Details of Interest and Controversy in the Anatomy of the Esophageal Hiatus and Hiatal Hernia

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

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Low-dose combined spinal-epidural anesthesia for a patient with a giant hiatal hernia who underwent urological surgery

Journal of International Medical Research ◽

10.1177/0300060518793800 ◽

2018 ◽

Vol 46 (10) ◽

pp. 4354-4359 ◽

Cited By ~ 1

Author(s):

Mi Kyeong Kim ◽

Junoik Shin ◽

Jeong-Hyun Choi ◽

Hee Yong Kang

Keyword(s):

Hiatal Hernia ◽

Epidural Catheter ◽

Epidural Anesthesia ◽

Low Dose ◽

Intrathecal Injection ◽

Vital Signs ◽

Esophageal Hiatus ◽

Urological Surgery ◽

Gastrointestinal Problems ◽

Giant Hiatal Hernia

A hiatal hernia refers to herniation of the abdominal organs through the esophageal hiatus of the diaphragm. A giant hiatal hernia affects digestive and cardiopulmonary function by compressing the organs. We report a patient who had low-dose combined spinal and epidural anesthesia (CSEA) for safe and effective anesthesia for conservative treatment of a giant hiatal hernia. An 84-year-old woman who had a giant hiatal hernia was scheduled for ureteroscopic removal of a ureteral stone. CSEA was performed at the L4 to L5 lumbar interspace and an epidural catheter tip was placed 5 cm cephalad from the inserted level. The T12 block was checked after 10 minutes of intrathecal injection of 6 mg of 0.5% bupivacaine. The T10 block was checked after additional injection of 80 mg of 2% lidocaine through the epidural catheter. During anesthesia and surgery, the patient's vital signs remained stable and the operation was completed within 1 hour without any problems. In conclusion, low-dose CSEA may be safely used without any cardiopulmonary and gastrointestinal problems in patients with a giant hiatal hernia undergoing urological surgery.

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Hiatal Hernia as a Total Gastrectomy Complication

Case Reports in Oncology ◽

10.1159/000443633 ◽

2016 ◽

Vol 9 (1) ◽

pp. 100-105 ◽

Cited By ~ 5

Author(s):

Bruna do Nascimento Santos ◽

Marcos Belotto de Oliveira ◽

Renata D'Alpino Peixoto

Keyword(s):

Hiatal Hernia ◽

Gastric Adenocarcinoma ◽

Epigastric Pain ◽

Abdominal Cavity ◽

Esophageal Hiatus ◽

The Third ◽

Esophageal Anastomosis ◽

Folfox Chemotherapy ◽

Laparoscopic Assisted ◽

Severe Epigastric Pain

Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

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Combined laparoscopic intervention for compression syndrome of the celiac trunk and hiatal hernia

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2020-179-2-47-50 ◽

2020 ◽

Vol 179 (2) ◽

pp. 47-50

Author(s):

Z. M. Khamid ◽

D. I. Vasilevskii ◽

A. Yu. Korol’kov ◽

S. G. Balandov

Keyword(s):

Abdominal Pain ◽

Hiatal Hernia ◽

Celiac Trunk ◽

Chronic Abdominal Pain ◽

Esophageal Hiatus ◽

Simultaneous Operation ◽

Compression Syndrome ◽

Laparoscopic Intervention ◽

Esophageal Hiatus Hernia ◽

Laparoscopic Removal

The OBJECTIVE was to present the results of surgical treatment of the patient with the combined pathology: celiac trunk compression syndrome and hiatal hernia. In the 63-year-old patient with chronic abdominal pain and dysphagia, a type III esophageal hiatus hernia and a celiac trunk compression syndrome were detected during the examination. The simultaneous operation was performed: laparoscopic decompression of the celiac trunk and laparoscopic removal of the hiatal hernia with fundoplication according to R. Nissen.

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Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery

Surgical Endoscopy ◽

10.1007/s00464-005-0467-0 ◽

2006 ◽

Vol 20 (3) ◽

pp. 367-379 ◽

Cited By ~ 118

Author(s):

F. A. Granderath ◽

M. A. Carlson ◽

J. K. Champion ◽

A. Szold ◽

N. Basso ◽

...

