Type Of Diaphragmatic Hernia Research Articles

CT diagnosis of intermittent type IV paraoesophageal hernia in a dog

In hiatal hernia, elements of the abdominal cavity herniate through the oesophageal hiatus into the mediastinum. Although they are uncommon in both human and veterinary medicine, patients can develop significant...

Right-sided Bochdalek hernia in an elderly adult: a case report with a review of surgical management

BackgroundBochdalek hernias are one of the most common types of diaphragmatic hernia, with most cases diagnosed during the neonatal period. In contrast, diagnosis of a Bochdalek hernia in an adult is rare and is typically observed on the left side of the diaphragm. Even more rare is the diagnosis of a right-sided Bochdalek hernia in an adult, where there is concurrent visceral malformation in most cases.Case presentationWe describe a case of an 89-year-old female who presented with abdominal pain. An abdominal computed tomography (CT) scan showed decreased intravenous contrast uptake and thickening of the wall of herniated small intestine through the right side of the diaphragm, which led to the diagnosis of a strangulated diaphragmatic hernia. The patient underwent emergent laparotomy and required a partial resection of the necrotic ileum and a hernia repair with direct closure. Interestingly, in this case, organ malformation was not observed. The patient was discharged approximately 2 weeks after surgery without complication.ConclusionsAdult right-sided Bochdalek hernia with strangulation in the absence of hepatic atrophy is a rare entity. Considering the severity of this condition, accurate diagnosis and proper treatment are needed. A tailored operative approach is required on an individual case basis.

Minimally invasive therapy of upside-down stomach: A single-center experience

Introduction: The aim of this study is to evaluate short-term and long-term outcomes of minimally invasive therapy in Type IV hiatal hernia (upside-down stomach). Patients and Methods: A retrospective study of 58 consecutively operated patients with Type IV hiatal hernia between 1998 and 2015 was conducted. Short-term outcome was evaluated using Clavien-Dindo classification and long-term outcomes using phone survey and subjective assessment of patients at least 1 year following surgery. Results: Laparoscopic hiatoplasty was performed in all patients, with gastropexy in 55.2%, fundoplication in 39.6%, and combination of fundoplication and gastropexy in 5.2%. Complications were observed in 6.9%. Two early reoperations (within 30 days) due to acute reherniation were necessary. Adverse events occurred in seven cases – pleural opening and peroperative bleeding. Three patients were reoperated laparoscopically 2–17 months after the first surgery due to receiving partial stomach herniation. In 67.2% of patients, long-term subjective quality of life assessment was available. Eighty percent of them were completely satisfied, without recurrence of preoperative symptoms. Conclusion: Elective laparoscopic surgery of hiatal hernia Type IV is a safe procedure, which has all the benefits of minimally invasive therapy with favorable short- and long-term results.

Prenatal ultrasound diagnosis of fetal diaphragmatic hernia

Objective : To evaluate the prenatal ultrasound detection in the diagnosis of fetal diaphragmatic hernia. Methods : After routine prenatal ultrasonic examination in pregnant women, the suspected fetal diaphragmatic hernia cases were taken thoracic and abdominal multidetector continuous scanning, focus on the following ultrasonic appearance: abnormal echo in thoracic cavity, image features and the blood supply of the echo, displacement of the heart, position and structure of abdominal organs. In order to determine the existence and the type of diaphragmatic hernia, other malformations screening was practiced simultaneously. Results : 25 cases with fetal diaphragmatic hernia were detected by ultrasonography and clinic approved with 26 cases, only 1 case missed. Among the 26 cases of fetal diaphragmatic hernia,there were 23 cases of left side diaphragmatic hernia（88.5%,23/26), 3 cases of right side diaphragmatic hernia（11.5%, 3/26）. 11 cases of fetal diaphragmatic hernia complicated with other organ abnormal(42.3%，11/26). 17 cases of fetaldiaphragmatic hernia complicated with polyhydramnios (65.4％，17/26）. Conclusions : Prenatal ultrasound can accurately diagnose the fetal diaphragmatic hernia, it is indeed valuable in clinical application.

Laparoscopic treatment of type III and IV hiatal hernia - authors' experience.

IntroductionThere are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases.AimTo analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias.Material and methodsA total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis.ResultsAs many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life.ConclusionsThe laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia.

Hiatal Hernias: Why and How Should They Be Surgically Treated?

IntroductionThere is controversy in the literature about the choice of expectant medical treatment vs surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. Patients and methodA total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. ResultsIn 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (P<.05). Type iv hernias (complex) and those with diameters measuring more than 16cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type IV complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type III hernia and severe oesophagitis required reoperation. ConclusionWe recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality.

