Abstracts
2002 Digestive Disease Week

# 100904 Abstract ID: 100904 Anterior Gastropexy Reduces the Recurrence Rate after Laparoscopic Paraesophageal Hernia Repair
Michael Rosen, Alicia Fanning, Terive Duperier, Fred Brody, Jeffrey Ponsky, Cleveland, OH

Introduction: While laparoscopic repair of type III paraesophageal hernias is safe and results in symptomatic relief, recent data has questioned the anatomic integrity of the laparoscopic approach. These reports document up to a 42% asymptomatic recurrence rate with radiologic follow up in type III paraesophageal hernias repaired laparoscopically. This disturbingly high recurrence rate has prompted the addition of an anterior gastropexy to our standard laparoscopic paraesophageal hernia repair. Methods: A prospective series of 22 patients underwent laparoscopic repair of large type III hiatal hernias between September 2000 and September 2001 at the Cleveland Clinic Foundation by one surgeon. All patients underwent reduction of the hernia, sac excision, crural repair, antireflux procedure, and anterior gastropexy. Patients underwent a video esophagram at 24 hours postoperatively and at 3,6, and 12 months follow up visits. Symptomatic outcomes were assessed with a standard questionnaire at each follow up visit. Results: Seventeen females and 5 males with a mean age of 69 years (range 35-82) underwent successful laparoscopic paraesophageal repair. Mean operative time was 150 minutes (110-187) with an average blood loss of 71 cc (range 10-200). One intraoperative complication occurred with a small esophageal mucosal tear occurring during esophageal dissection that was repaired laparoscopically. At 24 hour UGI there were no leaks identified. Currently 19/22 patients have undergone video esophagram at 3 months follow up. All patients were asymptomatic and all exams were normal. Sixteen patients have undergone follow up at 6 months, and all exams were normal and the patients complained of no symptoms. The nine patients available for one year follow up remained asymptomatic with normal video swallows. Conclusion: With up to one year of follow up, the addition of an anterior gastropexy to the laparoscopic repair of type III hiatal hernias resulted in no recurrences. With these encouraging results, further follow up is necessary to document the long term effects of anterior gastropexy in reducing postoperative recurrence after laparoscopic repair of paraesophageal hernias.