Parahiatal Hernia Research Articles

Laparoscopic repair of a primary parahiatal hernia combined with gastric volvulus: a case report and literature review

BackgroundParahiatal hernias present a hernial orifice at the diaphragm that is adjacent to the esophageal hiatus, differing from the paraesophageal type of hiatal hernias. Although diagnostic imaging has advanced in recent years, diagnosing parahiatal hernias remains challenging. We herein report a case in which we performed laparoscopic surgery and intraoperatively diagnosed a parahiatal hernia.Case presentationA 67-year-old man presented to our hospital with difficulty eating, epigastric pain, and vomiting. We suspected a paraesophageal hiatal hernia. Laparoscopic surgery was performed, and a diagnosis of parahiatal hernia was made. We closed the hernial orifice with direct simple closure using nonabsorbable threads. The patient’s postoperative recovery course was reasonable, and he was discharged on the twelfth postoperative day.ConclusionsParahiatal hernias are rare, and a definitive diagnosis is difficult. Laparoscopic surgery can help accurately diagnose and treat patients presenting with the condition.

True parahiatal hernia: a case of laparoscopic management for a rare type of diaphragmatic hernia

Parahiatal hernias are the rare variant of a diaphragmatic hernias. They are characterized by the formation of the neck of the hernia sac laterally to the diaphragm crura (usually the left), which distinguishes them from hiatal hernias. Hernia usually affects the fundus and body of the stomach, the esophagogastric junction remains below the level of the diaphragm, and clinical manifestations are associated with episodes of strangulation or axial volvulus. The article describes a case of parahiatal hernia complicated by chronic gastric volvulus with subsequent development of acute axial volvulus, which required urgent laparoscopic management.

Parahiatal hernia: A rare type of hernia and the answer to an anatomical challenge

Parahiatal hernias are rare. They are difficult to diagnose preoperatively, as the clinical symptoms may be similar to hiatal and paraoesophageal hernias. Here, we report two cases of parahiatal hernia that were preoperatively diagnosed and successfully repaired laparoscopically; using the particular anatomic characteristics of this hernia, we also review the controversial oesophageal hiatal anatomy, as the surgical community often refers to the left bundle of the right crus as the left crus. There is no consensus on the indication or surgical technique to repair them. The first case is a 59-year-old woman with non-specific abdominal symptoms, in whom the preoperative gastroscopy and computed tomography (CT) raised the suspicion for parahiatal hernia. The second case is a 68-year-old woman who presented to the emergency department with abdominal distention and nausea, but no vomiting. Preoperative CT raised the suspicion of an incarcerated parahiatal hernia. Both patients underwent laparoscopic repair of the parahiatal hernia and a Toupet fundoplication. They had an uneventful postoperative course. After more than 4 years of follow-up, they are both asymptomatic. Parahiatal hernias are a rare form of diaphragmatic hernia that occur through a diaphragmatic defect lateral to an anatomically normal oesophageal hiatus, with herniation of contents between the left portion of the right crus and the left crus. Up to five different anatomical variations have been described. The knowledge of these anatomical variations has an impact on the type of surgical repair that will need to be performed if a parahiatal hernia is found.

Type II hiatal hernias: do they exist or are they actually parahiatal hernias?

Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist? We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021. We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts. Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion.

V-016 PARAHIATAL HERNIA: A RARE CASE OF DIAPHRAGMATIC HERNIA ROBOTICALLY REPAIRED

Abstract Aim Parahiatal hernia is a rare type of diaphragmatic hernia, consisting in a adjacent but separated defect, lateral to the oesophageal hiatus and crus. It's not so familiar for surgeons, preoperative diagnosis is unlikely to be confirmed, and it is mostly found incidentally during intervention, leading to a complex and difficult repair. We present a case of parahiatal hernia robotically treated with the aim of emphasizing how robotic system can successfully help surgeons in performing even unexpected confusing and challenging anatomic dissections and procedures. Material and Methods A 65-year-old woman underwent robotic parahiatal hernia repair at our Institution. Four robotic trocars were positioned along the transverse umbilical line with the additional Air-seal port at the periumbilical left side for assistant's use. Dissection and isolation of both parahiatal defect and crural musculature were performed; the defect was closed with not absorbable barbed suture, conventional iatoplasty was also performed and a biosynthetic mesh was placed and fixed as a reinforcement. Results The duration of the intervention was of 100 minutes. No. intr- or post-operative complications occurred. Blood loss were inferior than 100 millilitres. The patient started oral intake at the second post-operative day and after discharged. At six months no recurrences were detected. Conclusions Parahiatal hernia are rare entities of which surgeons should be aware. Robotic treatment is safe and feasible and it represents a good tool for a successful management.

