Paraesophageal hernia

Multiple complicated concurrent hernias with obturator hernia and paraesophageal hernia unusually occur in clinical settings. The obturator hernias belong to a rare pelvic hernia that accounts for a minority of all abdominal hernias. Besides, paraesophageal hernias occur commonly in elderly female patients. Clinical manifestations of these hernias are usually unspecific and the diagnosis is based on computed tomography (CT). In this paper, we presented a case of multiple complicated hernias in an 81-year-old woman...

BACKGROUND: Paraesophageal hernia repairs (PEHRs) have high rates of radiographic recurrence, with some patients requiring repeat operation. This study characterizes patients who underwent PEHR to identify the factors associated with postoperative symptom improvement and radiographic recurrence. We furthermore use propensity score matching to compare patients undergoing initial and reoperative PEHR to identify the factors predictive of recurrence or need for reoperation. METHODS: After IRB approval, patients who underwent PEHR at a tertiary care center between January 2018 and December 2022 were identified...

A Bochdalek hernia is a rare congenital diaphragmatic hernia often diagnosed in infancy and classically occurring on the left side. We report a case of a 78-year-old female who presented with a right-sided posterolateral diaphragmatic hernia containing multiple loops of bowel with evidence of ischemia as well as a type 4 paraesophageal hernia. The stomach was rotated on the organoaxial plane, and the duodenum was within the mediastinum. The patient was taken emergently for an exploratory laparotomy. A posterolateral hernia defect containing 50 cm of strangulated small bowel was identified and resected, a primary stapled enteroenterostomy was performed and the hernia defect was repaired primarily...

Hiatal hernias, protrusions of abdominal viscera through the esophageal hiatus, are classified into four types. Types I and II involve ascent of the stomach without affecting the gastroesophageal junction. Types III and IV involve the gastroesophageal junction. Type IV specifically may have stomach as well as other abdominal organ involvement, such as pancreas or omentum. Among these types, type IV is the most complex and rare form, accounting for only 0.1% of all cases of hiatal hernias. This report presents a case of a type IV hiatal hernia involving the lesser omentum and a significant portion of the stomach in an 86-year-old male cadaver with a history of mediastinal surgery...

Background: Indications for combined colon surgery together with other procedures include oncologic multivisceral resections and abdominal trauma. It is unclear if combining minimally invasive (MI) colon surgery with unrelated other procedures increases the risk for complications. Patients and Methods: The surgical database from two institutions during a 10-year period was queried for combined colon surgeries together with other interventions. All open cases, combined cases performed for one pathology and MI colectomies together with a minor procedure, were excluded...

BACKGROUND AND OBJECTIVE: The adoption of robotic surgery for general thoracic surgery has rapidly progressed over the last two decades from its application in basic operations to complex pathologies. As such, the purpose of this narrative review is to highlight the collective experience of tackling complex thoracic surgical operations with minimally invasive robotic solutions. METHODS: Electronic searches of PubMed were conducted for each subtopic, using specific keywords and inclusion criteria...

The management of giant hiatal hernias (HHs) remains challenging and is associated with a high risk of recurrence. Currently, several strategies are used to reduce recurrence, and a newly proposed trend is the administration of adjuvant botulinum toxin type A (BTX), a procedure already performed in complex ventral hernias. Here, we present a case of a 63-year-old man with a giant paraesophageal HH type IV containing the entire stomach and transverse colon with loss of domain, who underwent adjuvant BTX and subsequently laparoscopic hiatoplasty with a biological mesh with partial fundoplication...

Chyle leak is a rare but potentially morbid complication of abdominal surgery. There have been seven reported cases of chylous ascites following cholecystectomy, but no such occurrences are reported with percutaneous cholecystostomy tube (PCT) insertion. We report the case of a 67-year-old female with stage IVb recurrent uterine papillary serous carcinoma and extensive abdominal surgical history including a paraesophageal hernia repair, and a robotic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, gastrocolic omentectomy, and hepatoduodenal lymphadenectomy...

OBJECTIVE: To report the developmental phase results of posterior rectus sheath hiatal flap augmentation (PoRSHA), a promising surgical innovation for large and recurrent paraesophageal hernias. BACKGROUND: Durable hernia repair for large paraesophageal hernias continues to be a surgical challenge. PoRSHA addresses the challenges of current and historical approaches to complex paraesophageal hernias and demonstrates significant promise as a successful alternative approach...

