{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:00:41Z","timestamp":1784721641927,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2013,4,19]],"date-time":"2013-04-19T00:00:00Z","timestamp":1366329600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Laparoscopy has been widely used for surgical repair of large paraesophageal hernias (PEHs). The technique, however, entails substantial technical difficulties, such as repositioning the stomach in the abdominal cavity, sac excision, closure of the hiatal gap, and fundoplication. Knowledge of the long\u2010term outcome (&gt;10 years) is scarce. The aim of this article was to evaluate the long\u2010term results of this approach, primarily the anatomic hernia recurrence rate and the impact of the repair on quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We identified all patients who underwent laparoscopic repair for PEH between November 1997 and March 2007 and who had a minimum follow\u2010up of 48\u00a0months. In March 2011, all available patients were scheduled for an interview, and a radiologic examination with barium swallow was performed. During the interview the patients were asked about the existence\/persistence of symptoms. An objective score test, the gastrointestinal quality of life index (GIQLI), was also administered.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 77 patients were identified: 17\u00a0men (22 %) and 60 women (78 %). The mean age at the time of fundoplication was 64 years (range 24\u201387 years) and at the review time 73 years (range 34\u201396 years). The amount of stomach contained within the PEH sac was &lt;50 % in 39 patients (50 %), &gt;50 % in 31 (40 %), and 100 % (intrathoracic stomach) in 7 (9.5 %). A 360\u00ba PTFe mesh was used to reinforce the repair in six cases and a polyethylene mesh in three. In May 2011, 55 of the 77 patients were available for interview (71 %), and the mean follow\u2010up was 107\u00a0months (range 48\u2013160\u00a0months). Altogether, 43 patients (66 %) were asymptomatic, and 12 (21 %) reported symptoms that included dysphagia in 7 patients, heartburn in 3, belching in 1, and chest pain in 1. Esophagography in 43 patients (78 %) revealed recurrence in 20 (46 %). All recurrences were small sliding hernias (&lt;3\u00a0cm long). In all, 37 patients (67 %) answered the GIQLI questionnaire. The mean GIQLI score was 111 (range 59\u2013137; normal 147). Patients with objective anatomic recurrence had a quality of life index of 110 (range 89\u2013132) versus 122\u00a0in the nonrecurrent hernia group (range 77\u2013138, <jats:italic>p<\/jats:italic> &lt; 0.01). Mesh was used to buttress the esophageal hiatus in nine patients. One patient died during the follow\u2010up period. Five of the remaining eight patients (62 %) developed dysphagia, a mesh\u2010related symptom. Three patients required reoperation because of mesh\u2010related complications. Esophagography revealed recurrence in four (50 %) of the eight patients. GIQLI scores were similar in patients with recurrence (126, range 134\u2013119) and without it (111, range 133\u2013186) (<jats:italic>p<\/jats:italic> &gt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Long\u2010term follow\u2010up (up to 160\u00a0months) in our study showed that laparoscopic PEH repair is clinically efficacious but is associated with small anatomic recurrences in \u226450 % of patients. Further studies are needed to identify the anatomic, pathologic, and physiological factors that may impair outcome, allowing the procedure to be tailored to each patient.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-013-2047-0","type":"journal-article","created":{"date-parts":[[2013,4,18]],"date-time":"2013-04-18T18:43:06Z","timestamp":1366310586000},"page":"1878-1882","source":"Crossref","is-referenced-by-count":42,"title":["Long\u2010Term Outcome and Quality of Life After Laparoscopic Treatment of Large Paraesophageal Hernia"],"prefix":"10.1002","volume":"37","author":[{"given":"Eduardo M.","family":"Targarona","sequence":"first","affiliation":[{"name":"Service of Surgery, Hospital Sant Pau Autonomous University of Barcelona Padre Claret, 167 08025 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Grisales","sequence":"additional","affiliation":[{"name":"Service of Surgery, Hospital Sant Pau Autonomous University of Barcelona Padre Claret, 167 08025 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ozlem","family":"Uyanik","sequence":"additional","affiliation":[{"name":"Service of Surgery, Hospital Sant Pau Autonomous University of Barcelona Padre Claret, 167 08025 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Balague","sequence":"additional","affiliation":[{"name":"Service of Surgery, Hospital Sant Pau Autonomous University of Barcelona Padre Claret, 167 08025 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Carlos","family":"Pernas","sequence":"additional","affiliation":[{"name":"Service of Radiology, Hospital Sant Pau Autonomous University of Barcelona Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Trias","sequence":"additional","affiliation":[{"name":"Service of Surgery, Hospital Sant Pau Autonomous University of Barcelona Padre Claret, 167 08025 Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,4,19]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thorsurg.2009.08.006"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605\u2010011\u20101690\u20108"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1072\u20107515(00)00260\u2010X"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464\u2010003\u20109227\u20101"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2009.03.008"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181ff44c0"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.10.005"},{"key":"e_1_2_7_9_2","first-page":"80","article-title":"Postoperative results after laparoscopic approach for treatment of large hiatal hernias: is mesh always needed? 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