In our initial experience of four cases from March to November 1994, large
paraesophageal hernias were repaired by conventional primary closure of the hiatus with interrupted, nonabsorbable
sutures, adding a 360 degrees
fundoplication. In all four cases the
hernia recurred. Subsequently, we modified the procedure. The technique and results are described. From March 1995 to May 1998, 12 patients with
paraesophageal hernia (4 following a previous Nissen procedure) underwent elective laparoscopic repair. In all patients a "tension-free" hiatoplasty and a floppy 360 degrees
fundoplication were performed. The hiatal defect was repaired with a
polypropylene mesh, fixed to the diaphragm by staples. A gastrophrenic anchorage procedure was added in the eight patients undergoing surgery for the first time, utilizing the peritoneum of the
hernia sac. There were no conversions to open surgery or
intraoperative complications. Two patients developed postoperative
pleural effusion, which was treated medically. Mean
hospital stay was 5 days. Three patients developed postoperative transient
dysphagia to solid food that lasted 10 days. At a mean follow-up of 22.7 months (range 1-40), all patients are asymptomatic without
dysphagia, reflux, or
hernia recurrence. Laparoscopic "tension-free" hiatoplasty, 360 degrees
fundoplication, and anterior gastrophrenic anchorage are effective in the treatment of large
paraesophageal hernias.