therefore, most of the studies retrieved were low in hierarchy of evidence (level II-c or lower). The overall median hospital time as published was 3 days for patients operated laparoscopically and 10 days in the conventional group. Postoperative complications, such as pneumonia, thrombosis, hemorrhage, and urinary and wound tract infections, appeared to be more frequent after conventional surgery. Follow-up was longer for conventional surgery (median 45 months versus 17.5 months after the laparoscopic technique). Recurrence rates reported were higher in patients operated conventionally (median 9.1% versus 7.0% for patients operated laparoscopically). Recurrences after PHH repair may decrease with usage of mesh in the hiatus, although uniform criteria for this procedure are lacking. No conclusions could be drawn regarding the necessity for an additional antireflux procedure. Furthermore, uniform specific indications for the need of an esophageal lengthening procedure or preoperative assessment methods for shortened esophagus could not be detected.

Conclusion

Treatment based on standardized protocols for preoperative assessment and postoperative follow-up is required to clarify the current controversies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Altorki NK, Yankelevitz D, Skinner DB (1998) Massive hiatal hernias: the anatomic basis of repair J Thorac Cardiovasc Surg 115: 828–835

    PubMed  Google Scholar 

  2. Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagne DJ, Caushaj PF, Landreneau RJ, Keenan RJ (2004) Laparoscopic repair of large paraesophageal hernia is associated with a low incidence of recurrence and reoperation Surg Endosc 18: 444–447

    Article  PubMed  Google Scholar 

  3. Assendelft WJ, van Tulder MW, Scholten RJ, Bouter LM (1999) The practice of systematic reviews. II. Searching and selection of studies Ned Tijdschr Geneeskd 143: 656–661

    PubMed  Google Scholar 

  4. Athanasakis H, Tzortzinis A, Tsiaoussis J, Vassilakis JS, Xynos E. (2001) Laparoscopic repair of paraesophageal hernia Endoscopy 33: 590–594

    Article  PubMed  Google Scholar 

  5. Basso N, DeLeo A, Genco A, et al. (2000) 360 Degrees laparoscopic fundoplication with tension free hiatoplasty in the treatment of symptomatic gastroesophageal reflux disease Surg Endosc 14: 164–169

    Article  PubMed  Google Scholar 

  6. Casabella F, Sinanan M, Horgan S, Pellegrini CA (1996) Systematic use of gastric fundoplication in laparoscopic repair of paraesophageal hernias Am J Surg 171: 485–489

    Article  PubMed  Google Scholar 

  7. Cook DJ, Guyatt GH, Laupacis A, Sackett DL, Goldberg RJ (1995) Clinical recommendations using levels of evidence for antithrombotic agents Chest 10 108(4 Suppl): 227S–230S

    Google Scholar 

  8. Cuschieri A, Shimi S, Nathanson LK (1992) Laparoscopic reduction, crural repair, and fundoplication of large hiatal hernia Am J Surg 163: 425–430

    Article  PubMed  Google Scholar 

  9. Dahlberg PS, Deschamps C, Miller DC, Allen MS, Nichols FC, Pairolero PC (2001) Laparoscopic repair of large paraesophageal hiatal hernia Ann Thorac Surg 72: 1125–1129

    Article  PubMed  Google Scholar 

  10. Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients J Gastrointest Surg 7: 59–66

    Article  PubMed  Google Scholar 

  11. Edye MB, Canin-Endres J, Gattorno F, Salky BA (1998) Durability of laparoscopic repair of paraesophageal hernia Ann Surg 228: 528–535

    Article  PubMed  Google Scholar 

  12. Edye M, Salky B, Posner A, Fierer A (1998) Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia Surg Endosc 12: 1259–1263

    Article  PubMed  Google Scholar 

  13. Ellis FH Jr, Crozier RE, Shea JA (1986) Paraesophageal hiatus hernia Arch Surg 121: 416–420

    PubMed  Google Scholar 

  14. Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19: 4–8

    Article  PubMed  Google Scholar 

  15. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia Arch Surg 137: 649–652

    Article  PubMed  Google Scholar 

  16. Gantert WA, Patti MG, Arcerito M, Feo C, Stewart L, DePinto M, Bhoyrul S, Rangel S, Tyrrell D, Fujino Y, Mulvihill SJ, Way LW (1998) Laparoscopic repair of paraesophageal hiatal hernias J Am Coll Surg 186: 428–432

