Parahiatal Hernia Research Articles

A case of parahiatal hernia with vomiting, and a review of the literature

A case of parahiatal hernia with vomiting, and a review of the literature

Laparoscopic repair of parahiatal hernias with mesh: a retrospective study

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. In our institute, we retrospectively identified 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 performed for all of the patients, fundoplication wherever indicated and meshplasty in the cases with large defects. Gastropexy was performed for the patient with volvulus. 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/m2. The mean size of the defects was 18 cm2. 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 surgery. There were no conversions, recurrences or mortality. 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, effective and provides all of the benefits of minimally invasive surgery.

Laparoscopic Adjustable Gastric Banding in a Patient with an Incidental <I>Para-Hiatal</I> Hernia

Laparoscopic adjustable gastric banding (LAGB) in patients with a sliding hiatus hernia has become an accepted procedure. However, LAGB in patients with less common types of diaphragmatic hernia is rarely described. We report a super-super-obese woman with a para-hiatal hernia (non-hiatal, diaphragmatic hernia) where LAGB was performed. The para-hiatal hernia was successfully repaired laparoscopically at the same time that the LAGB was performed. A para-hiatal hernia is not a contraindication to LAGB and can be repaired at the same operation.

Long-term outcome of laparoscopic Nissen and Toupet fundoplication in normal and neurologically impaired children.

Laparoscopic fundoplication is a commonly performed procedure in children. This report describes the incidence of long-term recurrence and complications after laparoscopic Nissen or Toupet fundoplication in neurologically impaired and normal children. Fifty-three children operated on before 1999 were reviewed. All children were evaluated clinically and with a barium meal study thereafter. Symptomatic children and those with abnormal barium meal underwent 24 h pH monitoring. A total of 45 patients were included in the study. The mean follow-up was 4.5 years. All, except one asymptomatic child that declined, had a barium meal. Four were abnormal (2 parahiatal hernias and 2 slight episodes of reflux). Four patients had symptoms related to the operation and 2 to clinical recurrence. Only 1 asymptomatic child with slight reflux at barium meal revealed abnormal 24 h pH monitoring. Finally, 6.6% patients were found to have late recurrence (2 clinical and 1 pHmetry). There was an obvious increase in children's weight, especially in neurologically impaired patients. Laparoscopic antireflux surgery is of value in children with gastroesophageal reflux disease. The long-term results are comparable with open surgery, and there was no difference in term of wrap failure between neurologically impaired and normal children.

“True” parahiatal hernia: a rare entity radiologic presentation and clinical management

Background. True parahiatal diaphragmatic hernias are rare entities that are sparsely accounted for in the literature. The current report is intended to depict the clinical profile and assess the feasibility of laparoscopic repair of parahiatal hernias. Methods. We conducted a retrospective review of all patients diagnosed and treated for parahiatal hernias. Clinical presentation and radiological assessment, as well as operative findings and repair, are discussed. Results. Of the 917 laparoscopic hiatal hernia repairs, 2 (0.2%) patients were identified with a parahiatal hernia. The presenting symptoms and preoperative testing were similar to those with more common paraesophageal hernias. Laparoscopic repair was successful in repairing the diaphragmatic defect and alleviating symptoms up to 4 years postoperatively. Conclusions. Parahiatal hernias of the diaphragm appear to be rare primary diaphragmatic defects. The clinical presentation of parahiatal hernias is often indistinguishable from the more common paraesophageal pathology. Laparoscopic repair of this rare entity can be safely and successfully accomplished in conjunction with antireflux surgical interventions when indicated.

Laparoscopic management of giant paraesophageal herniation

Background. Many surgeons have found laparoscopic fundoplication effective management of medically recalcitrant gastroesophageal reflux disease (GERD) associated with sliding type I hiatal hernias. The anatomic distortion and technical difficulty inherent with repair has limited the use of laparoscopy for repair of “giant” paraesophageal hernias (gPH). Methods. Since July 1993, we have accomplished laparoscopic repair of paraesophageal hiatal hernias in 54 of 60 (90%) patients. Five patients had classic type II hernias with total intrathoracic stomachs, and 53 patients had large sliding/paraesophageal type III herniation. Two patients had true parahiatal hernias. None had gastric incarceration. Median age was 53 years and 28 of 60 (47%) were women. Chest pain and dysphagia were primary complaints from 39 of 60 (65%). Heartburn with or without regurgitation was present in 52 of 60 (85%). Preoperative manometry and prolonged pH testing were obtained on 43 of 60 (72%) and 44 of 60 (73%) patients, respectively. Principles of repair included reduction of the hernia, excision of the sac, crural approximation, and fundoplication over a 54F bougie (Nissen, 41; Dor, 1; Toupet, 18) to “pexy” the stomach within the abdomen and to control postoperative reflux. Results. Mean operative time was 202 ± 81 minutes. Conversion to “open” repair was required in 6 patients (iatrogenic esophageal injury in 2 patients and difficult hernia sac dissection in 4 patients). One postoperative mortality occurred as a result of sepsis and multiorgan failure after an intraoperative esophageal perforation. Follow-up barium swallow performed in 44 of 60 patients demonstrated recurrent hiatal hernias in 3 patients. Preoperative symptoms have been relieved in all but 3 patients. Reoperation for recurrent paraesophageal herniation has been required in these latter 3 patients. Conclusions. Although technically challenging, laparoscopic repair of paraesophageal hiatal hernias is a viable alternative to “open” surgical approaches. Control of the herniation and the patient’s symptoms are equivalent and hospitalization and return to full activity are shorter.

