Laparoscopic repair of paraesophageal hernia requires cautious enthusiasm.

The article tries to address the dilemma confronting the repair of paraesophageal hernia (PEH). The case has been made for repair upon diagnosis. The initial results of laparoscopic repair were projected as successful. However, recurrence and reflux have plagued many studies. Whereas adjunct fundoplication is now consistently performed by most surgeons, the basis is uncertain. Recurrence rate is often higher than that reported if only the 'imaged' follow-up patients are considered. Esophageal lengthening is believed to potentially benefit both the hallmark complications. The worldwide experience with laparoscopic esophageal lengthening is scanty (although it was not uncommon in the days of open surgery). Compared to the open repair, the laparoscopic method has a higher recurrence rate, higher major specific complication rate, comparable symptom outcome and a shorter hospital stay.