    Article  PubMed  Google Scholar 

  17. Gastal OL, Hagen JA, Peters JH, Campos GMR, Heshemi M, Theisen J, Bremmer CG, DeMeester TR (1999) Short esophagus: analysis of predictors and clinical implications Arch Surg 134: 633–636

    Article  PubMed  Google Scholar 

  18. Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair Surgery 128: 623–630

    Article  PubMed  Google Scholar 

  19. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremmer CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate J Am Coll Surg 190: 553–560

    Article  PubMed  Google Scholar 

  20. Hill LD, Tobias JA (1968) Paraesophageal hernia Arch Surg 96: 735–744

    PubMed  Google Scholar 

  21. Horgan S, Eubanks TR, Jacobsen G, Omelanczuk P, Pellegrini CA (1999) Repair of paraesophageal hernias Am J Surg 177: 354–358

    Article  PubMed  Google Scholar 

  22. Horvath KD, Swanstrom LL, Jobe BA (2000) The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery Ann Surg 232: 630–640

    Article  PubMed  Google Scholar 

  23. Huntington TR, (1997) Short-term outcome of laparoscopic paraesophageal hernia repair. A case series of 58 consecutive patients Surg Endosc 11: 894–898

    Article  PubMed  Google Scholar 

  24. Jobe BA, Horvath KD, Swanstrom LL (1998) Postoperative function following laparoscopic collis gastroplasty for shortened esophagus Arch Surg 133: 867–874

    Article  PubMed  Google Scholar 

  25. Kamolz T, Granderath FA, Basmmer T, Pasiut M, Pointer R (2002) Dysphagia and quality of life after laparoscopic Nissen fundoplication in patients with and without prosthetic reinforcement of the hiatal crura Surg Endosc 16: 572–577

    Article  PubMed  Google Scholar 

  26. Khaitan L, Houston H, Sharp K, Holzman M, Richards W (2002) Laparoscopic paraesophageal hernia repair has an acceptable recurrence rate Am Surg 68: 546–551

    PubMed  Google Scholar 

  27. Krahenbuhl L, Schafer M, Farhadi J, Renzulli P, Seiler CA, Buchler MW (1998) Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach J Am Coll Surg 187: 231–237

    Article  PubMed  Google Scholar 

  28. Lal DR, Pellegrini CA, Oelschlager BK (2005) Laparoscopic repair of paraesophageal hernia Surg Clin North Am 85: 105–118

    Article  PubMed  Google Scholar 

  29. Luketich JD, Raja S, Fernando HC, Campbell W, Christie NA, Buenaventura PO, Weigel TL, Keenan RJ, Schauer PR (2000) Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases Ann Surg 232: 608–618

    Article  PubMed  Google Scholar 

  30. Mattar SG, Bowers SP, Galloway KD, Hunter JG, Smith CD (2002) Long-term outcome of laparoscopic repair of paraesophageal hernia Surg Endosc 16: 745–749

    Article  PubMed  Google Scholar 

  31. Maziak DE, Todd TR, Pearson FG (1998) Massive hiatus hernia: evaluation and surgical management J Thorac Cardiovasc Surg 115: 53–60

    PubMed  Google Scholar 

  32. Myers GA, Harms BA, Starling JR (1995) Management of paraesophageal hernia with a selective approach to antireflux surgery Am J Surg 170: 375–380

    Article  PubMed  Google Scholar 

  33. Offringa M, de Craen AJ (1999) The practice of systematic reviews. I. Introduction Ned Tijdschr Geneeskd 143: 653–656

    PubMed  Google Scholar 

  34. O’Rourke RW, Khajanchee YS, Urbach DR, Lee NN, Lockhart B, Hansen PD, Swanstrom LL (2003) Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus Arch Surg 138: 735–740

    Article  PubMed  Google Scholar 

  35. Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD (2004) A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia J Thorac Cardiovasc Surg 127: 843–849

    Article  PubMed  Google Scholar 

  36. van der Peet DL, Klinkenberg-Knol EC, Alonzo Poza A, Sietses C, Eijsbouts QAJ, Cuesta MA (2000) Laparoscopic treatment of large paraesophageal hernias: both excision of the sac and gastropexy are imperative for adequate surgical treatment Surg Endosc 14: 1015–1018

