Reparación laparoscópica de hernia hiatal paraesofágica con material protésico / Laparoscopic repair of paraesophageal hiatal hernia with prosthetic material

El manejo quirúrgico de las Hernias Hiatales Paraesofágicas puede ser realizado por toracotomía izquierda o por laparoscopía. Ambos abordajes son aceptables, pero actualmente se ha incrementado mucho el abordaje laparoscópico por las características de mínima invasividad, pero con la utilización de material protésico como forma de refuerzo, cuando el hiato esofágico es superior a 5 cm. Los objetivos del abordaje laparoscópico son la reducción anatómica completa y la competencia del esfínter esofágico inferior. Estos objetivos se consiguen con el cierre de la crura diafragmática y la funduplicatura laparoscópica. Se presentan dos casos clínicos donde se ha utilizado malla de Poliester fijada con tackers colocada en forma de C con la apertura hacia la cara anterior y el solapamiento por delante del esófago. CONCLUSIÓN: El uso de material protésico en la reparación del defecto de las Hernias Hiatales Gigantes es una alternativa razonable.

The surgical management of Paraesophageal Hiatal Hernia can be performed by left thoracotomy or by laparoscopy. Both approaches are acceptable, but currently the laparoscopic approach has increased greatly due to the characteristics of minimal invasiveness, but with the use of prosthetic material as a form of reinforcement, when the esophageal hiatus is greater than 5 cm. The objectives of the laparoscopic approach are a complete anatomic reduction and lower esophageal sphincter competition. These objectives are achieved with the closure of the diaphragmatic crural and laparoscopic fundoplication. Two clinical cases were presented where Polyester mesh, fixed with tackers, was placed in a C shaped disposition with the opening facing the anterior and the overlap in front of the esophagus. CONCLUSION: The use of prosthetic material in the repair of the defect of Giant Hiatal Hernia is a reasonable alternative.

Dolor precordial como forma de presentación de la hernia hiatal paraesofágica / Presentation of Paraesophageal hiatal hernia. A case report

Fundamento: la hernia hiatal es una afección del tracto digestivo, dentro de ella la variedad paraesofágica es infrecuente. Objetivo: ofrecer una panorámica clínica y quirúrgica de la hernia hiatal paraesofagica y realizar diagnóstico diferencial con patologías cardiovasculares por las complicaciones graves que trae consigo esta enfermedad. Presentación de caso: paciente de la sexta década de la vida acudió a consulta de gastroenterología por presentar dolor precordial, epigastralgia cuando ingería alimentos en grandes cantidades, saciedad precoz, disfagia a los líquidos en ocasiones, regurgitaciones ácidas, salida de alimentos por las fosas nasales y pérdida de peso progresiva. Se le realizó estudio contrastado de esófago, estómago y duodeno donde se diagnosticó hernia hiatal paraesofágica, fue intervenido por vía laparoscópica; se le realizó reducción de la hernia, cirugía de los pilares y funduplicatura de Nissen-Rossell ,con evolución satisfactoria. Conclusiones: ante el dolor precordial es necesario detenerse en la semiología del mismo y diferenciar el cardiovascular del no cardiovascular pues en la hernia hiatal paraesofágica sus complicaciones tienen una alta morbimortalidad.

Background: hiatal hernia is a condition of the digestive tract; within it the paraesophageal variety is uncommon. Objective: to offer a clinical and surgical review of this kind of paraesophageal hiatal hernia and perform a differential diagnosis with cardiovascular pathologies due to the severe complications this disease may bring about. A case presentation : a 60 years- old patient came to the gastroenterology consultation presenting precordial and epigasttric pain when eating great amount of food, precocious satiety, frequent dysphagia due to liquids consumption, acid regurgitation, food exit through the nasal cavity and loss of weight. A contrasted study of esophagus, stomach and duodenum was done and it was diagnosed paraesophageal hiatal hernia, he underwent laparoscopic surgery where hernia reduction, pilars surgery and Nissen funduplication were performed and the prognosis was good. Conclusions: before presenting precordial pain, it is necessary to take into account its semiology and differenciate cardiovascular from non-cardiovascular pain as in paraesophageal hiatal hernia its complications have a high morbi-mortality.

