Long Term Results of Surgery for Paraesophageal and Mixed types of Hiatus Hernia.

Background. To assess the long-term results of one center in which particular attention was paid to the length of the oesophagus and the reinforcement of the diaphragmatic pillars while performing surgery. Methods. In the period 1980-2006, 85 patients were operated upon. The reinforcement of the hiatoplasty, more often with dacron pledgets was performed in 75%. The Collis procedure was performed in 21.17 %. I patient(l.l7%) died for Collis fistula, I patient(l.l7%) had partial intrathoracic migration of the gastroplasty and was reoperated upon five days after, 3 patients (3.5%) had pleuric effusion, I patient(l.l7%) had atrial fibrillation, I patient(l.l7%) had PNX. Patients were periodically controlled with clinical interview, UGI tract endoscopy and barium swallow. Results. The median follow up of 84 months. Hiatus hernia relapse occurred in the whole in 7.3 % and in detail in 0 % of thoracic, 10.5% of laparotomic, 0% mini-invasive, 15% of not reinforced hiatoplasty, in 4.68% of reinforced hiatoplasty, 8.69% in standard antireflux procedures and in 0 Collis +antireflux procedures. According to symptoms and oesophagitis results were excellent and good in 84.3%, fair (mild symptoms and hyperemia) in 10.9% and poor (reflux symptoms and or dysphagia + erosive oesophagitis) in 4.8%. In the whole poor results (symptoms + oesophagitis and /or hernia relapse) occurred in 7.3%. Conclusion; Long-term results of surgery for complex hiatus hernias are satisfactory if careful attention is paid to short oesophagus and the diaphragmatic pillars reinforcement. The mini-invasive techniques appear valid but need further follow up.