Hernias hiatales: ¿cuándo y por qué deben ser operadas?

IntroductionThere is controversy in the literature about the choice of expectant medical treatment versus surgical treatment of hiatal hernias, depending on the presence or absence of symptoms. This study presents the results obtained by our group, considering disease duration and postoperative results. Patients and methodA total of 121 patients were included and divided by age, disease duration, type of hiatal hernia and postoperative outcome. ResultsIn 32% of the patients younger than 70 years, symptom duration was longer than 11 years and 68% of those aged more than 71 years had long-term symptoms (p<.05). Type iv hernias (complex) and those with diameters measuring more than 16cm were observed in the group with longer symptom duration. Complications were more frequent in the older age group, in those with longer symptom duration and in those with type iv complex hernias. There was no postoperative mortality and only one patient (0.8%) with a type iii hernia and severe oesophagitis required reoperation. ConclusionWe recommend that patients with hiatal hernia undergo surgery at diagnosis to avoid complications and risks. Older patients should not be excluded from surgical indication but should undergo a complete multidisciplinary evaluation to avoid complications and postoperative mortality.

Assistive esophagoscopy during laparoscopic surgery for intra-thoracic stomach

Background Intra-thoracic stomach (ITS) is a rare type of hiatal hernia. Laparoscopic surgery for ITS is technically demanding due to the distorted surgical anatomy. We incorporated assistive esophagoscopy during laparoscopic surgery for ITS. In this study, we assessed the clinical value of esophagoscopy in laparoscopic surgery.

Laparoscopic repair of secondary parahiatal hernia with incarceration of the stomach: a case report

IntroductionParahiatal hernia is an extremely rare subtype of hiatal hernia, which in turn is a type of diaphragmatic hernia in adults, and only a few cases have been reported to date. We report the case of a patient who suffered from gastric incarceration through an anatomically separate diaphragmatic defect, immediately lateral to a structurally normal esophageal hiatus, that developed after treatment of a malignant mesothelioma.Case presentationA 70-year-old Japanese man, who had undergone treatment for a left malignant pleural mesothelioma a year ago at another hospital, was referred to our institution following a 4-day history of epigastric pain. Esophagogastroscopy demonstrated a normal esophagogastric junction, with remarkable stenosis and active gastric ulcer of the gastric body. Histopathological examination of the gastric biopsy specimen confirmed a gastric ulcer. Furthermore, computed tomography revealed a large fluid-filled structure in the retrocardiac space. On the basis of preoperative data, we decided to attempt laparoscopic repair for the gastric volvulus. During surgery, gastric and omental herniation was observed within a peritoneal lined defect immediately lateral to the esophageal hiatus. Dissection near the esophageal hiatus revealed a discrete extrahiatal defect 3cm in diameter immediately adjacent to the left crus of the diaphragm. The parahiatal defect was closed using interrupted nonabsorbable heavy suture. The patient’s postoperative course was uneventful, and anastomotic leakage was not observed at postoperative barium swallowing.ConclusionsAlthough preoperative diagnosis of parahiatal hernia is difficult, a laparoscopic approach can be a useful therapeutic procedure not only for paraesophageal hernia but also for parahiatal hernia.

Laparoscopic repair of a huge paraoesophageal hernia

Background — Aim There are four main types of hiatal hernia (HH), mainly caused by increased intraabdominal pressure. This condition may lead to disturbing symptoms and sometimes dangerous complications. The aim of this study is to highlight the essential elements of proper surgical correction of a paraoesophageal (type III) HH, based on a case we managed laparoscopically.

Vascular diaphragmatic hernia in a patient with cirrhosis first case report

We report the case of an adult patient recently diagnosed with cirrhosis. The ultrasound evaluation described a multinodular inhomogeneous liver, requiring a magnetic resonance imaging scan for further characterization. The performed magnetic resonance imaging examination confirmed the diagnosis of cirrhosis associated with portal hypertension and detected a vascular left transdiaphragmatic hernia. Although various types of diaphragmatic hernias have been described - congenital or acquired - to the best of our knowledge, this type of pathology has never been reported.

