Laparoscopic surgery for large hiatus hernia

Abstract Background The results of laparoscopic surgery for large symptomatic hiatus hernia were revieved prospectively. Methods This was a prospective review of large (greater than 10 cm) hiatus hernias treated by laparoscopic surgery at the Royal Adelaide Hospital from January 1994 to July 1997. Demographic data, preoperative investigations, operative findings, operating times, conversion rate, complications and follow-up were recorded prospectively. Results Some 48 patients with a large hiatus hernia were treated laparoscopically. All had repair of the hiatal pillars and 47 had a fundoplication. The median age was 58 (range 30–87) years and there were 25 women. There were 11 sliding, eight paraoesophageal and 29 mixed hiatus hernias, and 20 completely intrathoracic stomachs. Median operating time was 75 (range 48–195) min and there were 12 conversions to an open operation; four because of difficulty reducing the hernia, three for obesity, two for bleeding, two because it was not possible to define the anatomy and one for gastric perforation. The majority of conversions occurred earlier in this experience and a change in technique to dissecting the sac out of the thoracic cavity reduced the conversion rate (38 to 15 per cent; P = 0·03, Fisher's exact test). Complications occurred in eight patients and resulted in early reoperation in two (one open and one laparoscopic). There was no death. The median stay was 3 (range 2–10) days. At a median follow-up of 19 (range 3–46) months, eight patients had minor dysphagia and two patients had an incisional hernia (both converted to open operation). One patient had a recurrent paraoesphageal hernia at 6 months and required further surgery. Median satisfaction scores were 10 (range 7–10) of 10 and all patients said they would have the operation again. Conclusion Large hiatus hernias can be effectively treated laparoscopically. The initial high rate of conversion to open operation was reduced by a change in operative technique.