Gastropexy via a short upper midline laparotomy for Paraesophageal hernia

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Introduction

Paraesophageal hernias are uncommon but can lead to dysphagia, dyspnoea, early satiety, chronic iron deficiency anaemia and may undergo torsion and occasionally necrosis and death. In gastropexy the stomach is sutured to the abdominal wall and or the diaphragm.

Aims

We assessed patient experiences post mini-open gastropexy focusing on morbidity, mortality and quality of life.

Methods

In 6 years 2008 to 2014 a total of 31 elective patients with high morbidity underwent gastropexy via a short upper midline laparotomy for Paraesophageal hernia. In almost all cases 2 pledget and strong Ethibond sutures were used to fix the stomach to the diaphragm and 2 to 3 pledget sutures were used to fix the stomach to the left lateral abdominal wall. All patients had a post op CXR, barium swallow and after nine months underwent an OGD at which time patients answered a questionnaire.

Results

There was no operative death. The mean hospital stay was 4.5 days. The complication rate was 3.2%. There was no early or late recurrence of hernia. All patients were kept on their PPI post op. 87.1 % were satisfied with procedure, while 2 regretted the gastropexy.

Conclusion

Gastropexy via an upper midline laparotomy is a safe procedure in high risk paraoesophageal patients with high morbidity. It provides good symptomatic relief in the short and long term. Has lower complication rate compared to less invasive gastropexy. Comparing literature our mini-open gastropexy had no recurrence rates unlike the higher rate of failure in laparoscopic gastropexy.