BACKGROUND: The objective of this study was to analyze our initial results after laparoscopic repair of large @entity357 . METHODS: Between October 1997 and May 2000, 37 @entity1 (23 @entity1 , 14 @entity1 ) underwent laparoscopic repair of a large type II (pure paraesophageal) or type III (combined sliding and paraesophageal) @entity357 with more than 50% of the stomach herniated into the chest. Median age was 72 years (range 52 to 92 years). Data related to @entity1 demographics, esophageal function, operative techniques, postoperative symptomatology, and complications were analyzed. RESULTS: @entity547 repair and Nissen fundoplication was possible in 35 of 37 @entity1 (95.0%). Median hospitalization was 4 days (range 2 to 20 days). @entity3816 occurred in 6 @entity1 (16.2%) and included pneumothorax in 3 @entity1 , @entity130 in 2, and crural tear in 1. Early @entity260 occurred in 5 @entity1 (13.5%) and included esophageal leak in 2, severe bloating in 2, and a @entity1744 in 1. Two @entity1 died within 30 days (5.4%), 1 from delayed @entity548 and 1 from adult respiratory distress syndrome secondary to a recurrent @entity357 . Follow-up was complete in 31 @entity1 (94.0%) and ranged from 3 to 34 months (median 15 months). Twenty-seven @entity1 (87.1%) were improved. Four @entity1 (12.9%) required early postoperative dilatation. Recurrent @entity357 occurred in 4 @entity1 (12.9%). Functional results were classified as excellent in 17 @entity1 (54.9%), good in 9 (29.0%), fair in 1 (3.2%), and poor in 4 (12.9%). CONCLUSIONS: Laparoscopic repair of large @entity357 is a challenging operation associated with significant morbidity and mortality. More experience, longer follow-up, and further refinement of the operative technique is indicated before it can be recommended as the standard approach.

Laparoscopic repair of large XXXX .

@entity1 :: ('9606', 'Species') :: ['men', 'women', 'patients', 'patient'] @entity548 :: ('MESH:D006470', 'Disease') :: ['splenic bleeding'] @entity260 :: ('MESH:D011183', 'Disease') :: ['postoperative complications'] @entity357 :: ('MESH:D006551', 'Disease') :: ['paraesophageal hiatal hernia', 'strangulated hiatal hernia', 'paraesophageal hiatal hernias', 'hiatal hernia'] @entity547 :: ('MESH:D006547', 'Disease') :: ['Laparoscopic hernia'] @entity1744 :: ('MESH:D043183', 'Disease') :: ['small bowel obstruction'] @entity130 :: ('MESH:D014947', 'Disease') :: ['splenic injury'] @entity3816 :: ('MESH:D007431', 'Disease') :: ['Intraoperative complications']
@entity357 :: (MESH:D006551,Disease) :: ['paraesophageal hiatal hernia']