A Case of Congenital Paraesophageal Hiatal Hernia in Infancy / 대한소아소화기영양학회지

Esophageal hiatal hernia is the hernia of a part of or the whole of stomach to posterior mediastinum through esophageal hiatus. Esophageal hiatal hernia can be classified as sliding hiatal hernia (type I), paraesophageal (type II), combined sliding and paraesophageal (type III), and complex paraesophageal (type IV). Type III and IV are clinically classified as paraesophageal hernia. The authors by chance found cystic mass filled with air in the lower lobe of the right lung during the treatment of mycoplasma pneumonia of 10 month-old patient. It was found to be paraesophageal hernia on the chest computed tomography and treated with the operation. As complex paraesophageal hernia is not usual among infants, the authors report it here with literature review.

Congenital para esophageal hernia: A 10 year experience from Saudi Arabia.

Objective. To study the presentation and the outcome of treatment of congenital para esophageal hernias (CPEH) over a period of 10 years from a single tertiary care hospital in Saudi Arabia. Methods. The records of 9 patients presenting between 1997 and 2007, were retrospectively analyzed for demographics, presenting features, referral diagnoses, investigations, management including operative procedures, their outcome and follow-up. Results. Nine patients (3 males and 6 females) aged between 8 days to 34 months were seen. Respiratory distress (n=6), vomiting (n=5) and frequent respiratory tract infections (n=3) were the most common presentations. Cyanosis (n=2), cough and excessive crying were the other important symptoms. The referral diagnoses in these patients included congenital Bochdalek's hernias, lung abscess, bronchogenic cyst, pneumatocoele, bronchiolitis, and pneumonias which reflected a misinterpretation of their clinical findings and chest X-rays. Seven of these patients had other associated congenital anomalies. Three had cardiovascular abnormalities and 2 had lesions of the central nervous system. A pair of siblings had Marfan’s syndrome. All the patients had abnormal chest C-rays and an UGS (upper GI series) proved to be diagnostic in 8 patients. The CT scans done in 4 patients corroborated the findings of the UGS. A laparotomy was done on most patients (n=8) which comprised of reduction of the stomach, resection of the hernial sac, tightening of the hiatus and a gastropexy or a gastrostomy. One patient, who underwent thoracotomy died of surgical complications. Two others died of causes unrelated to the surgery. The remaining six operated patients have been followed up for a median of 3.5 years and are doing well. Conclusion. CPEH is uncommon in children, presents with respiratory tract symptoms and vomiting, and may be associated with Martan syndrome. It should be considered in the workup of a child with vomiting or frequent chest infections. Abnormal chest X-rays may indicate the diagnosis and a subsequent UGS, is confirmatory. The present study found laparotomy a good approach for repair of the wide hiatus. A gastropexy and a floppy fundoplication were added to prevent reherniation and post operative reflux though given the small numbers it is not possible to determine the place of either of these procedures. CPEH may be frequently associated with other congenital problems which may impact survival.

Two Cases of Congenital Paraesophageal Hiatal Hernia in Infancy

Herniation of the stomach through the esophageal hiatus into the posterior mediastinum is a commom affliction of humans. The incidence of hiatal hernia is difficult to determine because of the absence of symptoms in a large number of patients. Hiatal hernias are classified into two major types; type I sliding hiatal hernia and type II paraesophageal hiatal hernia. Sliding hernia is common, but paraesophageal hernia(PEH) is rare. Most PEH is demonstrated in elderly women. PEH in infancy is really rare. PEH is a true hernia, so it is a potentially life-threatening condition because of the risk of volvulus, incarceration, strangulation, and perforation. PEH is itself the indication for surgery. We experienced congenital PEH in two infants. One case was nearly asymptomatic, found incidentally by plain chest X-ray taken for pneumonia in a 12 month old female infant. She had no vomiting or reflux, but history of frequent feeding of small amount and often gurgling noise in her right chest. She had type IV PEH including herniation of the transverse colon. Another case was presented because of vomiting, and was diagnosed by ultrasonography initially in a 48 day old male infant. He had intrathoracic stomach, type III PEH with idiopathic hypertrophic pyloric stenosis and gastroesophageal reflux.