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Hiatal and paraesophageal hernia repair in pediatric patients

Erin M Garvey1, Daniel J Ostlie1

  • 1Department of Surgery, Phoenix Children׳s Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016.

Seminars in Pediatric Surgery
|May 29, 2017
PubMed

Insights

Hiatal and paraesophageal hernia (HH/PEH) can arise congenitally or be acquired after surgery. Minimizing esophageal dissection during Nissen fundoplication significantly reduces the risk of acquired HH/PEH.

Area of Science:

  • Gastroenterology and Surgical Science

Background:

  • Hiatal and paraesophageal hernia (HH/PEH) are conditions that can be congenital or acquired, often following gastroesophageal surgery like fundoplication.
  • Acquired HH/PEH is frequently linked to surgical procedures, with significant rates reported after Nissen fundoplication.

Purpose of the Study:

  • To investigate the incidence of acquired hiatal and paraesophageal hernia (HH/PEH) after Nissen fundoplication.
  • To evaluate the impact of surgical technique, specifically minimizing circumferential esophageal dissection, on the occurrence of acquired HH/PEH.

Main Methods:

  • Analysis of patient data following Nissen fundoplication surgery.
  • Comparison of HH/PEH rates between standard and modified surgical techniques (minimizing esophageal dissection).

Main Results:

  • The risk of acquired HH/PEH decreased from 36.5% to 12.2% when circumferential esophageal dissection was minimized during Nissen fundoplication.
  • Gastrointestinal, respiratory, and constitutional symptoms, including anemia and failure to thrive, are common in patients with HH/PEH, often associated with gastroesophageal reflux.

Conclusions:

  • Minimizing circumferential esophageal dissection during Nissen fundoplication is a crucial technical modification to reduce the incidence of acquired HH/PEH.
  • Surgical correction of HH/PEH involves hernia reduction, sac excision, crural closure, and an antireflux procedure, with laparoscopy being a safe and effective approach.

Keywords:
Hiatal herniaMeshParaesophageal herniaPediatricRecurrence

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