Complex and acute paraesophageal hernias—type IV, strangulated, and irreducible

Baison, George N.; Aye, Ralph W.

doi:10.21037/ales-20-7

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…Like type I-III hiatal hernias, type IV hiatal hernias are associated with gastric reflux, dysphagia, early satiety, anemia, and pain due to the displacement of the esophageal junction and compression of the stomach within the hiatus [ 18 , 12 ]. Furthermore, additional organ strangulation distinctively becomes the main concern for surgeons when identifying a type IV hiatal hernia [ 19 ]. Herniation of the small bowel, spleen, and pancreas has been reported in cases of type IV hiatal hernias.…”

Section: Discussionmentioning

confidence: 99%

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Hiatal Hernia of Stomach and Lesser Omentum in a Cadaver: Is It a Type III or IV?

Alvarez,

Debski,

Egli

et al. 2024

Cureus

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Hiatal hernias, protrusions of abdominal viscera through the esophageal hiatus, are classified into four types. Types I and II involve ascent of the stomach without affecting the gastroesophageal junction. Types III and IV involve the gastroesophageal junction. Type IV specifically may have stomach as well as other abdominal organ involvement, such as pancreas or omentum. Among these types, type IV is the most complex and rare form, accounting for only 0.1% of all cases of hiatal hernias. This report presents a case of a type IV hiatal hernia involving the lesser omentum and a significant portion of the stomach in an 86-year-old male cadaver with a history of mediastinal surgery. To our knowledge, this presentation in a cadaver has not previously been reported in the literature. This case highlights classification inconsistencies in the literature, particularly regarding type IV hiatal hernias. It is unclear given the current classification system, whether this presentation would be considered a type III or type IV hiatal hernia as it fits both criteria and there are several interpretations of the criteria of a type IV hiatal hernia. Inconsistencies in the classification system may impede standardization of care. This report highlights the need for a more precise classification system that better accounts for anatomical changes and clinical presentation.

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Section: Discussionmentioning

confidence: 99%

“…Herniation of the small bowel, spleen, and pancreas has been reported in cases of type IV hiatal hernias. Subsequent compression and strangulation of these organs can be devastating, leading to organ insufficiency or even rupture [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Hiatal Hernia of Stomach and Lesser Omentum in a Cadaver: Is It a Type III or IV?

Alvarez,

Debski,

Egli

et al. 2024

Cureus

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“…Laparoscopic Nissen fundoplication is now considered a golden standard in treating hiatal hernia and gastroesophageal reflux disease (Kohn et al 2013;Rodriguez and Ponsky 2017). Despite good postoperative results in gastroesophageal reflux control and a low recurrence rate, because of the specific surgical skills required, postoperative life-threatening complications could be seen (Köhler et al 2015;Baison and Aye 2021;Laxague et al 2021).…”

Section: Introductionmentioning

confidence: 99%

Nissen fundoplication in a series of 53 consecutive patients

Stoyanov

2024

JBCR

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Hiatal hernia (HH) is often seen in surgery practice. The main feature of HH is the migration of abdominal viscera in the mediastinum via the esophageal hiatus. We performed - on 53 patients from November 2009 to June 2018 in the Department of General and Digestive Surgery of General Hospital of Villarobledo. Forty-one patients were diagnosed with hiatal hernia, 9 - with gastroesophageal reflux disease (GERD), and 3 - with Barrett’s esophagus. The average operative time was 89 ± 33 minutes, and the average follow-up was four years. The following complications were recorded: perforation of the distal esophagus in 1 patient (1.9%), postoperative spleen hemorrhage requiring emergency laparotomy in 1 patient (1.9%), dysphagia in 6 patients (11.3%) in the early postoperative period (treated conservatively), one patient had small bowel obstruction in the fourth postoperative year, three patients (5.6%) had radiological signs of HH recurrence and GERD despite the fundoplication. One patient (1.9%) was reoperated for stenosis of the distal esophagus and recurrent paraesophageal hiatal hernia one year after the first intervention. Postoperative ventral hernia (POVH) was seen in 2 patients (3.8%). All recurrence rate was 7.5%, recorded in 4 patients.

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