Chest Pain: A Relatively Benign Symptom of Type IV Hiatal Hernia

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.

Download Full-text

Diagnosis and Surgical Treatment of a Congenital Type-IV Hiatal Hernia in a German Shepherd Pup

International Journal of Livestock Research ◽

10.5455/ijlr.20200521042653 ◽

2020 ◽

pp. 1

Author(s):

Mohamed Shafiuzama ◽

Mohamed Ali ◽

K Gayathri ◽

M Bharathidasan ◽

G Shriram ◽

...

Keyword(s):

Surgical Treatment ◽

Hiatal Hernia ◽

German Shepherd ◽

Type Iv

Download Full-text

Severe type IV hiatal hernia secondary to congenital shortened esophagus

Journal of the American Academy of Physician Assistants ◽

10.1097/01.jaa.0000524729.59643.5f ◽

2017 ◽

Vol 30 (10) ◽

pp. 1-3

Author(s):

Samantha Weller ◽

Christin Powers ◽

Bethany Sly ◽

Nata Parnes ◽

Mario James Ciani

Keyword(s):

Hiatal Hernia ◽

Type Iv ◽

Severe Type

Download Full-text

A Rare Coincidence of Two Coronary Anomalies in an Adult

Cardiology Research and Practice ◽

10.4061/2010/376067 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Cesar Cruz ◽

Dalton Mclean ◽

Matthew Janik ◽

Paolo Raggi ◽

A. Maziar Zafari

Keyword(s):

Computed Tomography ◽

Case Report ◽

Chest Pain ◽

Coronary Angiography ◽

Coronary Arteries ◽

Coronary Anomalies ◽

Left Main ◽

Atypical Chest Pain ◽

Selective Coronary Angiography ◽

Type Iv

Anomalous right-sided left main coronary arteries and dual type IV left anterior descending arteries are rare coronary anomalies. In this case report, we present a 59 year old man with atypical chest pain and a combination of the above coronary anomalies as identified by selective coronary angiography and computed tomography angiography. To the best of our knowledge, the coincidence of these coronary anomalies has not been previously described.

Download Full-text

Type IV para-oesophageal hiatal hernia: it's a gut feeling

BMJ Case Reports ◽

10.1136/bcr.06.2008.0302 ◽

2009 ◽

Vol 2009 (feb04 1) ◽

pp. bcr0620080302-bcr0620080302

Author(s):

F. Irani ◽

V. Mahajan

Keyword(s):

Hiatal Hernia ◽

Type Iv

Download Full-text

A Rare Case of Pancreatitis Due to Trans-Hiatal Herniation of the Pancreas Within a Type IV Hiatal Hernia

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-01271 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S730

Author(s):

Patrick Chen ◽

David Do ◽

Steve Mudroch ◽

Rajan Prakash ◽

Padmini Krishnamurthy

Keyword(s):

Hiatal Hernia ◽

Rare Case ◽

Type Iv

Download Full-text

Large Paraesophageal Hiatal Hernia in a Patient With Chest Pain

The Journal of the American Osteopathic Association ◽

10.7556/jaoa.2015.055 ◽

2015 ◽

Vol 115 (4) ◽

pp. 282 ◽

Cited By ~ 1

Author(s):

Gregory K. Wanner ◽

James P. Nangeroni ◽

Bruce Nisbet

Keyword(s):

Chest Pain ◽

Hiatal Hernia ◽

Paraesophageal Hiatal Hernia

Download Full-text

Hiatal Hernia Repair with or without Esophageal Lengthening

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000012 ◽

2013 ◽

Vol 8 (5) ◽

pp. 341-347 ◽

Cited By ~ 4

Author(s):

Varun Puri ◽

Kyle Jacobsen ◽

Jennifer M. Bell ◽

Traves D. Crabtree ◽

Daniel Kreisel ◽

...

Keyword(s):

Chest Pain ◽

Hiatal Hernia ◽

Functional Outcomes ◽

Perioperative Complications ◽

Hiatal Hernia Repair ◽

Validated Questionnaire ◽

Symptom Evaluation ◽

Before And After ◽

Institutional Experience ◽

Continued Use

Objective The need for esophageal lengthening (EL) as part of hiatal hernia (HH) repair is perceived to elevate perioperative risk and provide functionally inferior outcomes. Our objectives were to determine the risk factors of undergoing EL and to compare outcomes between operations with and without EL. We hypothesized that operative and functional outcomes for HH repair were similar in patients whether they required EL or not. Methods We reviewed institutional experience with EL as part of HH repair. The patients underwent symptom evaluation before and after surgery using a validated tool. Results Between 1999 and 2009, a total of 375 patients underwent HH repair. The operative approach was thoracotomy, 153 (41%); laparotomy, 18 (5%); laparoscopy, 167 (44%); or combined, 37 (10%). Of these, 168 (45%) required EL. There was a higher need for thoracotomy in the patients undergoing EL (79/168 vs 74/207, χ2 = 4.88, P = 0.034). The incidence of perioperative complications (leak, pneumonia, ileus, respiratory failure, and bleeding) was similar between the groups. Sixty-five selected patients undergoing EL were compared with 63 patients with comparable demographics not requiring EL. In a well-validated questionnaire that assessed symptoms before and after surgery, the patients undergoing EL showed significant improvement in their heartburn (76.8%), dysphagia (67.6%), regurgitation (71.7%), chest pain (91.9%), and nausea (86.5%) ( P < 0.05). The patients not undergoing EL also showed significant improvement in their heartburn (81.1%), dysphagia (71.1%), regurgitation (64.4%), chest pain (64.1%), and nausea (61.0%) ( P < 0.05). Improvement in symptoms, the continued use of antacid medications, and overall surgery satisfaction score were statistically similar between the two groups. Conclusions Operative and functional outcomes for HH repair with or without EL are acceptable and comparable. Thoracic surgeons should use EL without reservations for appropriate indications.

Download Full-text