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Congenital hiatus hernia: A case series
Didem Baskin Embleton1, Ahmet Ali Tuncer1, Mehmet Surhan Arda2
1Department of Pediatric Surgery, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey.
Insights
Congenital hiatus hernia in infants is rare. Recurrence was more frequent with Thal fundoplication, suggesting mediastinal dissection may prevent recurrence in complex cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Congenital hiatus hernia is a rare condition in infants.
- Management strategies for this condition require careful consideration.
Purpose of the Study:
- To describe a cohort of infants diagnosed with congenital hiatus hernia.
- To evaluate the management and outcomes of these patients.
Main Methods:
- Retrospective analysis of 7 infant patients (3 male, 4 female) diagnosed between 2010 and 2016.
- Evaluation of demographic data, symptoms, diagnostic methods (X-ray, CT, upper GI series), surgical procedures (laparotomy/laparoscopy), and follow-up.
- Specific surgical techniques included Nissen fundoplication (2 patients) and Thal fundoplication (3 patients).
Main Results:
- One patient diagnosed prenatally; mean age at diagnosis was 18.6 months for others.
- Hernia types included IV (4 patients), III (2 patients), and I (1 patient).
- Recurrence of hernia occurred in 2 patients who underwent Thal fundoplication.
Conclusions:
- Thal fundoplication may be associated with a higher recurrence rate for sliding hernias in this series.
- Achieving adequate abdominal esophagus length through mediastinal dissection may be crucial for preventing recurrence, especially when the esophagogastric junction is intrathoracic.
Objective:
Hiatus hernia is frequent in adults and rare in children; congenital hiatus hernia is even rarer. In this study, we describe a group of infants with congenital hiatus hernia and discuss its management.
Methods:
Records of patients (male: 3, female: 4) who were diagnosed with congenital hiatus hernia between 2010 and 2016 were extracted. Demographic data, presenting symptoms, diagnostic investigations, operative details, postoperative follow-up, and early and late postoperative complications were evaluated retrospectively.
Results:
Four patients were female and three were male. One patient was diagnosed prenatally while the mean age at diagnosis for others was 18.6 months. Four patients had type IV hernia, 2 had type III hernia, and one had type I hernia. The diagnosis was confirmed by chest X-ray, computerized tomography (CT) and/or upper gastrointestinal series. The hiatal repair was done in all patients either by laparotomy or laparoscopy. During the procedure, 2 patients had Nissen fundoplication and 3 patients had Thal fundoplication. Recurrence of hernia occurred in the 2 patients who had Thal fundoplication.
Conclusion:
Recurrence of sliding hernias with Thal fundoplication seem more frequent in the series. If the esophagogastric junction is present in the thorax, mediastinal dissection of the esophagus may be required to achieve a good abdominal esophagus structure, which will prevent a recurrence.
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