Diaphragmatic Hernia after Ivor-Lewis Esophagectomy Manifested as Lower Gastrointestinal Bleeding

Diaphragmatic hernia after esophageal resection is a recognized but rare complication. Parahiatal hernias may result from manipulation and extension of the crura during surgery. This can lead to a wide array of symptoms depending on the extent and organ that is herniated. A high index of suspicion is required because there is no one symptom that is specific for herniation. This report represents the first case of a patient presenting with lower gastrointestinal bleed from a parahiatal hernia after esophageal resection.

A 32-year experience in 100 patients with giant paraesophageal hernia: The case for abdominal approach and selective antireflux repair

Background. Giant paraesophageal hiatal hernia (GPEH) presents a risk of catastrophic complications that include massive bleeding, strangulation, and perforation and should be repaired. Controversy persists as to the surgical approach and whether an antireflux repair is required. Methods. This study reviews the experience with 100 patients with GPEH who underwent surgical repair between 1967 and 1999. Eighty patients underwent an elective operation, and 20 patients underwent an emergency procedure for complications of GPEH. The gastroesophageal junction was above the hiatus (“combined” hernia with sliding component) in 23 patients and in the abdomen in 77 patients, including 3 patients with a true parahiatal hernia. Results. A thoracic approach was used in 18 patients, mostly early in our experience; postoperative gastric volvulus requiring transabdominal repair developed in 2 patients. The remaining 82 patients underwent an abdominal repair, with temporary gastrostomy to prevent gastric displacement in 75 patients; the hernial sac was resected, and the hiatus was reconstructed in all of the patients. Thirty-five patients with reflux on preoperative work up underwent a fundoplication, with gastroplasty in 2 patients because of a short esophagus. No patient has experienced hernia recurrence. Whereas symptomatic relief was excellent in all patients with elective repair, mild reflux was present in 2 patients after emergency operation. There were no deaths among the patients who underwent elective operation; there were 2 hospital deaths among those patients who underwent emergency operation (10%). Conclusions. GPEH should be repaired soon after recognition. Reflux should be evaluated before the operation, and if present, fundoplication should be part of the repair along with the reduction of the hernia, excision of the sac, gastropexy, and crural closure. These are best achieved with an abdominal approach. (Surgery 2000;128:623-30.)

Parahiatal hernia with volvulus and incarceration: laparoscopic repair of a rare defect

A rare case of parahiatal hernia with gastric volvulus and incarceration is reported. An anatomically distinct diaphragmatic defect was present adjacent to a structurally normal esophageal hiatus. Laparoscopic repair was performed with excellent results.

Strangulated parahiatal hernia: Not just another paraesophageal hernia

Exploratory thoracotomy was necessary to establish the diagnosis of a rare incarcerated parahiatal hernia. Symptomatology, signs, and radiographic findings are compared with those of paraesophageal hernias.

Incarcerated Parahiatal Hernia with Gastric Necrosis

A parahiatal diaphragmatic hernia developed five years after transthoracic Heller myotomy. Failure to recognize this complication resulted in strangulation and necrosis of the gastric fundus. To our knowledge, this is the first reported case of a postoperative parahiatal hernia that did not follow the use of a diaphragmatic counterincision. Prompt recognition of this complication will prevent unnecessary morbidity and mortality.

Paraesophageal hernia.

THE multiplicity of terms that have been used to describe herniation of the stomach alongside the esophagus and into the posterior mediastinum suggest the confusion which exists concerning both the pathophysiology and the management of this disorder. Up-side-down stomach, rolling hernia, intrathoracic stomach, parahiatal, and paraesophageal hernia are only a few of the terms applied to this problem. With few exceptions, this condition has not been separated in the literature from sliding hernia, and yet the sequelae and management of the two conditions are entirely different. In textbooks published as recently as 1958,¹illustrations of what are called parahiatal hernia show a component of the diaphragm between the herniated stomach and the esophagus, with a separate opening adjacent to the esophageal hiatus through which the stomach reportedly herniates. A substantial segment of the diaphragm lying between the herniated stomach pouch and esophagus is described, but the anatomical details of

Upside-down stomach in a parahiatal hernia.

Medical Journal of AustraliaVolume 1, Issue 26 p. 925-926 Report of Case UPSIDE-DOWN STOMACH IN A PARAHIATAL HERNIA Richard Flynn, Richard Flynn SydneySearch for more papers by this author Richard Flynn, Richard Flynn SydneySearch for more papers by this author First published: 01 June 1953 https://doi.org/10.5694/j.1326-5377.1953.tb85042.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume1, Issue26June 1953Pages 925-926 RelatedInformation