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Muramatsu R, Nobuoka T, Ito T, Ogawa T, Korai T, Takemasa I. Laparoscopic mesh repair and Toupet fundoplication for parahiatal hernia complicated by sliding hiatal hernia: A case report. Int J Surg Case Rep 2022; 100:107664. [PMID: 36270209 PMCID: PMC9586990 DOI: 10.1016/j.ijscr.2022.107664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The parahiatal hernia is a rare type of diaphragmatic hernia in adults. Although there have been occasional reports of parahiatal hernias, few have reported simultaneous laparoscopic mesh repair of a parahiatal hernia with a hiatal hernia. This report describes laparoscopic mesh repair and fundoplication for a parahiatal hernia combined with an esophageal hiatal hernia. Presentation of case A 39-year-old woman presented with left-side postprandial abdominal pain. Esophagogastroduodenoscopy revealed a parahiatal hernia and sliding hiatal hernia. Computed tomography (CT) showed that the stomach had prolapsed into the thorax from the outside of the left diaphragm. The preoperative diagnosis was parahiatal hernia with a hernial sac complicated by sliding hiatal hernia. Laparoscopic mesh repair was planned. The stomach had prolapsed on the left side of the esophagus and was extruded. The diagnosis of a parahiatal hernia with a hernial sac complicated by a sliding hiatal hernia was confirmed. The esophageal hiatal hernia was repaired using two non-absorbable sutures. The congenital defect was further reinforced with mesh fixed to the orifice of the adjacent parahiatal hernia. We performed Toupet fundoplication to treat gastroesophageal reflux disease and sutured the right diaphragmatic crus and stomach to prevent migration. The patient was discharged home on postoperative day 5. Conclusion We encountered a patient with a parahiatal hernia complicated by a sliding hiatal hernia. The parahiatal hernia can be diagnosed by CT imaging. Preoperative diagnostic imaging can lead to appropriate treatment. The parahiatal hernia is a rare type of diaphragmatic hernia in adults This report describes laparoscopic mesh repair and fundoplication for a parahiatal hernia combined with an esophageal hiatal hernia. The parahiatal hernia can be diagnosed by CT imaging and preoperative diagnostic imaging can lead to appropriate treatment
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De la Cruz Garcia I, Chan K. Gastric outlet obstruction secondary to omental fat in a parahiatal hernia resulting in a gastric volvulus. ANZ J Surg 2021; 92:2320-2321. [PMID: 34913551 DOI: 10.1111/ans.17428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Kevin Chan
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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3
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Plourde C, Comeau É. Life-threatening presentation of a parahiatal hernia after esophagectomy: a case report and review of the literature. BMJ Case Rep 2021; 14:14/6/e242158. [PMID: 34193453 DOI: 10.1136/bcr-2021-242158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman presented to our hospital with acute abdominal pain 7 months following an oesophagectomy. A chest X-ray revealed a new elevation of the left diaphragm. CT demonstrated a large left diaphragmatic hernia incarcerated with non-enhancing transverse colon and loops of small bowel. She deteriorated rapidly into obstructive shock and was urgently brought to the operating room for a laparotomy. The diaphragmatic orifice was identified in a left parahiatal position, consistent with a parahiatal hernia. Incarcerated necrotic transverse colon and ischaemic loops of small bowel were resected, and the diaphragmatic defect was closed primarily. Because of haemodynamic instability, the abdomen was temporarily closed, and a second look was performed 24 hours later, allowing anastomosis and definitive closure. Parahiatal hernias are rare complications following surgical procedures and can lead to devastating life-threatening complications, such as an obstructive shock. Expeditious diagnosis and management are required in the acute setting.
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Affiliation(s)
- Camille Plourde
- Département de chirurgie, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Émilie Comeau
- Département de chirurgie, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
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4
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Kohama T, Sakamoto T, Okino T. Parahiatal Hernia Sac Tumor of Localized Malignant Peritoneal Mesothelioma. Ann Thorac Surg 2020; 112:e57-e60. [PMID: 33359504 DOI: 10.1016/j.athoracsur.2020.09.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/15/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022]
Abstract
We describe an extremely rare case of a parahiatal hernia sac tumor. A computed tomography scan showed a solitary mass located adjacent to the diaphragm and esophagus in a 72-year-old woman. Thoracoscopic surgery revealed that a tumor protruded through a diaphragmatic defect lateral to the crus and adhered to the perigastric fat in the gastric fundus. Radical resection of the tumor and herniorrhaphy of the diaphragmatic defect were performed. Pathologic and clinical findings indicated this was a parahiatal hernia sac tumor of localized malignant peritoneal mesothelioma. No recurrence was observed without adjuvant therapy 10 months after surgery.