A Case of Parahiatal Hernia Treated by Laparoscopic Repair

A Case of Parahiatal Hernia Treated by Laparoscopic Repair

Gastric outlet obstruction secondary to omental fat in a parahiatal hernia resulting in a gastric volvulus.

Gastric outlet obstruction secondary to omental fat in a parahiatal hernia resulting in a gastric volvulus.

Concomitant Paraesophageal Parahiatal Hernia: a Rare Entity

Paraesophageal hernia (PEH) is herniation of fundus of the stomach or very rarely other abdominal structures like colon/spleen through a hiatal opening in the diaphragm, usually towards the left side. PEH comprises about 3.5–5% of all hiatal hernias. They are more common in elderly population. Laparoscopic management of PEH is the preferred treatment of choice especially in elderly patients. The concomitant occurrence of parahiatal hernia (PH) with PEH is a very rare scenario with only a handful number of cases reported in the literature. A 72-year lady patient presented to us with chief complaints of pain abdomen in the right upper quadrant region and vomiting intermittently for the last 6 months. Upper GI endoscopy showed the presence of hiatal hernia with GE junction at 37 cm. The patient underwent laparoscopic repair of hiatus and paraesophageal hernia. The pre-operative diagnosis of PH is difficult, a laparoscopic approach is helpful both as a diagnostic as well as therapeutic tool for treatment of PH. The various things to keep in mind while dealing with such rare cases are the patient’s profile, symptoms, expected complications and outcomes.

Parahiatal hernia in structure of hernias in region of esophageal diaphragmatic hiatus

Parahiatal hernia in structure of hernias in region of esophageal diaphragmatic hiatus

Another type of diaphragmatic hernia to remember: parahiatal hernia.

Parahiatal hernia is a less common form of diaphragmatic hernia, with the defect lateral to the crus and oesophageal hiatus, and the unfamiliarity of this disease would cause confusion to general surgeons. In the present study, the literature on parahiatal hernia were reviewed, the clinical profile of this disease, as well as our own experience is presented and analysed. In the present study, a thorough identification of all published reports on parahiatal hernias was made, together with our own cases, the available data were summarized, analysed and discussed. A total of 27 cases of parahiatal hernias were identified since 1987. Among them, 19 cases were primary parahiatal hernias, and eight cases were secondary or acquired parahiatal hernias. None of the 27 cases were pre-operatively diagnosed, and the majority of them were pre-operatively diagnosed as paraoesophageal hernias. Detailed treatment data were available in 26 of the 27 cases. Three patients received open surgery, and 23 patients were treated with laparoscopic procedures. Suture repair was used in 12 cases, and 14 cases were repaired with mesh reinforcement. In addition, two cases underwent partial gastrectomy, stomach suture was performed in another two cases. Patients with parahiatal hernia have a high risk of developing hernia incarceration or gastric vovulus. Laparoscopic treatment of parahiatal hernia is feasible and safe in the majority cases. Surgeons should be aware of this disease when performing paraoesophageal hernia repair, as parahiatal hernias may occur with or without previous diaphragmatic surgery.

Chronic Mesentero-Axial Gastric Volvulus Associated with a Parahiatal Diaphragmatic Hernia: A Rare Entity

Gastric volvulus, a rare entity, seldom presents with diaphragmatic hernia and is usually missed during preliminary workup (Demmy et al. in Ann Thorac Surg [Internet] 58(1):226–227, 2010). We present the case of a 55-year-old lady who presented with vomiting, pain upper abdomen, heartburns, and episodic unproductive retching for the past 6 months. The diagnosis of diaphragmatic hernia was made on erect chest X-ray and the barium study findings. Intraoperatively, a mesentero-axial gastric volvulus was found to be associated with a parahiatal hernia (Scheidler et al. in Ann Thorac Surg 73(2):416–419, 2002). The contents were reduced back into the abdomen, and diaphragmatic defect was approximated. Chronic gastric volvulus with or without diaphragmatic hernia should be kept as a differential in old age groups suffering from intractable dyspepsia unresponsive to conventional therapies (McElreath et al. in Dig Dis Sci 53(11):3033–3036, 2008; Teague et al. in Br J Surg 87(3):358–361, 2000).

564 – Laparoscopic Repair of a Combined Parahiatal and Hiatal Hernia with Mesh and Magnetic Sphincter Augmentation

564 – Laparoscopic Repair of a Combined Parahiatal and Hiatal Hernia with Mesh and Magnetic Sphincter Augmentation

PS01.066: LAPAROSCOPIC PARA-HIATAL HERNIA REPAIR

Abstract Description This is a video submission showing laparoscopic repair of a parahiatal hernia. The patient is a 44 year old female who presented with heartburn, regurgitation and chest pain. EGD and CT showed a type 3 paraesophageal hernia. Intra-operatively, we discovered instead a diaphragmatic defect adjact to the hiatus through which the stomach had herniated. Although this has been reported in some case reports it is uncommon. We approached the repair laparoscopically with dissection of the right and left crus followed by dissection of the parahiatal hernia and reduction of the stomach. We then repaired the hernia defect and reinforced the repair with mesh. We concluded with a Nissen fundoplication. Disclosure All authors have declared no conflicts of interest.

