A Safe and Effective Technique of Paraesophageal Hernia Reduction Using Combined Laparoscopy and Nonsutured PEG Gastropexy in High-Risk Patients.

backgroundParaesophageal hernias (PHs) can cause significant morbidity and even mortality in untreated patients. While formal surgical repair remains the ideal treatment option, patients who are elderly and/or frail and who have with multiple comorbidities may be unsuitable candidates for a surgical repair. We present a case series of 5 patients treated with a combined laparoscopic reduction of PH and 2-point percutaneous endoscopic gastropexy (PEG).

methodsData on the 5 patients were collated, and a review of the literature was performed to determine similar cases and outcomes.

resultsFive elderly patients (mean age 80 y, range 71-89 y) with significant existing comorbidities (average ASA 3) presented acutely with large PH at our institution. All had abdominal pain, nausea/vomiting, symptoms of gastric outlet obstruction, and an element of hypoxia. Computed tomography examination results confirmed the diagnosis. Because the patients were elderly and frail, a formal surgical repair of the PHs was not feasible. A combined laparoscopy/PEG gastropexy was undertaken to reduce the PH, and a 2-point PEG fixation was performed. Four of the 5 patients returned to normal oral intake before discharge. A fifth patient was successfully fed via the PEG. There were no complications, and all were discharged to their usual place of residence.

conclusionA combination of laparoscopic reduction and nonsutured PEG gastropexy is a safe and effective alternative treatment for high-risk patients (with significant morbidity and mortality) with symptomatic PHs. Most patients (80%) returned to normal oral intake postprocedure and were discharged home within 3 d.