HP25P SLEEVE GASTRECTOMY FOR LARGE PARAOESOPHAGEAL HIATUS HERNIAS

Abstract

Purpose: The initial experience with laparoscopic partial sleeve gastrectomy to excise the herniated stomach to treat symptomatic, large para-oesophageal hernias is reported. Methodology: The laparoscopic repair consisted of 1 Reduction of the herniated stomach from the chest 2 Partial sleeve gastrectomy 3 Repair of hiatal defect with or without mesh 4 Gastropexy. Results: Since May 2006, 11 patients had surgery for large para-oesophageal hernias. All suffered with post prandial discomfort and vomiting preoperatively. One patient underwent open Nissen fundoplication instead of laparoscopic sleeve gastrectomy because of intraoperative haemorrhage. Ten patients had a partial sleeve gastrectomy. Hiatal repair included the use of mesh in 7 out of the 10 patients and 9 of the patients had an anterior gastropexy. The only patient not to have a gastropexy suffered a symptomatic recurrence 13 days after surgery. Five out of 10 patients had complete relief of symptoms after surgery. Four out of ten patients were symptomatic with reflux. One patient continues to have post prandial discomfort and vomiting intermittently, due to a “twist” of the gastric tube. Observations: In this series, laparoscopic partial sleeve gastrectomy for large para-oesophageal hernia repair was associated with a recurrence rate of 1 in 10. Anterior gastropexy may be important in preventing recurrence. Relief of preoperative symptoms was achieved in 9 out of 10 patients but 4 of these 9 report reflux symptoms.