Abstract
The majority of large hiatal hernias are paraesophageal hiatal hernias (PEH). Once prolapse of the stomach to the chest cavity reaches a high degree, it is called an intrathoracic stomach. More than 25 years have elapsed since laparoscopic surgery was carried out as minimally invasive surgery for PEH. The feasibility and safety thereof has nearly been established. PEH may cause serious complications such as strangulation and perforation. The outcome of elective repair of PEH is better than emergent repair, so we should carry out elective repair as much as possible. Although not a major clinical problem, following PEH repair the rate of anatomical recurrence increases with age. In order to reduce the recurrence rate, mesh reinforcement by crural repair has been widely performed. Although this improves the short‐term outcomes, the long‐term outcomes are unclear. For PEH repair, fundoplication and gastropexy are believed desirable. We should select the procedure associated with a lower incidence of dysphagia and so on following surgery. While relaxing incision is useful for primary tension‐free closure, it has not contributed to improvement in the recurrence rate.
Highlights
30 years have elapsed since the first report on laparoscopic surgery for gastroesophageal reflux disease (GERD) by Dallemagne et al in 1991
Others reported that the addition of fundoplication to intrathoracic stomach (ITS) surgery does not contribute to quality of life (QOL) improvement,[27] and that there was no difference in the symptom scores, satisfaction, and use of proton pump inhibitors in accord‐ ance with the presence or absence of anti‐reflux surgery (ARS).[6]
The outcomes of elective repair are obviously better than emergency repair, attention should be paid to performing elective repair on patients with no symptoms, taking into consideration their age and complications
Summary
30 years have elapsed since the first report on laparoscopic surgery for gastroesophageal reflux disease (GERD) by Dallemagne et al in 1991. Fundoplication needs to be con‐ ducted to prevent postoperative GER, with intra‐abdominal gastric fixation recommended to reduce recurrence.[25] On the other hand, some argue that the merits are unclear regarding conducting fun‐ doplication on patients without reflux,[26] while others have reported that fundoplication increased the postoperative incidence of dyspha‐ gia, which reached a maximum of 50% following PEH repair.[4] Blake et al reported that fundoplication should not be carried out on pa‐ tients without a history of significant reflux, or with poor esophageal motility, SE, or debilitating comorbidities.[13] Others reported that the addition of fundoplication to ITS surgery does not contribute to QOL improvement,[27] and that there was no difference in the symptom scores, satisfaction, and use of proton pump inhibitors in accord‐ ance with the presence or absence of anti‐reflux surgery (ARS).[6] The guidelines state, “Fundoplication must be performed during repair of a sliding type hiatal hernia to address reflux. Ponsky et al reported that they carried out fundoplication and anterior fixa‐ tion by suturing and fixing two sites on the stomach anterior wall and TA B L E 1 Laparoscopic fundoplication and/or gastropexy for paraesophageal hiatal hernia
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