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Affiliation(s)
- Takuya Kohama
- Department of Thoracic Surgery, Kobe Red Cross Hospital, Hyogo, Japan.
| | - Toshihiko Sakamoto
- Department of Thoracic Surgery, Steel Memorial Hirohata Hospital, Hyogo, Japan
| | - Takeshi Okino
- Department of Pathology, Kobe Red Cross Hospital, Hyogo, Japan
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Li J, Guo C, Shao X, Cheng T, Wang Y. Another type of diaphragmatic hernia to remember: parahiatal hernia. ANZ J Surg 2020; 90:2180-2186. [PMID: 32356615 DOI: 10.1111/ans.15926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Chenchen Guo
- School of medicine Southeast University Nanjing China
| | - Xiangyu Shao
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Tao Cheng
- Department of General Surgery, Affiliated Zhongda Hospital Southeast University Nanjing China
| | - Yong Wang
- Department of Gastrointestinal Surgery, West China Hospital Sichuan University Chengdu China
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6
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Carr MJ, Oxner C, Elster EA, Ritter EM, Vicente D. Management of Acute Upper Gastrointestinal Disease While at Sea. Mil Med 2018; 183:e658-e662. [PMID: 29420777 DOI: 10.1093/milmed/usx103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 10/21/2017] [Indexed: 11/14/2022] Open
Abstract
Management of complex acute surgical pathology in austere environments necessitates rapid evaluation and resource appropriate management to avoid time-associated morbidity and potentially mortality. Obstructive upper gastrointestinal (UGI) pathologies can be particularly challenging and associated with significant morbidity. Herein, we present six patients with UGI obstructions encountered over the course of an 8-mo deployment onboard a US Navy Aircraft Carrier. Each patient presented to our medical department with signs and symptoms of obstructive UGI pathology including one gastric volvulus requiring operative management at sea, one with a new diagnosis of achalasia requiring transportation and continental United States outpatient evaluation, and four patients with food impaction requiring urgent endoscopic management. Although UGI pathology is seldom encountered at sea, definitive surgical interventions, including prompt evaluation and management of these acute pathologies, can be performed in an austere environment. We wish to call attention to these potential encounters in order that underway deployed medical units and supporting resources ashore are prepared and equipped to intervene on acute UGI obstructive pathology.
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Affiliation(s)
- Matthew J Carr
- Aviation Medicine, Carrier Airwing Seven, 1640 Tomcat blvd STE 300, Virginia Beach, VA
| | - Christopher Oxner
- Department of General Surgery, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA
| | - Eric A Elster
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
| | - Eric M Ritter
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
| | - Diego Vicente
- The Department of Surgery at Uniformed Services University of the Health Sciences & The Walter Reed National Military Medical Center
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7
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Jindal S, Hukkeri VS, Qaleem M, Tandon V, Govil D. Robotic repair of a parahiatal hernia with gastric volvulus. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Staerkle RF, Skipworth RJE, Leibman S, Smith GS. Emergency laparoscopic mesh repair of parahiatal hernia. ANZ J Surg 2016; 88:E564-E565. [PMID: 27017940 DOI: 10.1111/ans.13492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/16/2016] [Accepted: 01/19/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Ralph F Staerkle
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Richard J E Skipworth
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Clinical Surgery, University of Edinburgh, Edinburgh, UK
| | - Steven Leibman
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Garett S Smith
- Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Main WP, Tymitz KM. Iatrogenic Parahiatal Hernia with Gastric Herniation and Necrosis after Robotic Hiatal Hernia Repair. Am Surg 2015. [DOI: 10.1177/000313481508101204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- William P.L. Main
- Department of Surgery Good Samaritan TriHealth Hospital Cincinnati, Ohio
| | - Kevin M. Tymitz
- Department of Surgery Good Samaritan TriHealth Hospital Cincinnati, Ohio
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10
