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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article reviews the preoperative evaluation of patients with paraesophageal hernia (PEH) and details the principles and components of a laparoscopic PEH repair. Complete hernia sac dissection and excision, adequate esophageal mobilization, reapproximation of the crura, and creation of an antireflux barrier make up the key steps in any repair and are described. Although the preferred operative approach to PEH has undergone significant modification, especially since the introduction of minimally invasive laparoscopic techniques, many controversies still exist. The decision of whether to use mesh to reinforce the crural closure remains an unresolved issue in the surgical literature, and further evolution in this and other areas of PEH surgery is sure to occur in the near future.
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PMID:Modern treatment of paraesophageal hernia: preoperative evaluation and technique for laparoscopic repair. 2287 77

We report a case of a primary parahiatal hernia that was repaired laparoscopically with a composite mesh. A 51-year-old woman presented with vomiting and epigastric pain. CT scan showed a giant paraesophageal hernia with intrathoracic gastric volvulus. Intraoperatively, a diaphragmatic muscular defect was found lateral to an attenuated left crus of the diaphragm, distinct from the normal esophageal hiatus. The defect ring was fibrotic, making a tension-free primary repair difficult. A laparoscopic mesh repair was performed with a composite mesh, which was covered with the hernia sac to prevent potential erosion into the esophagus or stomach. Recovery was uneventful and the patient was discharged on the 5 days postoperatively. She remained asymptomatic at subsequent follow-up. Laparoscopic repair of parahiatal hernia can be safely performed. In circumstances where a large or fibrotic defect prevents a tension-free primary repair, the use of a composite mesh can provide effective repair of the hernia.
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PMID:Laparoscopic mesh repair of parahiatal hernia: a case report. 2387 18

An 81-year-old gentleman with congenital polycystic kidney disease presented to his primary care physician with dysphagia, gastroesophageal reflux refractory to medical management, and 11.25 kg weight loss in a 6 mo-period. A barium swallow misdiagnosed a paraesophageal hernia for a Bochdalek hernia. Herein, we highlight how a Bochdalek hernia may be disregarded in the differential diagnosis and how providers can resort to a more common diagnosis, a paraesophageal hernia, which is more frequently encountered in old age and whose radiologic appearance might mimic a Bochdalek hernia.
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PMID:An 81-year-old gentleman with symptomatic Bochdalek hernia. 2389 90

Laparoscopic paraesophageal hernia repair is an operation that allows for relief of gastrointestinal and respiratory symptoms with a minimal recovery time and a high degree of satisfaction. It is a difficult and complex operation; however, if the important tenets are adhered to by surgeons with a lot of experience in laparoscopic PEH repair, the results are good. Patient selection is important. Older or frail patients who are asymptomatic should not have an operation, and some who are very symptomatic should probably consider just a reduction of their gastric volvulus and gastropexy. Still, most of the patients will be symptomatic and will be able to tolerate a laparoscopic definitive repair. The important aspects of repair include: complete resection of the hernia sac from the mediastinum, adequate esophageal mobilization, adequate closure of the hiatus, and fundoplication. The most troublesome aspect of the operation is the recurrence rate, which is up to 50% at 5 years of follow-up. Fortunately, most recurrences are asymptomatic and the vast majority of patients still have greatly improved quality of life.
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PMID:Laparoscopic paraesophageal hernia repair. 2410 83

Paraesophageal hiatus hernia is an extremely rare variety of hiatus hernia and it is rarely seen in the paediatric age group. We present an instance of this hernia in which an 8-month-old female infant was admitted with a history of ongoing vomiting and irritability since past 7 days. The subsequent imaging study showed paraesophageal hiatus hernia with twisting of the stomach along its longitudinal axis (organoaxial volvulus). Subsequent surgical repair led to the resolution of symptoms. This kind of volvulus is rare in hiatus hernia and once detected it requires prompt surgical management. Given the asymptomatic presentation of hiatus hernia clinicians need to realise that this can be associated with volvulus of stomach which, if left unrepaired, can lead to severe complications. Thus, prompt consideration is necessary with timely surgical referral to alleviate this rare but important variety of hiatus hernia.
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PMID:Paraesophageal hiatus hernia in an 8-month-old infant with organoaxial volvulus of the stomach. 2479 65

Omental hernia through the esophageal hiatus is extemely infrequent. Paraesophageal hiatal hernia with omentum in the herniary sac mimics a mediastinal lipomatous tumor and differential diagnosis should be made. This diagnosis requires experience and knowledge of the differences between these two pathologies. In the following study we describe the case of an omental hernia and the characteristics that make it different from other pathologies.
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PMID:[Omental hernia through esophageal hiatus simulates mediastinal lipomatous tumor]. 2484 29

We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery.
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PMID:Transthoracic repair of paraesophageal diaphragmatic hernia presenting with symptoms mimicking cardiac disease (chest pain and breathlessness). 2547 1

Paraesophageal hernias are considered to be benign entities which are usually managed conservatively. We present a case of a middle-aged male with no previous history of esophageal hernia who presented with acute chest and abdominal pain. The patient was diagnosed to have a type 2 paraesophageal hernia with gastro-thorax. Laparotomy was performed during which it was found that herniated segment of the stomach had strangulated and gangrenous. Thoracotomy was performed and gangrenous stomach segment resected. A roux-en-Y esophago-jejunostomy was performed. Diaphragmatic defect was plicated. Patient recovered with adequate post operative support. A review of the literature revealed that paraesophageal hernias presenting as acute abdominal pain is a rare clinical entity and those with gastric gangrene is even rarer, with high mortality rates. We suggest that paraesophageal hernias require to be managed actively considering the seriousness of potential complications and the relative safety of newer elective surgical modalities. A high index of suspicion is needed in order to avoid missing this diagnosis in patients presenting with chest pain.
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PMID:Gastric Gangrene Due to a Strangulated Paraesophageal Hernia-a Case report. 2597 48

Simultaneously occurring Morgagni hernia and paraesophageal hernia is an extremely rare clinical condition with only six case reports in the English-language literature and only two laparoscopic repair reports. We report a 73-year-old woman with both Morgagni hernia and paraesophageal hernia who underwent successful laparoscopic repair of the hernia defects using transabdominal wall suturing. The laparoscopic operation can provide excellent exposure and repair the hernia defect easily with minimal invasiveness and fewer complications. This case report reported the concurring Morgagni and paraesophageal hernias and validated the feasibility of laparoscopic repair both hernias simultaneously.
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PMID:A Rare Case of Laparoscopic Repair of Simultaneously Occurring Morgagni and Paraesophageal Hernias. 2628 30

Chylous ascites is an accumulation of milky lipid-rich lymph in the peritoneal cavity. Spontaneous chyle leak is a rare occurrence, often associated with malignancy or cirrhosis. This is a report of spontaneous chylous ascites, chylomediastinum and chylothoraces encountered in the setting of an incarcerated paraesophageal hernia. A 60-year-old female presented to the emergency department with epigastric pain, dysphagia and vomiting. Clinical presentation and imaging were concerning for an incarcerated paraesophageal hernia, and the patient was taken to the operating room. During laparoscopic reduction of the hernia and repair, chyle was encountered in the peritoneal cavity, mediastinum and pleural spaces. Postoperatively, the chyle leak resolved with a nonfat diet. The unusual occurrence of a chyle leak in this case may have been due to compression of the thoracic duct within the chest by the incarcerated paraesophageal hernia.
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PMID:Spontaneous chylous ascites, chylomediastinum and bilateral chylothoraces encountered during laparoscopic incarcerated paraesophageal hernia repair. 2650 35


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