Emergency laparoscopic mesh repair of parahiatal hernia

Surgical repair for a parahiatal hernia with an esophageal hiatal hernia: A case report and literature review

INTRODUCTION AND IMPORTANCE

A parahiatal hernia (PH) is a rare diaphragmatic hernia (DH) adjacent to but separated from the esophageal hiatus. The surgical repair for PH needs primary suture closure or complicated hernioplasty and the addition of an anti-reflux procedure. This report describes a case of PH with a symptomatic esophageal hiatal hernia managed using three-dimensional (3D) laparoscopy.

CASE PRESENTATION

A 65-year-old woman with back pain and breathlessness was referred to our hospital for a DH. Computed tomography showed a diaphragmatic defect on the left side of the esophageal hiatus. Upper gastrointestinal endoscopy and 24-hour esophageal impedance-pH monitoring showed a symptomatic esophageal hiatal hernia. Laparoscopic repair for both hernias was performed using 3D laparoscopy. The DH orifice was located in the left crus of the diaphragm, and it was separated from the esophageal hiatus. These findings showed that this DH was a PH. The PH was repaired with primary suturing, and a hiatoplasty was performed. Toupet fundoplication was performed with a 270° posterior wrap of the gastric fornix. The patient has remained asymptomatic a year after surgery without any complications.

CLINICAL DISCUSSION

3D laparoscopy provides significant advantages in surgeries requiring precise suturing. PH repairs require complex procedures, including mesh repair or suturing. Approximately 44 % of PH cases also necessitate fundoplication. 3D laparoscopy was useful for the present case.

CONCLUSIONS

A rare PH and a symptomatic type 1 hiatal hernia were repaired with 3D laparoscopy, which is helpful for PH treatment in cases requiring complicated procedures.

Unusual Presentation of Incarcerated True Parahiatal Hernia: Management of a Rare Clinical Entity

True parahiatal hernia is a type of diaphragmatic hernia in which herniation occurs through a defect in the diaphragm, adjacent to the normal oesophageal hiatus. Its reported incidence is very rare, and it is commonly misdiagnosed as paraoesophageal hernia. Although the clinical distinction between paraoesophageal and parahiatal hernia is difficult, it is essential to recognise these two separate entities clinically as their management differs. Clinical presentation of parahiatal hernia includes symptoms related to gastro-oesophageal reflux disease (GERD). Patients may also present emergently with symptoms of respiratory distress and chest symptoms. With that in mind, we describe a compelling case of a young lady who initially presented with symptoms suggestive of acute coronary syndrome. However, she was found to have an incarcerated parahiatal hernia.

Laparoscopic mesh repair and Toupet fundoplication for parahiatal hernia complicated by sliding hiatal hernia: A case report

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.

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The parahiatal hernia is a rare type of diaphragmatic hernia in adults

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This report describes laparoscopic mesh repair and fundoplication for a parahiatal hernia combined with an esophageal hiatal hernia.

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The parahiatal hernia can be diagnosed by CT imaging and preoperative diagnostic imaging can lead to appropriate treatment

When should we use mesh in laparoscopic hiatal hernia repair? A systematic review

The use of mesh in laparoscopic hiatal hernia repair (LHHR) remains controversial. The aim of this systematic review was to determine the usefulness of mesh in patients with large hiatal hernia (HH), obesity, recurrent HH, and complicated HH. We performed a systematic review of the current literature regarding the outcomes of LHHR with mesh reinforcement. All articles between 2000 and 2020 describing LHHR with primary suturing, mesh reinforcement, or those comparing both techniques were included. Symptom improvement, quality of life (QoL) improvement, and recurrence rates were evaluated in patients with large HH, obesity, recurrent HH, and complicated HH. Reported outcomes of the use of mesh in patients with large HH had wide variability and heterogeneity. Morbidly obese patients with HH should undergo a weight-loss procedure. However, the benefits of HH repair with mesh are unclear in these patients. Mesh reinforcement during redo LHHR may be beneficial in terms of QoL improvement and hernia recurrence. There is scarce evidence supporting the use of mesh in patients undergoing LHHR for complicated HH. Current data are heterogeneous and have failed to find significant differences when comparing primary suturing with mesh reinforcement. Further research is needed to determine in which patients undergoing LHHR mesh placement would be beneficial.

Primary parahiatal hernias: A case report and review of the literature

BACKGROUND

Parahiatal hernias (PHHs) are rare occurring disease, with a reported incidence of 0.2%-0.35% in patients undergoing surgery for hiatal hernia. We found only a handful of cases of primary PHHs in the literature. The aim of this paper is to present a case of a primary PHH and perform a systematic review of the literature.

CASE SUMMARY

We report the case of a 60-year-old Caucasian woman with no history of thoraco-abdominal surgery or trauma, which accused epigastric pain, starting 2 years prior, pseudo-angina and bloating. Based on imagistic findings the patient was diagnosed with a PHH and an associated type I hiatal hernia. Patient underwent laparoscopic surgery and we found an opening in the diaphragm of 7 cm diameter, lateral to the left crus, through which 40%-50% of the stomach had herniated in the thorax, and a small sliding hiatal hernia with an anatomically intact hiatal orifice but slightly enlarged. We performed closure of the defect, suture hiatoplasty and a “floppy” Nissen fundoplication. Postoperative outcome was uneventful, with the patient discharged on the fifth postoperative day. We performed a review of the literature and identified eight articles regarding primary PHH. All data was compiled into one tabled and analyzed.

CONCLUSION

Primary PHHs are rare entities, with similar clinical and imagistic findings with paraesophageal hernias. Treatment usually includes laparoscopic approach with closure of the defect and the esophageal hiatus should be dissected and analyzed. Postoperative outcome is favorable in all cases reviewed and no recurrence is cited in the literature.

Laparoscopic repair of parahiatal hernia after esophagectomy: a case report

Background

Diaphragmatic hernia is a potential complication of esophagectomy, which usually occurs as a hiatal hernia and more frequently after minimally invasive esophagectomy. Parahiatal hernia is a rare form of diaphragmatic hernia, and to the best of our knowledge, parahiatal hernia after esophagectomy has not been previously reported. Here, we report a case of parahiatal hernia after esophagectomy that was successfully managed laparoscopically.

Case presentation

A 73-year-old man underwent thoracoscopic esophagectomy for esophageal cancer with gastric tube reconstruction via the posterior mediastinum. Postoperative morbidity was ileus, which required conservative treatment, and intestinal obstruction for which operation with laparotomy was necessary. He was admitted with abdominal pain and vomiting at 15 months after esophagectomy. Abdominal X-ray revealed colon gas in the intrathoracic space. A barium enema examination showed a transverse colon incarcerated in the intrathoracic space. The patient was preoperatively diagnosed with hiatal hernia after esophagectomy, and laparoscopic hernia repair was performed. During the surgery, the hiatus was found to be intact, and the defect was clearly separated from the left crus of the diaphragm. Parahiatal hernia was the operative diagnosis. The incarcerated colon was repositioned in the abdominal cavity, and the defect was repaired using a composite mesh.

Conclusions

Laparoscopic surgery was found to be effective for the diagnosis and repair of parahiatal hernia.