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The term paraesophageal hernia is described as a herniation of the gastric fundus through the open hiatus into the thoracic cavity while the lower esophageal sphincter (LES) remains in its normal anatomic position. This is considered a rolling esophageal hernia (Type II), and it is the least commonly encountered hiatal hernia. A more commonly encountered herniation of the fundus of the stomach is the Type III hernia, in which both the LES and the fundus herniate into the chest. This has also been classified as a paraesophageal hernia. The most common hiatal hernia is a sliding hiatal hernia (Type I), which consists of herniation of the stomach through the esophageal hiatus, causing the LES and gastric cardia to lie in the thoracic cavity. There are several controversial issues involved in paraesophageal hernia repair, including indications for surgery, the most appropriate surgical approach, and the need for a concomitant antireflux procedure. The increasing popularity of laparoscopic paraesophageal hernia repair has dramatically altered the approach to these patients and has allowed patients at higher risk to better tolerate this procedure with a decrease in morbidity and mortality. However, they remain difficult surgical procedures.
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PMID:Laparoscopic paraesophageal hernia repair. 1181 41

The combination of a Morgagni hernia and a paraesophageal hernia in adults is very rarely encountered in clinical practice. In fact, to our knowledge, only three cases of this condition, which is probably a coincidental occurrence, have been reported in the medical literature. We discuss the management of a 74-year-old man found to have combined Morgagni and paraesophageal hernia who presented with clinical features of a restrictive pulmonary disease.
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PMID:An unusual combination of diaphragmatic hernias in a patient presenting with the clinical features of restrictive pulmonary disease: report of a case. 1182 87

A 40-year-old woman with complaints of relapse in the upper abdomen and dysphagia was referred for laparascopic hiatal hernia repair. Chest radiograph, barium-swallow, and upper endoscopy revealed a paraesophageal hernia. Esophageal manometry and 24-h-pH study showed no pathological findings. A laparoscopic gastropexy was planned. Intraoperatively, in contradiction to the preoperative findings, an extrahiatal hernia containing most of the stomach was found. After resection of the hernia sac, the beating heart without covering pericardium was seen. These findings were confirmed by an additional thoracoscopy at the end of the operation. The defect was closed by direct suturing. The postoperative course and 2-month follow-up were uneventful. The resected parts of the hernia sac showed an embryonic and dysgenetic etiology. This rare malformation has been reported in combination with complex syndromes, which appear with serious clinical and morphological signs in the neonatal period. In adults, the pericardial aplasia can be observed during diagnostic or surgical interventions. In these patients, complaints are usually not caused by the malformation but may be due to the occasional herniation of abdominal organs. We consider laparoscopic repair to be a gentle and safe procedure for the treatment of extrahiatal hernias.
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PMID:Laparoscopic repair of an extrahiatal hernia caused by congenital dysplasia: a case report. 1196 97

We report a case of a paraesophageal hernia, which was successfully treated with laparoscopic surgery after a natural history of eight years. Eight years before surgery only the fundus of the stomach was included in the hernia sac. At surgery, although the gastroesophageal junction and fundus were found in their normal positions, the distal half of the stomach and the omentum were pulled into the thorax, which demonstrated an organoaxial gastric volvulus. As the omentum tightly adhered to the top of the hernia sac and there was no tight adhesion between the stomach and hernia sac, the omentum could serve as the lead point for the gastric volvulus. This patient was successfully treated with laparoscopic surgery and is presently in good condition without any recurrence of the hernia.
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PMID:Paraesophageal hiatus hernia, which has progressed for 8 years: report of a case. 1214 61

Morgagni hernias have been recognized with increasing frequency as a source of abdominal pain and dyspnea in adults. Morgagni hernias are rarely accompanied by paraesophageal hernias. We report a case of Morgagni hernia associated with paraosephageal hernia, both repaired laparoscopically. On the 65-year-old woman patient, diaphragmatic defect and paraesophageal hernia were closed with primary sutures, and Hill-type gastropexy was performed successfully. The procedure lasted 115 min. The patient was discharged 5 days after surgical treatment and there were no complications following the operation. Primary closure with direct sutures is rapid, simple, and effective and can be combined with other laparoscopic procedures, as in our case. It can be performed by surgeons trained in intracorporeal suturing and knotting in all kinds of hospitals. The laparoscopic approach to Morgagni hernias minimizes trauma and shortens postoperative hospital stay, and patients have a comfortable postoperative period.
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PMID:Laparoscopic repair of Morgagni hernia and paraesophageal hernia on the same patient. 1257 35

