Abstract
Background. Giant paraesophageal hiatal hernia (GPEH) presents a risk of catastrophic complications
that include massive bleeding, strangulation, and perforation and should be repaired.
Controversy persists as to the surgical approach and whether an antireflux repair
is required. Methods. This study reviews the experience with 100 patients with GPEH who underwent surgical
repair between 1967 and 1999. Eighty patients underwent an elective operation, and
20 patients underwent an emergency procedure for complications of GPEH. The gastroesophageal
junction was above the hiatus (“combined” hernia with sliding component) in 23 patients
and in the abdomen in 77 patients, including 3 patients with a true parahiatal hernia.
Results. A thoracic approach was used in 18 patients, mostly early in our experience; postoperative
gastric volvulus requiring transabdominal repair developed in 2 patients. The remaining
82 patients underwent an abdominal repair, with temporary gastrostomy to prevent gastric
displacement in 75 patients; the hernial sac was resected, and the hiatus was reconstructed
in all of the patients. Thirty-five patients with reflux on preoperative work up underwent
a fundoplication, with gastroplasty in 2 patients because of a short esophagus. No
patient has experienced hernia recurrence. Whereas symptomatic relief was excellent
in all patients with elective repair, mild reflux was present in 2 patients after
emergency operation. There were no deaths among the patients who underwent elective
operation; there were 2 hospital deaths among those patients who underwent emergency
operation (10%). Conclusions. GPEH should be repaired soon after recognition. Reflux should be evaluated before
the operation, and if present, fundoplication should be part of the repair along with
the reduction of the hernia, excision of the sac, gastropexy, and crural closure.
These are best achieved with an abdominal approach. (Surgery 2000;128:623-30.)
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Article info
Footnotes
*Reprint requests: Alexander S. Geha, MD, Professor and Chief, Division of Cardiothoracic Surgery, The University of Illinois at Chicago, 840 S Wood, Rm 417CSB MC 958, Chicago, IL 60612.
**Surgery 2000;128:623-30
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
