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Symptomatic diaphragmatic hernia: surgical treatment
1Department of Thoracic Surgery, Tel Aviv University Sackler School of Medicine, Holon, Israel.
Scandinavian Journal of Thoracic and Cardiovascular Surgery
|January 1, 1995
Summary
This study reviewed 78 symptomatic diaphragmatic hernia cases, finding surgery effective for most. Sliding hiatal hernias require reflux management, while other types necessitate surgical repair to prevent incarceration.
Area of Science:
- Surgery
- Gastroenterology
- Thoracic Surgery
Background:
- Diaphragmatic hernias, including hiatal and true hernias, present with varied symptoms and risks.
- Symptomatic cases necessitate a clear understanding of hernia type for appropriate management.
Observation:
- The study analyzed 78 cases: 55 hiatal hernias (42 sliding, 9 rolling, 4 intrathoracic stomach) and 19 true diaphragmatic hernias (12 Bochdalek, 7 Morgagni).
- Pulmonary function was impaired in 10 cases, and 4 hernias were incarcerated.
- Surgery was performed in 76 patients, with 10 requiring emergency intervention.
Findings:
- Sliding hiatal hernias primarily involve gastroesophageal reflux, managed with investigations like endoscopy and manometry, and surgical fundoplication if needed.
- Rolling hiatal hernias and true diaphragmatic hernias pose incarceration risks, mandating surgical reduction, sac excision, and repair.
- Overall, 72 of 76 surgically treated patients had satisfactory outcomes, with one death and three recurrences.
Implications:
- Differentiating hernia types is crucial for tailoring treatment strategies, optimizing patient outcomes.
- Prompt surgical intervention for non-sliding hernias is vital to mitigate risks of incarceration and complications.
- Effective management of diaphragmatic hernias improves pulmonary function and quality of life.