Iatrogenic hiatal and diaphragmatic hernias

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Surgery

Background:

• The Belsey repair is a common surgical procedure for treating hiatal hernias.
• Recurrence of hiatal hernias post-Belsey repair necessitates understanding of failure mechanisms.

Observation:

• Seven patients presented with recurrent hernias following prior Belsey hiatal hernia repair.
• Two distinct types of recurrent hernias were identified: paraesophageal and incisional.
• Paraesophageal hernias were linked to inadequate correction of a shortened esophagus.

Findings:

• Four patients developed paraesophageal hernias, attributed to a failure to address esophageal shortening.
• Three patients experienced incisional hernias through disrupted diaphragmatic counterincisions, potentially due to postoperative distension or technical issues.
• Collis-Belsey gastroplasty with an antireflux procedure successfully repaired paraesophageal hernias.
• Hernia reduction and diaphragmatic resuture corrected incisional hernias.

Implications:

• Accurate diagnosis of recurrent hiatal hernia type is crucial for selecting the appropriate surgical strategy.
• Addressing esophageal length is vital in preventing paraesophageal recurrences after Belsey repair.
• Meticulous surgical technique and management of postoperative complications are essential for preventing incisional hernias.