Combined surgical and endoscopic approach for the reduction of a congenital hiatal hernia in a cat: a case report

Abstract

A case of surgical resolution of type I or "sliding" hiatal hernia is reported. A seven-month-old kitten was presented because of abdominal discomfort, accelerated breathing after eating and chronic vomiting. The clinical examination was unremarkable. Thoracic radiographs and gastroscopy led to the diagnosis of type I hiatal hernia. The surgical resolution consisted of hiatal plication, oesophagopexy and left-flank incisional gastropexy. All procedures were carried out using a 6 mm videoendoscope positioned in the stomach to evaluate the right oesophago-gastric junction reduction. One week after surgery there was a recurrence of symptoms and a second laparotomy was performed. During the second surgery additional hiatal plication was necessary and an oesophagopexy was repeated after dissection of the phrenico-oesophageal ligament. Moreover, a new incisional gastropexy was carried out after resolution of the first one. The cat recovered without complications and at oneyear follow-up did show no signs related to the hiatal hernia. This communication reports on possible additional surgical techniques in cases of type I hiatal hernia and contributes to an understanding of the importance of oesophagopexy in cases of hiatus malformation.

Hiatal hernia in a five‐month‐old Bulldog

“…A second surgery which included an oesophagopexy was performed a week later, which resulted in a positive outcome. These authors suggested that an oesophagopexy was an essential part of the surgical management of a sliding hiatal hernia (Pisoni and others 2014). Due to the conflicting information within the literature, a phrenicoplasty, oesophagopexy and gastropexy were performed in this case study to reduce the risk of postoperative complications.…”

“…The degree to which the hiatus should be closed is another contentious issue surrounding the surgical repair of a hiatus hernia. There are unfortunately no clear guidelines or set standards for hiatal diameter and clinical judgement is generally used to determine the appropriate size (Sivacolundhu and others 2002, Pisoni and others 2014). Some reports advise aiming for a hiatal diameter of 1–2 cm, while others suggest that the hiatus should allow one or two fingers to pass through intraoperatively (White 1993).…”