Surgical management of paraesophageal (Type II hiatal) hernias: Report of four cases

Abstract

Purpose: We aimed to evaluate our surgical management and outcomes of the patients with paraesophageal hernias in this study.

Materials and Methods: Four patients were operated on for paraesophageal hernia in our hospital. Preoperative clinical findings, diagnostic methods, operative records, postoperative followup and results were evaluated.

Results: All four patients diagnosed with paraesophageal hernia had symptoms associated with gastroesophageal reflux disease such as heartburn. Diagnostic methods included chest X-ray, barium esophagogastroduodenography, upper gastrointestinal endoscopy, computed tomography, esophageal manometry and pH monitorization. The patients were operated on by the transabdominal open procedure under the elective conditions. Diaphragmatic closure was accomplished primarily in 2 patients with a hiatal defect of 5 cm or smaller. A patch of expanded polytetrafluoroethylene (ePTFE) was used to reinforce the closure of the hiatus in 2 patients with a hiatal defect of 8 cm or larger. Mean follow-up period was 26 months (range, 8-48 months). There were no recurrences or no additional complications were noted in any patients during the followup period.

Conclusion: In this study, satisfactory results for repair of paraesophageal hernia by using both primary cruroplasty alone and mesh reinforcement were achieved in the medium-term follow-up. Meticulous work-up and surgical technique are required for optimal results. The size of hiatal defect is obviously important for the selection of operative management.