Aims/introduction
The laparoscopic approach is now believed to be a safe and feasible means of repairing paraesophageal hiatal hernias. There is little data in the literature, however, examining technical aspects of the repair. The aim of this study was to compare the clinical outcome of patients who underwent either gastropexy alone or fundoplication without gastropexy during laparoscopic hiatal repair. Methods Over a nine-year period 39 patients underwent elective laparoscopic repair of paraesophageal hernia in our unit. Patients underwent gastropexy alone or a fundoplication. 2 months ago all patients were invited to be scored across a range of gastrointestinal symptoms either at clinic or by telephone. Results 23 patients underwent gastropexy and 16 underwent fundoplication. The groups were well matched for age, weight and severity of symptoms. All procedures were successfully completed laparoscopically. Operating time was similar between groups. Median hospital stay was 3 days (Range 1-12) in the gastropexy group and 2 days (Range 1-8) in the fundoplication group. At follow-up there was a seven-fold improvement in mean symptom scores following surgery in patients who had a gastropexy and a five-fold improvement in those who had a fundoplication. Satisfaction with surgery was stated as good or excellent in 93% ofpatients who had a gastropexy and 92% of those treated with a fundoplication. Conclusion Both gastropexy and fundoplication are equally effective in controlling symptoms from paraesophageal hernia but in our series inclusion of a wrap produced no symptomatic advantage.
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