Paraesophageal hiatal hernia is an uncommon condition that requires urgent correction to prevent life-threatening complications. It is present in 14% of all hiatal hernias. The incidence of Morgagni hernia among all diaphragmatic defects is 3-4% and about 90% of the hernias occur on the right, 8% are bilateral and 2% are on the left. The combination of a Morgagni hernia and paraesophageal hernia is very rare and only four cases have been reported in the literature. All of them occurred in the right. This report describes an old case admitted to our clinic with dyspnea, chest pain and chronic gastrointestinal symptoms, found to have combined left Morgagni and paraesophageal hernia. Surgical repair was performed via transabdominal approach. This unusual case and surgical approaches are discussed in light of the data presented in the literature.
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PMID:Combination of paraesophageal hernia and Morgagni hernia in an old patient. 1282 18

Hiatal hernias are usually classified into three distinct types: type I, sliding hernia; type II, paraesophageal hernia; and type III, a combination of type I and II hernias. Presentation of type I hernia is so-called reflux symptoms, in contrast with the symptoms associated with mechanical obstruction of the herniated stomach in type II and III hernias. Surgical indications for type I hernia depend upon the severity of esophagitis. In type II and III hernias, severe symptoms and complications represent the chief indications for repair. Totally intrathoracic stomach hernias generally present such a risk of volvulus, strangulation, and perforation that surgery is indicated even in asymptomatic and uncomplicated cases. Although the pathophysiology is different, the Nissen procedure is the surgical procedure of choice for both types of hiatal hernia. Since the first report in 1993, the laparoscopic Nissen procedure has gained wide acceptance. We have so far experienced 26 cases of hiatal hernia, 18 of type I and 8 of type II and III hernias. We used the laparoscopic Nissen procedure in all cases. There were no conversions to the open procedure. Hiatal hernia recurred only in one case with a short esophagus preoperatively. The laparoscopic Nissen procedure is here to stay for the repair of hiatal hernias regardless of their type.
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PMID:[Laparoscopic repair of esophageal hiatal hernia]. 1457 11

Four types of hernia may occur in the area of esophageal hiatus. Type I is represented by hiatus slipping hernia. Type II is represented by hernia, which is generally known as paraesophageal hernia. In this type of hernia, cardia and distal stomach remain under diaphragm. The weakened tissue in phreno-esophageal membrane is the place, where stomach fundus penetrates into thorax above the diaphragm. The authors present 10 patients with paraesophageal hernia, who were operated on at the 2nd Surgery Clinic of Medical Faculty, UPJS, Faculty Hospital L. Pasteur in Kosice. These were adult patients, five man and five women. In four patients, so called "upside-down stomach" was the case. Hernias were operated on in all cases by laparotomy, after reposition of the stomach into abdominal cavity the area of hiatus and diaphragm was reconstructed. One patient was operated on under emergency conditions for bleeding from stomach ulcer. Immediate postoperation results were good, the postoperation course was favorable in all patients, no complications occurred. In conclusion, the authors are of the opinion that every diagnosed paraesophageal hernia should be indicated for surgical intervention. An anti-reflux operation should be executed in symptoms of gastro-esophageal reflux. The question of operation approach (thoracotomy or laparotomy) is a matter of continuous discussion, each of them having its advocates. However, in recent years laparoscopic solution of paraesophageal hernia is getting increasing attention.
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PMID:[Surgical treatment of paraesophageal hernia]. 1466 55

The paraesophageal hernia is rarely seen in the neonatal period. Presentation in neonatal period can be confused with the possibility of esophageal atresia or esophageal web. The upper gastrointestinal tract contrast study is diagnostic in this disease, but careful viewing of the plain X-ray of the chest can also lead to suspicion of the diagnosis. Two neonates with para-esophageal hernia are reported, one with the mesenterico-axial volvulus and the second neonate without volvulus.
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PMID:Paraesophageal hernia in the neonatal period: suspicion on chest X-ray. 1500 8

This report describes anesthetic management of a case (a 64-year-old man) who was originally diagnosed as paraesophageal hernia before surgery and later diagnosed as Bochdalek hernia during laparoscopic surgery. Anesthesia was started with oxygen, nitrous oxide, and sevoflurane, and respiration was managed using controlled mechanical ventilation. Although left pneumothorax was noticed during laparoscopic surgery (aeroperitonia pressure: 10 cmH2O), the surgery was performed using the same anesthesia procedure, because hardly any changes were observed on the monitor and vital signs were stable. The surgery was completed without incident. However, postoperative chest X-rays revealed the residual large pneumothorax. A chest drain tube was inserted immediately, after which the pneumothorax was improved. Pneumothorax is considered to be inevitable in cases of laparoscopic repair of Bochdalek hernia. To prevent exacerbation of pneumothorax, anesthetic management should consist of discontinuing the use of nitrous oxide and lowering the aeroperitonia pressure concomitently with the use of positive airway pressure.
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PMID:Anesthetic management for repair of adult Bochdalek hernia by laparoscopic surgery. 1567 22


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