Hiatal hernias are commonly encountered in clinical practice. In certain cases, especially in large hiatal hernias, gastric volvulus can occur. Patients with volvulus typically will present with vomiting, chest pain, shortness of breath, and dysphagia. In extreme cases, gastric volvulus can result in gastric necrosis requiring partial or total gastrectomy. Here we highlight a case of a 76-year-old female with a known large type IV hiatal hernia who was found to have gastric volvulus with necrosis requiring partial sleeve gastrectomy...

BACKGROUND: The current paradigm of watchful waiting (WW) in people 65 years or older with an asymptomatic paraesophageal hernia (PEH) is based on a now 20-year old Markov analysis. Recently we have shown that elective laparoscopic PEH repair (ELHR) provides an increase in life-years compared to watchful waiting (WW) in most healthy patients aged 40-90. However, elderly patients often have comorbid conditions and may have complications from their PEH such as Cameron lesions. The aim of this study was to determine the optimal strategy, ELHR or WW, in these patients...

BACKGROUND: The incidence of adverse events (AEs) and length of stay (LOS) varies significantly following paraesophageal hernia surgery. We performed a Canadian multicenter positive deviance (PD) seminar to review individual center and national level data and establish holistic perioperative practice recommendations. METHODS: A national virtual PD seminar was performed in October 2021. Recent best evidence focusing on AEs and LOS was presented. Subsequently, anonymized center-level AE and LOS data collected between 01/2017 and 01/2021 from a prospective, web-based database that tracks postoperative outcomes was presented...

No abstract text is available yet for this article.

Hiatal hernias are observed in approximately 15% to 20% of the population in Western society. Most patients are diagnosed with a sliding-type hiatal hernia, of which gastroesophageal reflux is the predominant driving symptom. Surgical repair of these types of hernias often involves a wrap procedure during the index operation as standard of care. For type 2, 3, and 4 hernias, also known as paraesophageal hernias (PEHs), the symptom complexes vary and often involve symptoms other than reflux, including dysphagia, anemia, shortness of breath, and chest pain...

PURPOSE: Magnetic Sphincter Augmentation (MSA) is an FDA-approved anti-reflux procedure with comparable outcomes to fundoplication. However, most data regarding its use are limited to single or small multicenter studies which may limit the generalizability of its efficacy. The purpose of this study is to evaluate the outcomes of patients undergoing MSA vs fundoplication in a national database. MATERIALS AND METHODS: The 2017-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Registry was utilized to evaluate patients undergoing MSA or fundoplication...

Hiatal hernia is a frequent pathology in the population; however, the most frequent hiatal hernia is type I, which accounts for up to 95% incidence, types II, III, and IV being less frequent and representing between 5% and 15%, and even less common are giant hernias. The definition of the giant hernia is still not exact in the literature; some authors define giant or massive hiatal hernia as one in which the hernia occupies more than 30% of the stomach and/or passes from other abdominal structures to the thorax...

This case presentation involves an elderly patient presenting with signs of severe anemia. Investigations lead to the detection of Cameron lesions within a large paraesophageal hiatus hernia (HH). These lesions have been described in the literature as being an incidental finding within the herniated stomach during endoscopy in patients with large HH who presented with microcytic hypochromic anemia. Progressive information regarding the relationship of this occurrence in patients with this specific type of anemia associated with HH has heightened physician awareness to rule out these lesions as a primary cause of chronic bleeding...

BACKGROUND: Symptomatic hiatal hernia (HH) with pouch migration after previous laparoscopic Roux-en-Y gastric bypass (RYGB) is an uncommon complication, with limited extant evidence for the utility of surgical repair. OBJECTIVE: To evaluate the presentation and resolution of symptoms in patients with HH repair after previous RYGB. SETTING: Multicenter University Hospital. METHODS: A retrospective review was conducted from 2010 to 2022...

RATIONALE: Paraesophageal hernias, accounting for a mere 5% to 10% of all hiatal hernias, occasionally present an exceedingly uncommon yet gravely consequential complication characterized by the inversion of the stomach. Delving into the clinical manifestations and optimal therapeutic approaches for patients afflicted by this condition merits substantial exploration. PATIENT CONCERNS: A 60-year-old man was referred to our hospital with acute onset of severe epigastric pain, abdominal distension, and vomiting...

Acute gastric volvulus is a surgical emergency that requires urgent intervention to prevent gastric ischemia and necrosis. Gastric volvulus manifests as an abnormal rotation or torsion of the stomach and may be associated with gastric outlet obstruction. This pathology can be classified as either mesentero-axial or organo-axial volvulus, depending on the axis of rotation. Similarly, it can be categorized as primary or secondary, depending on the etiology. We describe a case of a 63-year-old female with a history of peptic ulcer disease who presented with severe epigastric pain and vomiting of one-day duration...