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Related Concept Videos

Hiatal Hernia01:25

Hiatal Hernia

A hiatal hernia is the abnormal protrusion of the stomach or other abdominal organs through the esophageal hiatus of the diaphragm into the thoracic cavity.Normally, the gastroesophageal junction (GEJ) lies below the diaphragm and is supported by the phrenoesophageal membrane, the diaphragmatic crura, and connective tissues. Weakening of these structures—due to aging, congenital defects like a short esophagus, or increased intra-abdominal pressure from coughing, obesity, pregnancy, or heavy...
Gastroesophageal Reflux Disease01:25

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is the backward flow of stomach contents (acid, pepsin, or bile) into the esophagus, causing mucosal inflammation known as esophagitis. It results from failure of antireflux mechanisms, mainly the lower esophageal sphincter (LES), influenced by mechanical and physiological factors.Etiology and Risk FactorsGERD develops when LES function is weakened or when intra-abdominal pressure increases. Risk factors include aging, obesity, and sliding hiatal hernia,...
Gastroesophageal Reflux Disease I: Meaning and Pathophysiology01:29

Gastroesophageal Reflux Disease I: Meaning and Pathophysiology

Gastroesophageal Reflux Disease (GERD) involves the recurrent backflow of the stomach or duodenal contents into the esophagus, leading to troublesome symptoms and potential esophageal mucosal damage. Although GERD is often referred to as a disease, it is more accurately described as a syndrome, as it encompasses a range of symptoms and complications rather than a singular pathological entity, impacting a large number of individuals as the most prevalent upper gastrointestinal problem. Roughly...
Esophageal Achalasia01:27

Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
Esophageal Perforation-I: Introduction01:22

Esophageal Perforation-I: Introduction

Esophageal perforation is a severe medical condition characterized by a breach in the integrity of the esophageal wall. This breach can occur due to various factors such as trauma, medical procedures, or underlying diseases. When the esophageal wall is compromised, it allows food, fluids, and digestive juices into the chest cavity or adjacent structures, leading to potential complications and health risks.
The location of esophageal perforation can vary, occurring anywhere along the esophagus.
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:

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Updated: Jun 12, 2026

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
10:52

Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh

Published on: September 11, 2021

Giant hiatal hernia.

Mohi O Mitiek1, Rafael S Andrade

  • 1Department of Surgery, Division of General Thoracic and Foregut Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.

The Annals of Thoracic Surgery
|May 25, 2010
PubMed
Summary
This summary is machine-generated.

Giant hiatal hernias (HH) involve significant stomach displacement into the chest. Successful repair requires addressing esophageal length and reflux, with laparoscopic techniques matching open repair outcomes.

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Technical Considerations and Approach to Redo Foregut Surgery
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Area of Science:

  • Gastroenterology and General Surgery

Background:

  • A giant hiatal hernia (HH) is defined as at least 30% of the stomach herniating into the chest, often a Type III hernia with sliding and paraesophageal components.
  • The exact cause of giant HH is unclear, with theories including gastroesophageal reflux disease (GERD) causing esophageal shortening or chronic pressure leading to herniation and subsequent GERD.
  • Understanding the roles of a short esophagus and GERD is crucial for managing giant HH.

Purpose of the Study:

  • To outline the pathophysiology and essential components for successful surgical repair of giant hiatal hernias.
  • To compare the outcomes of open versus laparoscopic surgical techniques for giant HH repair.

Main Methods:

  • Review of existing literature and surgical principles for giant hiatal hernia repair.
  • Analysis of recurrence rates for both open and laparoscopic approaches.

Main Results:

  • Successful giant HH repair necessitates hernia sac excision, tension-free repair, correction of esophageal length, and an effective antireflux procedure.
  • Recurrence rates for open giant HH repair by experts range from 2% to 12%.
  • Meticulous laparoscopic techniques can achieve results comparable to open repairs.

Conclusions:

  • Giant HH management requires addressing esophageal shortening and GERD alongside standard hernia repair principles.
  • Laparoscopic surgery offers a viable alternative to open repair for giant HH, with similar efficacy and recurrence rates in experienced hands.