Preliminary Study of Hiatal Hernia Repair Using Polyglycolic Acid: Trimethylene Carbonate Mesh

Repairing large hiatal hernias using mesh has been shown to reduce recurrence. Drawbacks to mesh include added time to place and secure the prosthesis as well as complications such as esophageal erosion. We used a laparoscopic technique for repair of hiatal hernias (HH) >5cm, incorporating primary crural repair with onlay fixation of a synthetic polyglycolicacid:trimethylene carbonate (PGA:TMC) absorbable tissue reinforcement. The purpose of this report is to present short-term follow-up data. Patients with hiatal hernia types I-III and defects >5cm were included. Primary closure of the hernia defect was performed using interrupted nonpledgeted sutures, followed by PGA:TMC mesh onlay fixed with absorbable tacks. A fundoplication was then performed. Evaluation of patients was carried out at routine follow-up visits. Outcomes measured were symptoms of gastroesophageal reflux disease (GERD), or other symptoms suspicious for recurrence. Patients exhibiting these complaints underwent further evaluation including radiographic imaging and endoscopy. Follow-up data were analyzed on 11 patients. Two patients were male; 9 were female. The mean age was 60 years. The mean length of follow-up was 13 months. There were no complications related to the mesh. One patient suffered from respiratory failure, one from gas bloat syndrome, and another had a superficial port-site infection. One patient developed a recurrent hiatal hernia. In this small series, laparoscopic repair of hiatal hernias >5cm with onlay fixation of PGA:TMC tissue reinforcement has short-term outcomes with a reasonably low recurrence rate. However, due to the preliminary and nonrandomized nature of the data, no strong comparison can be made with other types of mesh repairs. Additional data collection is warranted.

Clinical Significance of Hiatal Hernia

The relationship between hiatal hernias and gastroesophageal reflux disease (GERD) has been greatly debated over the past decades, with the importance of hiatal hernias first being overemphasized and then later being nearly neglected. It is now understood that both the anatomical (hiatal hernia) and the physiological (lower esophageal sphincter) features of the gastroesophageal junction play important, but independent, roles in the pathogenesis of GERD, constituting the widely accepted "two-sphincter hypothesis." The gastroesophageal junction is an anatomically complex area with an inherent antireflux barrier function. However, the gastroesophageal junction becomes incompetent and esophageal acid clearance is compromised in patients with hiatal hernia, which facilitates the development of GERD. Of the different types of hiatal hernias (types I, II, III, and IV), type I (sliding) hiatal hernias are closely associated with GERD. Because GERD may lead to reflux esophagitis, Barrett's esophagus and esophageal adenocarcinoma, a better understanding of this association is warranted. Hiatal hernias can be diagnosed radiographically, endoscopically or manometrically, with each modality having its own limitations, especially in the diagnosis of hiatal hernias less than 2 cm in length. In the future, high resolution manometry should be a promising method for accurately assessing the association between hiatal hernias and GERD. The treatment of a hiatal hernia is similar to the management of GERD and should be reserved for those with symptoms attributable to this condition. Surgery should be considered for those patients with refractory symptoms and for those who develop complications, such as recurrent bleeding, ulcerations or strictures.

Intraoperative Measurement, Classification, And Abbreviated Description Of Hiatal Hernias

Aim: Classification of hiatal hernias should include the main parameters for intraoperative selection of the surgical treatment method. Abbreviated descriptions of hiatal hernias, such as HH I-IV are not complete and need further development. Methods: We have perfected a classification of hiatal hernias and used it in clinical practice to classify hernias in 75 patients who underwent surgical treatment. Four recognized types of hiatal hernias (HH) were used. Type I (sliding) hernias have the gastroesophageal (GE) junction above the level of the diaphragmatic hiatus. Type II (rolling) hernias have a normally positioned GE junction, but a portion of the fundus is above the hiatus. Type III hernias have displacement of the GE junction and fundus above the hiatus and type IV hernias are characterized by the presence of other viscera within the hernia sac. The width (W) defect between the right and left diaphragmatic crura is the most important size measurement that determines the difficulty of successfully repairing the hiatal hernia, with W1 8 cm. The length (L) of the hernia defect was defined as the vertical distance in cm between the high and low point of hiatal orifice with L1 4 cm. We considered that hiatal hernia recurrence (R) after previous repair should be included in the classification with R0, no recurrence and R (n), the number of previous hernia repairs.Results: Our perfected classification was in the format: HH I-IV; W1-4; L1-3; SE 0-2; R 0-n. According to our data, the parameters of hiatal hernia were formulated in most cases (49/75) as HH I; W 2; L 2; SE 0; R 0, which represented the prevalence of patients with sliding hernia with secondary width and length of the esophageal orifice, without shortening esophagus or recurrence.Conclusions: Our classification allows abbreviated description of the main intraoperative parameters of hiatal hernia, which facilitates the choice of the surgical treatment method.

Congenital Morgagni’s Hernia Presenting in Elderly Lady

Morgagni's hernia is an uncommon type of congenital diaphragmatic hernia. Large numbers are symptomatic but some may present in middle aged. Our patient was asymptomatic till 63years of age. X-ray chest, for her recent onset exertional dyspne, was suspicious of right lung mass. CT thorax revealed right Morgagni's type of diaphragmatic hernia, a very rare diagnosis at that age.