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Lew PS, Wong ASY. Laparoscopic mesh repair of parahiatal hernia: a case report. Asian J Endosc Surg 2013; 6:231-3. [PMID: 23879418 DOI: 10.1111/ases.12039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/03/2013] [Indexed: 01/17/2023]
Abstract
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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Affiliation(s)
- Pei Shi Lew
- Department of Surgery, Changi General Hospital, 2 Simei Street #3, Singapore
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11
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Takemura M, Mayumi K, Ikebe T, Hamano G. Laparoscopic repair of secondary parahiatal hernia with incarceration of the stomach: a case report. J Med Case Rep 2013; 7:50. [PMID: 23421939 PMCID: PMC3606404 DOI: 10.1186/1752-1947-7-50] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 01/24/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction Parahiatal hernia is an extremely rare subtype of hiatal hernia, which in turn is a type of diaphragmatic hernia in adults, and only a few cases have been reported to date. We report the case of a patient who suffered from gastric incarceration through an anatomically separate diaphragmatic defect, immediately lateral to a structurally normal esophageal hiatus, that developed after treatment of a malignant mesothelioma. Case presentation A 70-year-old Japanese man, who had undergone treatment for a left malignant pleural mesothelioma a year ago at another hospital, was referred to our institution following a 4-day history of epigastric pain. Esophagogastroscopy demonstrated a normal esophagogastric junction, with remarkable stenosis and active gastric ulcer of the gastric body. Histopathological examination of the gastric biopsy specimen confirmed a gastric ulcer. Furthermore, computed tomography revealed a large fluid-filled structure in the retrocardiac space. On the basis of preoperative data, we decided to attempt laparoscopic repair for the gastric volvulus. During surgery, gastric and omental herniation was observed within a peritoneal lined defect immediately lateral to the esophageal hiatus. Dissection near the esophageal hiatus revealed a discrete extrahiatal defect 3cm in diameter immediately adjacent to the left crus of the diaphragm. The parahiatal defect was closed using interrupted nonabsorbable heavy suture. The patient’s postoperative course was uneventful, and anastomotic leakage was not observed at postoperative barium swallowing. Conclusions Although preoperative diagnosis of parahiatal hernia is difficult, a laparoscopic approach can be a useful therapeutic procedure not only for paraesophageal hernia but also for parahiatal hernia.
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Affiliation(s)
- Masashi Takemura
- Department of Surgery, Gohshi Hospital, 1-8-20, Nagasu Nishi-Dori, Amagasaki, Hyogo 660-0807, Japan.
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Palanivelu C, Rangarajan M, Jategaonkar PA, Parthasarathi R, Balu K. Laparoscopic repair of parahiatal hernias with mesh: a retrospective study. Hernia 2008; 12:521-5. [PMID: 18661099 DOI: 10.1007/s10029-008-0380-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 04/18/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND Parahiatal hernias are very rare and distinct entities, the diagnosis of which is never made clinically. Laparoscopic repair has been reported in the literature. We present our experiences with the laparoscopic repair of this uncommon type of hernia. PATIENTS AND METHODS In our institute, we retrospectively identified a total of eight patients with parahiatal hernias from 1999 to 2007, of which four had primary and four had secondary defects. Laparoscopic crural repair was performed for all of the patients, fundoplication wherever indicated and meshplasty in the cases with large defects. Gastropexy was performed for the patient with volvulus. RESULTS The male:female ratio was 5:3, with a mean age of 46 years and a mean body mass index (BMI) of 29.3 kg/m2. The mean size of the defects was 18 cm2. The mean blood loss during surgery was 50 ml, the mean operative time was 103.5 min and the mean hospital stay was 4 days. One patient had the recurrence of symptoms 1 month after surgery. There were no conversions, recurrences or mortality. DISCUSSION Primary parahiatal hernias occur as a result of a congenital weakness and secondary defects follow hiatal surgery. The use of a mesh is advisable for large defects and defects of primary type. Secondary hernias following fundoplication do not need a redo fundoplication, but require an adequate crural repair with mesh. Laparoscopic repair of these uncommon hernias is safe, effective and provides all of the benefits of minimally invasive surgery.
