Transthoracic Collis-Nissen repair for massive type IV paraesophageal hernia

Type IV paraesophageal hernia as a cause of ileus: Report of a case

INTRODUCTION

Type IV paraesophageal hernias (PEHs) have been rarely reported in the literature. Transverse colon is the most common viscus to herniate in this category.

PRESENTATION OF CASE

Herein we present a case with an emergent admission of a 66 year old man with type IV PEH with small intestine into the hernia sac.

DISCUSSION

The diagnosis of PEHs can be challenging due to their extremely low incidence and the non-specific symptoms and can be easily missed from the initial differential diagnosis.

CONCLUSION

In this case, the hernia was diagnosed early and managed successfully with an immediate laparotomy.

Experience of laparoscopic paraesophageal hernia repair at a single institution

BACKGROUND

Paraesophageal hernia patients are often elderly with complicating medical comorbidities, making surgical management complex in formulating a management strategy.

METHODS

Between January 2005 and July 2009, 93 patients underwent surgical treatment of paraesophageal hernia, including 8 recurrent cases after multiple repairs. Open transabdominal surgeries were performed in 14 (15%) patients, and combined thoracotomy was performed in 1 (1%). Laparoscopic surgeries were performed in 78 (84%) patients with 4 (5%) conversions. Artificial prosthetics were used in 27 (29%) patients. Fundoplication was performed in 82 (88%) patients. Gastropexy or feeding tube gastrostomy was performed in 10 (11%) patients.

RESULTS

The average length of the surgery was 125 minutes (range, 51-304 min). The mean blood loss was 100 mL. The average length of stay was 4 days (range, 1-14 d). There were 2 mortalities (2%) and 4 re-operations, with a recurrence rate of 2%.

CONCLUSIONS

Laparoscopic paraesophageal hernia repair can be performed safely with acceptable results when following a standard approach.

When did the esophagus start shrinking? The history of the short esophagus

Even though the history of this condition extends for almost 100 years, the short esophagus (SE) is still one of the most controversial topics in esophageal surgery with its existence still denied by some distinguished surgeons. We reviewed the evolution behind the diagnosis and treatment of the SE and the persons who wrote its history, from the first descriptions by radiologists, endoscopists, and surgeons to modern treatment.