Hemorrhagic Pleural Effusion Secondary to an Unusual Type III Hiatal Hernia in a 4-Year-Old Great Dane

An unusual case of combined axial and paraesophageal (type III) hiatal hernia (HH) in a 4-year-old Great Dane is reported. The main presenting complaint was dyspnea, and no history of trauma was present. A tentative diagnosis of HH with secondary pleural effusion was made based on clinical signs and radiographic findings. Exploratory celiotomy revealed herniation of the gastric cardia, fundus, and body through the esophageal hiatus and an adjacent, distinct defect in the diaphragm. Rupture of the short gastric vessels lead to the formation of a hemorrhagic pleural effusion that impaired ventilation. The esophageal hiatus was surgically reduced in size, and the second defect was closed with nonabsorbable sutures. Esophagopexy and tube gastropexy procedures were also performed. The dog was clinically normal 9 months postoperatively. This type of HH is not currently defined within the traditional classification system and to the authors' knowledge has not been previously reported.

Relationship of the frequency scale for symptoms of gastroesophageal reflux disease with endoscopic findings of cardiac sphincter morphology

Kusano et al. developed a questionnaire for the evaluation of gastroesophageal reflux disease (GERD), the frequency scale for the symptoms of GERD (FSSG). The FSSG is now widely used in Japan. We investigated the relationship between FSSG results and cardiac sphincter endoscopic findings. The subjects were 470 patients who responded to the FSSG before undergoing endoscopy. From the FSSG results, we calculated the total, acid reflux, and dysmotility scores. Endoscopic findings were assessed in terms of the anatomic-functional-pathological (AFP) classification as the A factor, or degree and type of hiatal hernia, and the valve factor, or laxity of the cardiac sphincter. The degree of esophagitis was assessed using the modified Los Angeles classification. We investigated correlations between each score and the anatomy of the cardia. With either definition of esophagitis (grade M or greater, or grade A or greater), the total and acid reflux scores were both significantly higher in the group with reflux esophagitis than in the group without reflux esophagitis. Examination of the relationship between FSSG scores and the A factor revealed no significant differences in the total, acid reflux, or dysmotility scores whether a hiatal hernia was present or absent. Similarly, examination of the valve factor showed no significant difference in any scores between V0 and V1 versus V1 and V2, indicating no correlation between cardiac sphincter laxity and FSSG scores. The FSSG was useful in determining whether reflux esophagitis is present, but it did not predict the anatomy of the cardia.

Hiatal Hernia: An Uncommon Presentation of Chest Pain

Chest pain presents a diagnostic challenge with a long list of differential diagnosis. Chest pain due to gastrointestinal causes includes esophagitis, GERD, gastritis, esophageal spasms and rarely pancreatitis, cholecystitis and peptic ulcer disease. Here we present an uncommon cause of chest pain: hiatal hernia (HH). HH can be life threatening if not diagnosed and treated early. This case report reviews the different types of HH with symptoms and signs, diagnosis and therapeutic options.

Intrathoracic drainage of a perforated prepyloric gastric ulcer with a type II paraoesophageal hernia

BackgroundWith an incidence of less than 5%, type II paraesophageal hernias are one of the less common types of hiatal hernias. We report a case of a perforated prepyloric gastric ulcer which, due to a type II hiatus hernia, drained into the mediastinum.Case presentationA 61-year old Caucasian man presented with acute abdominal pain. On a conventional x-ray of the chest a large mediastinal air-fluid collection and free intra-abdominal air was seen. Additional computed tomography revealed a large intra-thoracic air-fluid collection with a type II paraesophageal hernia. An emergency upper midline laparotomy was performed and a perforated pre-pyloric gastric ulcer was treated with an omental patch repair. The patient fully recovered after 10 days and continues to do well.ConclusionType II paraesophageal hernia is an uncommon diagnosis. The main risk is gastric volvulus and possible gastric torsion. Intrathoracic perforation of gastric ulcers due to a type II hiatus hernia is extremely rare and can be a diagnostic and treatment challenge.

Hiatal Hernia: An Uncommon Presentation of Chest Pain

Chest pain presents a diagnostic challenge with a long list of differential diagnosis. Chest pain due to gastrointestinal causes includes esophagitis, GERD, gastritis, esophageal spasms and rarely pancreatitis, cholecystitis and peptic ulcer disease. Here we present an uncommon cause of chest pain: hiatal hernia (HH). HH can be life threatening if not diagnosed and treated early. This case report reviews the different types of HH with symptoms and signs, diagnosis and therapeutic options.