    Article  PubMed  Google Scholar 

  37. Perdikis G, Hinder RA, Filipi CJ, Walenz T, McBride PJ, Smith SL, Katada N, Klingler PJ (1997) Laparoscopic paraesophageal hernia repair Arch Surg 132: 586–589

    PubMed  Google Scholar 

  38. Pierre AF, Luketitch JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR, Schauer PR (2002) Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients Ann Thorac Surg 74: 1909–1915

    Article  PubMed  Google Scholar 

  39. Ponsky J, Rosen M, Fanning A, Malm J (2003) Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair Surg Endosc 17: 1029–1035

    Article  Google Scholar 

  40. Schauer PR, Ikramuddin S, McLaughlin RH, Graham TO, Slivka A, Lee KKW, Schraut WH, Luketitch JD (1998) Comparison of laparoscopic versus open repair of paraesophageal hernia Am J Surg 176: 659–665

    Article  PubMed  Google Scholar 

  41. Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients J Thorac Cardiovasc Surg 53: 33–54

    PubMed  Google Scholar 

  42. Stylopoulos N, Gazelle GS, Rattner DW (2002) Paraesophageal hernias: operation or observation? Ann Surg 236: 492–500

    Article  PubMed  Google Scholar 

  43. Swanstrom LL, Jobe BA, Kinzie LR, Horvath KD (1999) Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication Am J Surg 177: 359–363

    Article  PubMed  Google Scholar 

  44. Swanstrom LL, Marcus DR, Galloway GQ (1996) Laparoscopic Collis gastroplasty is the treatment of choice for the shortened esophagus Am J Surg 171: 477–481

    Article  PubMed  Google Scholar 

  45. Tagarona EM, Bendahan G, Balague C, Garriga J, Trias M (2004) Mesh in the hiatus; A controversial issue Arch Surg 139: 1286–1296

    Article  PubMed  Google Scholar 

  46. Targarona EM, Novell J, Vela S, Cerdan G, Bendahan G, Torrubia S, Kobus C, Rebasa P, Balague C, Garriga J, Trias M (2004) Mid term analysis of safety and quality of life after the laparoscopic repair of paraesophageal hiatal hernia Surg Endosc 18: 1045–1050

    Article  PubMed  Google Scholar 

  47. Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, Hunter JG (1997) Complications of laparoscopic paraesophageal hernia repair J Gastrointest Surg 1: 221–228

    Article  PubMed  Google Scholar 

  48. Tsuboi K, Tsukada K, Nakabayashi T, Kato H, Miyazaki T, Masuda N, Kuwano H (2002) Paraesophageal hiatus hernia, which has progressed for 8 years: report of a case Hepatogastroenterology 49: 992–994

    PubMed  Google Scholar 

  49. Watson DI, Davies N, Devitt PG, Jamieson GG (1999) Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias Arch Surg 134: 1069–1073

    Article  PubMed  Google Scholar 

  50. Wiechmann RJ, Ferguson MK, Naunheim KS, McKesey P, Hazelrigg SJ, Santucci TS, Macherey RS, Landreneau RJ (2001) Laparoscopic management of giant paraesophageal herniation Ann Thorac Surg 71: 1080–1086

    Article  PubMed  Google Scholar 

  51. Williamson WA, Ellis FH Jr, Streitz JM Jr, Shahian DM (1993) Paraesophageal hiatal hernia: is an antireflux procedure necessary? Ann Thorac Surg 56: 447–451

    PubMed  Google Scholar 

  52. Willekes CL, Edoga JK, Frezza EE (1997) Laparoscopic repair of paraesophageal hernia Ann Surg 225: 31–38

    Article  PubMed  Google Scholar 

  53. Wu JS, Dunnegan DL, Soper NJ (1999) Clinical and radiologic assessment of laparoscopic paraesophageal hernia repair Surg Endosc 13: 497–502

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, Post Office Box 85500, 3508 GA, Utrecht, The Netherlands

    W. A. Draaisma, H. G. Gooszen, E. Tournoij & I. A. M. J. Broeders

Authors
  1. W. A. Draaisma
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. G. Gooszen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Tournoij
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. A. M. J. Broeders
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. A. M. J. Broeders.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Draaisma, W.A., Gooszen, H.G., Tournoij, E. et al. Controversies in paraesophageal hernia repair; a review of literature. Surg Endosc 19, 1300–1308 (2005). https://doi.org/10.1007/s00464-004-2275-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-2275-3

Keywords

Search

Navigation