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 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.
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/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.
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, effective and provides all of the benefits of minimally invasive surgery.
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References
Flynn R (1953) Upside-down stomach in a parahiatal hernia. Med J Aust 1:925–926
Scheidler MG, Keenan RJ, Maley RH, Wiechmann RJ, Fowler D, Landreneau RJ (2002) “True” parahiatal hernia: a rare entity radiologic presentation and clinical management. Ann Thorac Surg 73:416–419
Demmy TL, Boley TM, Curtis JJ (1994) Strangulated parahiatal hernia: not just another paraesophageal hernia. Ann Thorac Surg 58:226–227
Aragaki M, Kojima T, Hiraguchi E, Murakami T, Matsumoto J, Teramoto K (2006) Laparoscopic surgery for parahiatal type of diaphragmatic hernia—report of a case. Jpn J Gastroenterol Surg 39:1577–1581
Ellis FH Jr (1990) Diaphragmatic hiatal hernias. Recognizing and treating the major types. Postgrad Med 88:113–124
Chattopadhyay A, Prakash B, Kumar V, Nagendhar Y (2003) Parahiatal hernia with gastric obstruction in a child. Indian J Gastroenterol 22:107–108
Naunheim KS, Baue AE (1994) Paraesophageal hiatal hernia. In: Shields TW (ed) General thoracic surgery, 4th edn. Williams & Wilkins, Baltimore, p 645
Choi YU, North JH Jr (2001) Diaphragmatic hernia after Ivor-Lewis esophagectomy manifested as lower gastrointestinal bleeding. Am Surg 67:30–32
Vallieres E, Waters PF (1987) Incarcerated parahiatal hernia with gastric necrosis. Ann Thorac Surg 44:82–83
Rodefeld MD, Soper NJ (1998) Parahiatal hernia with volvulus and incarceration: laparoscopic repair of a rare defect. J Gastrointest Surg 2:193–197
Geha AS, Massad MG, Snow NJ, Baue AE (2000) A 32-year experience in 100 patients with giant paraesophageal hernia: the case for abdominal approach and selective antireflux repair. Surgery 128:623–630
Puhalla H, Lenglinger J, Bischof G, Miholic J, Függer R, Stacher G (2002) Nissen and Toupet laparoscopic fundoplication in patients with gastroesophageal reflux and motility disorders of the distal esophagus. Chirurg 73:230–234
Streitz JM Jr, Ellis FH Jr (1990) Iatrogenic paraesophageal hiatus hernia. Ann Thorac Surg 50:446–449
Draaisma WA, Gooszen HG, Tournoij E, Broeders IAMJ (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19:1300–1308
Trus TL, Bax T, Richardson WS, Branum GD, Mauren SJ, Swanstrom LL, Hunter JG (1997) Complications of laparoscopic paraesophageal hernia repair. J Gastrointest Surg 1:221–228
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Palanivelu, C., Rangarajan, M., Jategaonkar, P.A. et al. Laparoscopic repair of parahiatal hernias with mesh: a retrospective study. Hernia 12, 521–525 (2008). https://doi.org/10.1007/s10029-008-0380-2
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DOI: https://doi.org/10.1007/s10029-008-0380-2