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Antireflux Surgery ◽

Laparoscopic Antireflux Surgery ◽

Esophageal Hiatus ◽

Hiatal Hernia Repair ◽

Large Hiatal Hernia

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Resorbable Synthetic Mesh Supported With Omentum Flap in the Treatment of Giant Hiatal Hernia

International Surgery ◽

10.9738/intsurg-d-13-00104.1 ◽

2014 ◽

Vol 99 (5) ◽

pp. 551-555

Author(s):

F. J. Pérez Lara ◽

R. Marín ◽

A. del Rey ◽

H. Oliva

Keyword(s):

Hiatal Hernia ◽

Synthetic Mesh ◽

Omental Flap ◽

Esophageal Hiatus ◽

Complication Rates ◽

Esophageal Erosion ◽

Basic Procedure ◽

Giant Hiatal Hernia ◽

Omentum Flap

Abstract Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary.

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One-Stage Laparoscopic Surgery for Pulmonary Sequestration and Hiatal Hernia in a 2-Year-Old Girl

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0037-1612611 ◽

2018 ◽

Vol 06 (01) ◽

pp. e11-e14 ◽

Cited By ~ 2

Author(s):

Hisayuki Miyagi ◽

Shohei Honda ◽

Hiromi Hamada ◽

Masashi Minato ◽

Momoko Ara ◽

...

Keyword(s):

Computed Tomography ◽

Laparoscopic Surgery ◽

Hiatal Hernia ◽

Mediastinal Mass ◽

Pulmonary Sequestration ◽

Posterior Mediastinum ◽

Esophageal Hiatus ◽

Postoperative Course ◽

One Stage ◽

Extralobar Pulmonary Sequestration

AbstractWe herein report a case of one-stage laparoscopic surgery for extralobar pulmonary sequestration (EPS) and hiatal hernia. Our patient was a 2-year-old girl who was diagnosed as a mediastinal mass lesion. Postnatal computed tomography revealed that the mediastinal mass was an EPS. Two weeks after birth, the patient developed gastroesophageal reflux (GER), and esophagography showed a hiatal hernia. At 2 years of age, she underwent one-stage laparoscopic Nissen's fundoplication for GER with resection of the EPS in the posterior mediastinum. The sequestrated lung was grasped via the esophageal hiatus; three aberrant blood vessels were dissected to allow removal of the sequestration through the umbilical port site. The esophageal hiatus was repaired and Nissen's fundoplication was performed laparoscopically. The patient's postoperative course was uneventful, with no recurrence of GER symptoms for 1 year. We conclude that one-stage laparoscopic surgery is useful for patients with EPS and hiatal hernia.

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Hemorrhagic Pleural Effusion Secondary to an Unusual Type III Hiatal Hernia in a 4-Year-Old Great Dane

Journal of the American Animal Hospital Association ◽

10.5326/0460336 ◽

2010 ◽

Vol 46 (5) ◽

pp. 336-340 ◽

Cited By ~ 2

Author(s):

Lena C. Gordon ◽

Edward J. Friend ◽

Michael H. Hamilton

Keyword(s):

Pleural Effusion ◽

Hiatal Hernia ◽

Clinical Signs ◽

Esophageal Hiatus ◽

Radiographic Findings ◽

Type Iii ◽

Clinically Normal ◽

Hemorrhagic Pleural Effusion ◽

Short Gastric Vessels ◽

Great Dane

An unusual case of combined axial and paraesophageal (type III) hiatal hernia (HH) in a 4-year-old Great Dane is reported. The main presenting complaint was dyspnea, and no history of trauma was present. A tentative diagnosis of HH with secondary pleural effusion was made based on clinical signs and radiographic findings. Exploratory celiotomy revealed herniation of the gastric cardia, fundus, and body through the esophageal hiatus and an adjacent, distinct defect in the diaphragm. Rupture of the short gastric vessels lead to the formation of a hemorrhagic pleural effusion that impaired ventilation. The esophageal hiatus was surgically reduced in size, and the second defect was closed with nonabsorbable sutures. Esophagopexy and tube gastropexy procedures were also performed. The dog was clinically normal 9 months postoperatively. This type of HH is not currently defined within the traditional classification system and to the authors’ knowledge has not been previously reported.

