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Invited Commentary

Lee L. Swanstrom, MD
Arch Surg. 1997;132(6):591. doi:10.1001/archsurg.1997.01430300033006.
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Dr Perdikis and his coauthors have presented a large series of laparoscopic paraesophageal hernia (PEH) repairs with excellent results, including an average operative time of only 2 hours! These results should be taken as a measure of this group's operative experience rather than as a gauge of this procedure's difficulty. Laparoscopic PEH repairs (or open PEH repair for that matter) are very difficult procedures. Even considering this group's expertise, they describe a greater morbidity for PEH repair with operative complications of 14%, a 3% conversion rate, and 20% of patients having postoperative problems requiring treatment (4% requiring a second operation, 6% requiring esophageal dilatation for dysphagia, 4% with reflux, and 6% with other complications). This is particularly remarkable when compared with the same group's results with elective antireflux surgery (3% conversion rate, 4% operative complications, and a 1.5% rate of postoperative failure requiring treatment)1 The increase in morbidity and

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