Laparoscopic repair of parahiatal hernia after esophagectomy: a case report

BackgroundDiaphragmatic hernia is a potential complication of esophagectomy, which usually occurs as a hiatal hernia and more frequently after minimally invasive esophagectomy. Parahiatal hernia is a rare form of diaphragmatic hernia, and to the best of our knowledge, parahiatal hernia after esophagectomy has not been previously reported. Here, we report a case of parahiatal hernia after esophagectomy that was successfully managed laparoscopically.Case presentationA 73-year-old man underwent thoracoscopic esophagectomy for esophageal cancer with gastric tube reconstruction via the posterior mediastinum. Postoperative morbidity was ileus, which required conservative treatment, and intestinal obstruction for which operation with laparotomy was necessary. He was admitted with abdominal pain and vomiting at 15 months after esophagectomy. Abdominal X-ray revealed colon gas in the intrathoracic space. A barium enema examination showed a transverse colon incarcerated in the intrathoracic space. The patient was preoperatively diagnosed with hiatal hernia after esophagectomy, and laparoscopic hernia repair was performed. During the surgery, the hiatus was found to be intact, and the defect was clearly separated from the left crus of the diaphragm. Parahiatal hernia was the operative diagnosis. The incarcerated colon was repositioned in the abdominal cavity, and the defect was repaired using a composite mesh.ConclusionsLaparoscopic surgery was found to be effective for the diagnosis and repair of parahiatal hernia.

Robotic repair of a parahiatal hernia with gastric volvulus

Abstract Parahiatal hernias are rare and distinct subtype of diaphragmatic hernia, which is very difficult to diagnose clinically. Laparoscopic repair has been reported in the literature. We report a case of parahiatal hernia with gastric volvulus, which was repaired successfully by robotic surgery along with gastropexy. We present the case of a 50-year-old male who presented with vomiting and epigastric pain. His CT scan showed a giant parahiatal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic and large, making a tension-free primary repair difficult. A prolene mesh repair was done and two point gastropexy to the anterior abdominal wall was performed robotically. Recovery was uneventful and the patient was discharged on the 5th postoperative day. He remained asymptomatic at subsequent follow-up. Robotic repair of parahiatal hernia can be safely performed with advantage of robotic surgery in this difficult access area. In circumstances where a large defect prevents a tension-free primary repair, the use of a mesh can provide effective repair of the hernia defect.

Para-oesophageal and parahiatal hernias in an Asian acute care tertiary hospital: an underappreciated surgical condition.

The prevalence of hiatal hernias and para-oesophageal hernias (PEHs) is lower in Asian populations than in Western populations. Progressive herniation can result in giant PEHs, which are associated with significant morbidity. This article presents the experience of an Asian acute care tertiary hospital in the management of giant PEH and parahiatal hernia. Surgical records dated between January 2003 and January 2013 from the Department of Surgery, Changi General Hospital, Singapore, were retrospectively reviewed. Ten patients underwent surgical repair for giant PEH or parahiatal hernia during the study period. Open surgery was performed for four patients with giant PEH who presented emergently, while elective laparoscopic repair was performed for six patients with either giant PEH or parahiatal hernia (which were preoperatively diagnosed as PEH). Anterior 180° partial fundoplication was performed in eight patients, and mesh reinforcement was used in six patients. The electively repaired patients had minimal or no symptoms during presentation. Gastric volvulus was observed in five patients. There were no cases of mortality. The median follow-up duration was 16.3 months. There were no cases of mesh erosion, complaints of dysphagia or recurrence of PEH in all patients. Giant PEH and parahiatal hernia are underdiagnosed in Asia. Most patients with giant PEH or parahiatal hernia are asymptomatic; they often present emergently or are incidentally diagnosed. Although surgical outcomes are favourable even with a delayed diagnosis, there should be greater emphasis on early diagnosis and elective repair of these hernias.

Iatrogenic Parahiatal Hernia with Gastric Herniation and Necrosis after Robotic Hiatal Hernia Repair

Iatrogenic Parahiatal Hernia with Gastric Herniation and Necrosis after Robotic Hiatal Hernia Repair

Laparoscopic mesh repair of parahiatal hernia: A case report

We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51-year-old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension-free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow-up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension-free primary repair, the use of a composite mesh can provide effective repair of the hernia.

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.

鏡視下手術で治療した胃軸捻を伴う横隔膜傍裂孔ヘルニアの1例

鏡視下手術で治療した胃軸捻を伴う横隔膜傍裂孔ヘルニアの1例