Hernia (2008) 12:521–525 DOI 10.1007/s10029-008-0380-2 123 ORIGINAL ARTICLE Laparoscopic repair of parahiatal hernias with mesh: a retrospective study C. Palanivelu · M. Rangarajan · P. A. Jategaonkar · R. Parthasarathi · K. Balu Received: 14 December 2007 / Accepted: 18 April 2008 / Published online: 26 July 2008  Springer-Verlag 2008 Abstract Background Parahiatal hernias are very rare and distinct entities, the diagnosis of which is never made clinically. Laparoscopic repair has been reported in the literature. We present our experiences with the laparoscopic repair of this uncommon type of hernia. Patients and methods In our institute, we retrospectively identiWed a total of eight patients with parahiatal hernias from 1999 to 2007, of which four had primary and four had secondary defects. Laparoscopic crural repair was per- formed for all of the patients, fundoplication wherever indi- cated and meshplasty in the cases with large defects. Gastropexy was performed for the patient with volvulus. Results The male:female ratio was 5:3, with a mean age of 46 years and a mean body mass index (BMI) of 29.3 kg/m 2 . The mean size of the defects was 18 cm 2 . The mean blood loss during surgery was 50 ml, the mean operative time was 103.5 min and the mean hospital stay was 4 days. One patient had the recurrence of symptoms 1 month after sur- gery. There were no conversions, recurrences or mortality. Discussion Primary parahiatal hernias occur as a result of a congenital weakness and secondary defects follow hiatal surgery. The use of a mesh is advisable for large defects and defects of primary type. Secondary hernias following fundoplication do not need a redo fundoplication, but require an adequate crural repair with mesh. Laparoscopic repair of these uncommon hernias is safe, eVective and pro- vides all of the beneWts of minimally invasive surgery. Keywords Parahiatal hernias · Laparoscopic repair · Composite mesh Introduction A “true” parahiatal hernia occurs through a diaphragmatic defect situated just next to but distinct from an anatomically intact oesophageal hiatus [1]. This is usually found on the left side probably because the liver is situated on the right side, thus, protecting the diaphragm on that side. The con- tent of the sac is most often the fundus of the stomach, with a propensity to undergo volvulus. Scheidler et al. [2], in their recent large series of 917 laparoscopic hiatus hernia repairs, reported that only 0.2% patients were diagnosed to have this disease; underlining its remarkably rare incidence, as also reported by other authors. Although comparatively rare in occurrence, it can give rise to potentially life-threat- ening complications once diagnosed [3]. The laparoscopic management of these rare hernias has been reported in the literature [4]. Herein, we present our experiences with parahiatal hernias successfully managed laparoscopically. Materials and methods From August 1999 to July 2007, we retrospectively identi- Wed eight patients with parahiatal hernias in our centre. Out of these, four hernias were primary and four occurred fol- lowing prior surgery. The data on the four primary parahia- tal hernias was found as part of our series of 1,127 patients with hiatus hernias who underwent fundoplication. Out of C. Palanivelu (&) · M. Rangarajan · P. A. Jategaonkar · R. Parthasarathi · K. Balu GEM Hospital and Postgraduate Institute, 45-A, Pankaja Mill Road, Ramanathapuram, Coimbatore 641045, India e-mail: drcp@gemhospital.net