Page 38 - WALS Journal

Role of Laparoscopy in the Management of Giant Hiatal Hernia
• Mean hospital stay was 4.8 day • Major morbidity was atrial fibrillation, pulmonary embolism
• Transient dysphagia occurred in 7 patients and splenectomy rate was 10.2%.
• Recurrent hernia present in 23 patients (35.4%) • Minor morbidity included – chest infection, jaundice,
• Recurrent rate was 77% in direct suture and 35% when mesh dysphagia, small pneumothorax rate was 20.4%
was used. • Recurrence rate of 27 patients that is 66% patients.
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Recurrence of hiatal hernia according to type of surgical LE Ferri et al 2005, performed repair 60 cases paraeso-
technique are given in Table 1: phageal hernia for reevaluation of result of laparoscopic repair
against open laparotomy from 1990 to 2002.
TABLE 1: Result of recurrences
• For this study 25 cases repaired with open transabdominal
Surgical technique Patients Recurrences Reintervention • 35 cases repaired with laparoscopy
(N) N (%) N (%) • Laparoscopic repair resulted in
Direct suture 14 10(77) 5 (36) – Lower blood loss
PTFE 4 4 (100) 3 (75) – Fewer intraoperative complication
Polypropylene 23 7 (30) 1 (4) – Shorter length of hospital stay
Mixed (PTFE + 10 2 (20) 1 (10) – Radiological recurrence was 44% for open and 23% for
Polypropylene)
Collies-Nissen 14 0 1 (7) laparoscopic procedure
• Laparoscopic repair was associated with a significant
PTFE, Polytetrafluoroethylene reduction in time to oral intake, parental opioid use and
Source: M. Morino et al 8 length of hospital stay.
Anatomic recurrence was identified in 8 of 18 open and 7 of
No patients with a Collies-Nissen fundoplication experience 31 that is (23%) patients in the laparoscopic group five
recurrence. recurrences occurred in the first 15 patients where only 2 of the
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R Parmeswaran et al 2006 performed laparoscopic repair last 20 patients have had recurrence.
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of large paraesophageal hiatal hernia between Jan 2000 and James D Luketich et al : In October 2000 performed
July 2004 on 49 patients. laparoscopic surgery for giant hiatal hernia from July 1995 to
• The median age of these patients was 68 years February 2000 on 100 patients.
• The techniques used Nissen fundoplication • There were three cases in which open conversion done due
• There were two conversion to open surgery to adhesion

TABLE 2: Operative and short-term outcome after open and laparoscopic paraesophageal hernia repair
Open Laparoscopic P value

Operative
Time (min) 123 (30-153) 120 (65-190) 0.6
Blood loss (ml) 300 (50-1500) 50 (25-250) <0.001
Complications 6/25 (24%) 2/35 (6%) 0.01
n (%)
Splenecotmy *4 Gastrotomy
Liver laceration Bleeding (converted)

Esophageal
Perforation
Short Term
Time to oral intake (days) 4 (2-35) 1 (1-3) <0.001
Length of stay (days) 13 (6-86) 3 (1-6) <0.001
Morphine (mg) 109 (50-243) 19 (0-175.6) <0.001
a
Complications (postop) n (%) 8/25 (32%) 5/35 (14%) 0.18
Minor (Class I) 5 4
Major (Class II-IV) 3 1
a Complication classification as proposed by Clavien et al 14
Source: L.E. Ferri et al 13

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