Laparoscopic treatment of type III and IV hiatal hernia - authors' experience.

Abstract

IntroductionThere are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases.AimTo analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias.Material and methodsA total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis.ResultsAs many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life.ConclusionsThe laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia.

Dynamics of quality of life improvement after floppy Nissen fundoplication for gastroesophageal reflux disease.

“…Nissen fundoplication is a simple and effective approach for patients with gastroesophageal reflux symptoms due to diaphragmatic esophageal hiatal hernia – it should be the method of choice in patients with type III and IV hernia [ 23 , 24 ]. What is more, it is the method of choice in the treatment of Barrett's esophagus in the cases of patients who were qualified for surgery [ 25 ].…”

Minding the Gap: Clinical Manifestations of a Rare Type IV Hiatal Hernia

“…Hiatal hernias are the protrusion of the stomach and occasionally other intra-abdominal organs into the thoracic cavity. Type IV hiatal hernias are extremely rare and include the protrusion of the stomach and other abdominal organs through the esophageal hiatus, accounting for less than 5% of all hiatal hernias [1,2]. In fact, the combination of types II, III, and IV hiatal hernias account for about 5% of all hiatal hernias.…”

“…This occurs due to a large defect in the phrenoesophageal membrane, as well as an increased laxity in the esophageal hiatus, providing more area for organ protrusion. Type IV hiatal hernias are considered rare, accounting for less than 5% of all hiatal hernias [2]. This case presents a patient with a type IV hiatal hernia resulting in atypical symptoms ultimately caused by mass effect.…”

Surgical treatment of GERD. Comperative study of WTP vs. Toupet fundoplication - results of 151 consecutive cases.

“…In most cases, heartburn can be relieved through diet and lifestyle changes; however, some people may require proton pump inhibitor treatment or eventually surgery. Recurrence and the severity of these symptoms cause patients to abandon pharmacological therapy and see a surgeon [ 6 , 7 , 11 ]. Currently the best choice of surgical management concerning GERD is considered to be laparoscopic surgery.…”