The Laparoscopic Approach to Paraesophageal Hernia Repair

Introduction Laparoscopic paraesophageal hernia repair continues to be one of the most challenging procedures facing the minimally invasive surgeon. Discussion A thorough understanding of the tenets of the operation and advanced skills in minimally invasive laparoscopy are needed for long-term freed...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2012-02, Vol.16 (2), p.417-426
Main Authors: Nason, Katie S., Luketich, James D., Witteman, Bart P.L., Levy, Ryan M.
Format: Article
Language:English
Subjects:
Anemia
Barium
Catheters
Esophagus
Gastroenterology
Gastroesophageal reflux
Gastroplasty
Hernia, Hiatal - surgery
Herniorrhaphy - methods
Hiatal hernias
How I do it
Humans
Laparoscopy
Laparoscopy - methods
Medicine
Medicine & Public Health
Morbidity
Motility
Ostomy
Patients rights
Stomach
Surgeons
Surgery
Thoracic surgery
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Summary:Introduction Laparoscopic paraesophageal hernia repair continues to be one of the most challenging procedures facing the minimally invasive surgeon. Discussion A thorough understanding of the tenets of the operation and advanced skills in minimally invasive laparoscopy are needed for long-term freedom from symptomatic and anatomic recurrence. These include complete reduction of the hernia sac from the mediastinum back into the abdomen with careful preservation of the integrity of muscle and peritoneal lining of the crura, aggressive and complete mobilization of the esophagus to the level of the inferior pulmonary vein, vagal preservation, clear identification of the gastroesophageal junction to allow accurate assessment of the intraabdominal esophageal length, and use of Collis gastroplasty when esophageal lengthening is required for a tension-free intraabdominal repair. Liberal mobilization of the phrenosplenic and phrenogastric attachments substantially increases the mobility of the left limb of the crura, allowing for a tension-free primary closure in a large percentage of patients. Conclusion The following describes our current approach to laparoscopic paraesophageal hernia repair following a decade of refinement in a high-volume center.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-011-1690-8