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Affiliation(s)
- C Palanivelu
- GEM Hospital and Postgraduate Institute, 45-A, Pankaja Mill Road, Ramanathapuram, Coimbatore, 641045, India.
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13
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Scheidler MG, Keenan RJ, Maley RH, Wiechmann RJ, Fowler D, Landreneau RJ. "True" parahiatal hernia: a rare entity radiologic presentation and clinical management. Ann Thorac Surg 2002; 73:416-9. [PMID: 11845852 DOI: 10.1016/s0003-4975(01)03373-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND True parahiatal diaphragmatic hernias are rare entities that are sparsely accounted for in the literature. The current report is intended to depict the clinical profile and assess the feasibility of laparoscopic repair of parahiatal hernias. METHODS We conducted a retrospective review of all patients diagnosed and treated for parahiatal hernias. Clinical presentation and radiological assessment, as well as operative findings and repair, are discussed. RESULTS Of the 917 laparoscopic hiatal hernia repairs, 2 (0.2%) patients were identified with a parahiatal hernia. The presenting symptoms and preoperative testing were similar to those with more common paraesophageal hernias. Laparoscopic repair was successful in repairing the diaphragmatic defect and alleviating symptoms up to 4 years postoperatively. CONCLUSIONS Parahiatal hernias of the diaphragm appear to be rare primary diaphragmatic defects. The clinical presentation of parahiatal hernias is often indistinguishable from the more common paraesophageal pathology. Laparoscopic repair of this rare entity can be safely and successfully accomplished in conjunction with antireflux surgical interventions when indicated.
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Affiliation(s)
- Michael G Scheidler
- Divisions of General Thoracic and Minimally Invasive Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15213, USA
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14
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Choi YU, North JH. Diaphragmatic Hernia after Ivor-Lewis Esophagectomy Manifested as Lower Gastrointestinal Bleeding. Am Surg 2001. [DOI: 10.1177/000313480106700107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diaphragmatic hernia after esophageal resection is a recognized but rare complication. Parahiatal hernias may result from manipulation and extension of the crura during surgery. This can lead to a wide array of symptoms depending on the extent and organ that is herniated. A high index of suspicion is required because there is no one symptom that is specific for herniation. This report represents the first case of a patient presenting with lower gastrointestinal bleed from a parahiatal hernia after esophageal resection.
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Affiliation(s)
- Yong U. Choi
- From the Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, Georgia
| | - James H. North
- From the Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, Georgia
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Abstract
BACKGROUND Intrathoracic herniation of abdominal viscera is a potentially life-threatening condition, especially when diagnosis is delayed. The aim of this study was to estimate its incidence following oesophageal resection and to define contributing factors that might influence its occurrence. METHODS All radiographic studies of the chest that were made during follow-up in a series of 218 patients who underwent oesophagectomy between 1993 and 1997 were reviewed. RESULTS Herniation of bowel alongside the oesophageal substitute was detected in nine patients (4 per cent). Four hernias occurred within the first week after operation and five were detected at late follow-up. Surgical treatment was indicated in six patients. Analysis of predisposing factors revealed that extended incision and partial resection of the diaphragm were associated with an increased risk of postoperative hernia formation (four of 29 following extended enlargement versus five of 189 after routine opening of the oesophageal hiatus; P = 0.02). CONCLUSION Diaphragmatic herniation was found in 4 per cent of patients after oesophagectomy. After extended iatrogenic disruption of the normal hiatal anatomy, narrowing of the diaphragmatic opening may be indicated to avoid postoperative herniation of bowel into the chest. Awareness of its possible occurrence may help prevent the development of intestinal obstruction and strangulation.
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Affiliation(s)
- J W van Sandick
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
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16
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Abstract
A rare case of parahiatal hernia with gastric volvulus and incarceration is reported. An anatomically distinct diaphragmatic defect was present adjacent to a structurally normal esophageal hiatus. Laparoscopic repair was performed with excellent results.
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Affiliation(s)
- M D Rodefeld
- Section of Hepatobiliary Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Abstract
Exploratory thoracotomy was necessary to establish the diagnosis of a rare incarcerated parahiatal hernia. Symptomatology, signs, and radiographic findings are compared with those of paraesophageal hernias.
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Affiliation(s)
- T L Demmy
- Division of Cardiothoracic Surgery, University of Missouri, Columbia 65212
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