Current surgical concepts for type III hiatal hernia: a survey among members of the Swiss Society of Visceral Surgery

Abstract Background Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA). Methods Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD. Results 38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence. Conclusion The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications. Disclosure All authors have declared no conflicts of interest.

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Surgery for Type III–IV hiatal hernia: anatomical recurrence and global results after elective treatment of short oesophagus with open and minimally invasive surgery

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezv280 ◽

2015 ◽

Vol 49 (4) ◽

pp. 1137-1143 ◽

Cited By ~ 2

Author(s):

Marialuisa Lugaresi ◽

Benedetta Mattioli ◽

Niccolò Daddi ◽

Massimo Pierluigi Di Simone ◽

Ottorino Perrone ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Hiatal Hernia ◽

Invasive Surgery ◽

Type Iii ◽

Short Oesophagus ◽

Elective Treatment

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Experience with Mesh Repair for Type III Esophageal Hiatal Hernia Developed Upside Down Stomach. A Case Report.

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.63.1404 ◽

2002 ◽

Vol 63 (6) ◽

pp. 1404-1407 ◽

Cited By ~ 2

Author(s):

Yukitake HASEBE ◽

Yasushige NAGASAWA ◽

Jun-ichi KOIKE ◽

Motoomi ZENNRI ◽

Shoji NISHIDA

Keyword(s):

Case Report ◽

Hiatal Hernia ◽

Mesh Repair ◽

Esophageal Hiatal Hernia ◽

Type Iii

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Laparoscopic Management of Giant Type III Hiatal Hernia and Short Esophagus Objective Follow-Up at Three Years

Journal of Gastrointestinal Surgery ◽

10.1016/s1091-255x(01)00067-1 ◽

2002 ◽

Vol 6 (2) ◽

pp. 181-188 ◽

Cited By ~ 74

Author(s):

B Jobe

Keyword(s):

Hiatal Hernia ◽

Short Esophagus ◽

Laparoscopic Management ◽

Type Iii

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Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate11No competing interests declared.

Journal of the American College of Surgeons ◽

10.1016/s1072-7515(00)00260-x ◽

2000 ◽

Vol 190 (5) ◽

pp. 553-560 ◽

Cited By ~ 355

Author(s):

Majid Hashemi ◽

Jeffrey H Peters ◽

Tom R DeMeester ◽

James E Huprich ◽

Marcus Quek ◽

...

Keyword(s):

Hiatal Hernia ◽

Laparoscopic Repair ◽

Type Iii ◽

Competing Interests ◽

Large Type

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Assessment of esophagogastric junction morphology by dynamic real-time MRI: comparison of imaging features to high-resolution manometry

Japanese Journal of Radiology ◽

10.1007/s11604-021-01210-9 ◽

2021 ◽

Author(s):

Lorenz Biggemann ◽

Johannes Uhlig ◽

Nina Gliem ◽

Omar Al-Bourini ◽

Edris Wedi ◽

...

Keyword(s):

High Resolution ◽

Real Time ◽

Hiatal Hernia ◽

Esophagogastric Junction ◽

Valsalva Maneuver ◽

Type I ◽

Imaging Features ◽

Type Ii ◽

High Resolution Manometry ◽

Type Iii

Abstract Purpose To assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphology on high-resolution manometry (HRM). Methods A total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD-like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM, EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A 10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ morphology on HRM. Results On HRM, n = 42 patients presented with EGJ type I (40.0%), n = 33 with EGJ type II (31.4%), and n = 30 with EGJ type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients with EGJ type I (26.2%) and EGJ type II (30.3%; p < 0.001). Sliding hiatal hernia was more frequent in patients with EGJ type II (33.3%) than in patients with EGJ type III (16.7%) and EGJ type I (7.1%; p = 0.017). The mean esophagus–fundus angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver. Conclusion Real-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time MRI can visualize dynamic changes of the EGJ during swallowing events.

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