Giant paraesophageal hernia in an elderly woman: laparoscopic fundoplication and mesh in the hiatus
© Ricciardi et al; licensee BioMed Central Ltd. 2009
Published: 1 April 2009
Large hiatal hernias are more common in older patients and they are more likely to be female. In addition, the patients who underwent operation for large hiatal hernia are on average 20 years older than patients without hiatal hernias treated for elective antireflux surgery. The laparoscopic surgery rapidly became the more acceptable approach for gastrooesophageal reflux disease and repair of any associated hernia, not only for surgeons but also for the medical community. The objective of this study is to analyze the feasibility, the safety and the efficacy of laparoscopic repair of giant paraesophageal hernia in an elderly woman.
In addition, endoscopy revealed the presence of severe esophagitis. At subsequent operation, the patient was placed in a dorsal lithotomy position with reverse Trendelenbourg tilt. The surgeon works positioned between patient's legs.
Four 5 mm and one 10 mm laparoscopic ports were placed in the upper abdomen. The left lateral segment of the liver was retracted anteriorly with a flexible retractor. Handling gently the stomach with grasper the hernia is reduced in the abdomen. The hernia sac is fully removed from the mediastinum using a combination of sharp dissection with ultrasonic shears and blunt dissection with graspers. Then a tape was passed around the oesophagus, and the gastroesophageal junction was pulled into the abdomen to facilitate full dissection of the oesophageal hiatus.
Complete resolution of the disease and of the symptoms.
This report confirms the feasibility, effectiveness of laparoscopic repair of a large hernia in the elderly. Moreover, a prosthesis must be used when defect's size precludes tension free repair. However, closure of the diaphragmatic defect with prosthetic material is not immune from the problem of erosion and migration.
Outcome depend more on surgeons possessing advanced laparoscopic skills and clinical experience.
In selected patients and properly managing the underlying medical problems, the laparoscopic surgery for hiatal hernia should not be refused solely on the basis of the age.
This article is published under license to BioMed Central Ltd.