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Techniques of Hiatal Hernia Repair

  • Beat Müller-Stich
  • Philip C. Müller
  • Rudoph Pointner
  • Stavros A. Antoniou
  • Burkhard H. A. von Rahden
  • Sumeet K. Mittal
Chapter

Abstract

Hiatal hernias are currently classified into type I–IV hernias (◘ Fig. 38.1). In type I hernias, also called sliding hernias, the gastroesophageal junction is situated above the diaphragm. They are the most common type of hiatal hernia with 80–85% of all hiatal hernias. Type II–IV hernias are less common and characterized by a paraesophageal involvement. Especially type II hernias are rare and characterized as pure paraesophageal hernias. Type III hernias are a combination of type I and type II hernias, the gastroesophageal junction, and the fundus herniate through the diaphragm. If an intra-abdominal organ other than the stomach herniates, a type IV hernia is present. Surgical treatment in type I hiatal hernia is only indicated for concomitant gastroesophageal reflux disease. Hiatal hernias with paraesophageal involvement should be operated if they are symptomatic because of the risk of progression and the risk for complications such as incarceration. The aim of the surgical therapy is the constant reposition of the hernia sac content and the repair of the hiatus. Hiatal hernia repair can either be performed transabdominally or by transthoracic access with an open or minimally invasive approach. The laparoscopic approach is associated with reduced perioperative morbidity and shorter hospital stay while showing equal symptomatic outcome compared to the open abdominal and the transthoracic approach. The minimally invasive abdominal access is thus the preferred approach for most hiatal hernias. Besides the access, the dissection of the hernia sac, the type of cruroplasty, the use of mesh augmentation, and the addition of a fundoplication are factors that have to be considered for an ideal hiatal hernia repair. The chapter gives an evidence-based overview on the mentioned technical considerations, and recommendations are made according to the SAGES Guidelines and the latest literature (◘ Tables 38.1 and 38.2).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Beat Müller-Stich
    • 1
  • Philip C. Müller
    • 2
  • Rudoph Pointner
    • 3
  • Stavros A. Antoniou
    • 4
    • 5
  • Burkhard H. A. von Rahden
    • 6
  • Sumeet K. Mittal
    • 7
  1. 1.Department of General SurgeryHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
  3. 3.Tauernklinikum GmbHStefan-Zweig-StraßeZell am SeeAustria
  4. 4.Department of Colorectal SurgeryRoyal Devon and Exeter NHS Foundation TrustExeterUK
  5. 5.Department of General SurgeryUniversity Hospital of HeraklionHeraklionGreece
  6. 6.Department of SurgeryUniversity Hospital WuerzburgWuerzburgGermany
  7. 7.Norton thoracic institute, Dignity healthPhoenixUSA

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