Laparoscopic Paraesophageal Hernia Repair


Hiatal hernias are heterogeneous anatomic and clinical entities.
Classification into four types is widely accepted. Sliding
hernia is the result of an upward migration of the esophagogastric
junction into the mediastinum (type I hiatus hernia).
Paraesophageal hiatus hernia (type II hiatus hernia) occurs as
a result of an anterior defect in the diaphragmatic hiatus leading
to an upward dislocation of the gastric fundus alongside
the cardia. Subsequent progressive enlargement of the hiatus
and the hernia sac leads to a mixed paraesophageal and sliding
hernia (type III hiatus hernia) which may evolve to the
final stage characterized by a complete, intrathoracic, “upsidedown”
stomach. Therefore, the distinction between type II
and type III hernias is somewhat artificial because they are
considered a continuous disease spectrum. Infrequently, the
colon can migrate into the hernia sac (type IV hiatus hernia).
Approximately 10% of hiatus hernias have a paraesophageal
component, and among these patients, 90% have a
mixed type III hernia.
The true incidence of paraesophageal hernia in the overall
population is unknown because of minimal or even absence
of symptoms in many individuals. The majority of patients
with paraesophageal hernia are elderly females who often
present with multiple comorbidities.