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Cardia Laxity under Retroflexed Endoscopy Is a Reflection of Esophageal Hiatus Enlargement

Gastroenterology Research and Practice ◽

10.1155/2020/9180167 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Dong Chen ◽

Shurui Tian ◽

Zhiwei Hu ◽

Jimin Wu

Keyword(s):

Clinical Practice ◽

Hiatal Hernia ◽

Correlation Coefficient ◽

Three Dimensional ◽

Esophageal Hiatus ◽

Spearman Correlation ◽

Specific Data ◽

Dimensional Reconstruction ◽

Selection Of Patients ◽

Selection Of

Background and Aim. In clinical practice, we found that the degree of gastroesophageal laxity (cardia or hiatus) under retroflexed endoscopy is associated with the enlargement of esophageal hiatus during operation, but specific data was lacking. The aim of this study was to confirm this correlation. Methods. Information from patients who underwent endoscopy and CT scan in our department was collected and analyzed retrospectively. Three-dimensional reconstruction of hiatus from CT images was performed using 3DSlicer software, and the degree of esophageal hiatus enlargement was compared with the degree of gastroesophageal laxity under retroflexed endoscopy. Results. Information from 104 patients was included for analysis. The Spearman correlation coefficient was 0.617 (p≤0.001). When subgroup correlation analysis was performed according to the presence of hiatal hernia on CT, the Spearman correlation coefficient was 0.816 (p≤0.001) in the hernia group and 0.351 (p=0.002) in the nonhernia group. The proportion of hiatal hernia and severe esophagitis was increasing gradually with the degree of gastroesophageal laxity. Conclusion. The degree of gastroesophageal laxity (cardia or hiatus) under retroflexed endoscopy reflects the degree of esophageal hiatus enlargement; with the degree of gastroesophageal laxity increasing, the proportion of HH and severe esophagitis increases gradually. This may be useful for physicians in China to guide themselves in the selection of patients for endoscopic antireflux treatment.

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P73 CONTRIBUTION TO THE IMPROVEMENT OF CARDIAC LOAD BY RADICAL SURGERY FOR ADVANCED ESOPHAGEAL HIATAL HERNIA

Diseases of the Esophagus ◽

10.1093/dote/doz092.73 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Tanabe Shunsuke ◽

Shirakawa Yasuhiro ◽

Maeda Naoaki ◽

Noma Kazuhiro ◽

Fujiwara Toshiyoshi

Keyword(s):

Hiatal Hernia ◽

Mixed Type ◽

Radical Surgery ◽

Circulatory System ◽

The Elderly ◽

Esophageal Hiatus ◽

Esophageal Hiatal Hernia ◽

Before And After ◽

Giant Hiatal Hernia ◽

Suture Closure

Abstract Aim The aim of this study is to clarify whether radical surgery for advanced esophageal hiatal hernia contribute to the improvement of cardiac load. Background & Methods In Japan, endoscopic surgery for esophageal hiatal hernia is increasing. In many cases, patients with mixed type hernia have the main symptom of meal passage disorder due to gastric torsion. On the other hand, there are cases in which the contents of hernia squeeze the heart and lung and the symptoms of respiratory and circulatory system get worse. And there are cases where cardiac load is exacerbated and QOL is got worse. Therefore, in addition to conventional surgical adaptation criteria such as vomiting and food loss, cardiac load aggravation may be added to the new surgical adaptation criteria. In this study, we measured BNP before and after surgery in the case of mixed type hiatal hernia who underwent surgery at our hospital, and examined changes in cardiac load. Our surgical procedure of laparoscopic fundoplication is basically toupet fundplication. In the elderly patients, the formation of toupet fundplication is about half a cycle, which is slightly looser than usual, in order to avoid passage obstruction of the wrap. If the esophageal hiatus is too large and it is difficult to suture closure, try to reduce the air pressure of laparoscopic surgery as much as possible to reduce the resistance to the suture closure. And we try not to damage the diaphragm leg. Results We experienced 70 esophageal hiatal hernia surgeries in 2012-2018 and 45 patient had mixed type hiatal hernia. In mixed type hiatal hernia case, 18 cases (40.0%) had chest symptoms such as fatigue and dyspnea on exertion. And there were 12 cases in which BNP could be measured before and after surgery as an evaluation for the presence of cardiac load. Postoperative BNP decreased in 11 of 12 cases from preoperative values. Almost all cases chest symptoms improved. In the above 45 cases, there have been no cases of reoperation and very few cases have taken proton pump inhibitors after surgery. Conclusion Surgical cases of giant hiatal hernia may increase in the future, especially in the elderly. Surgery for giant hiatal hernia can contribute to the improvement of cardiac load.

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