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Updated: Aug 13, 2026
10:52
Laparoscopic Repair of Para-Esophageal Hernia Using Absorbable Biosynthetic Mesh
Published on: September 11, 2021
Massive hiatus hernia: evaluation and surgical management
D E Maziak1, T R Todd, F G Pearson
1University of Toronto, Department of Thoracic Surgery, Ontario, Canada.
The Journal of Thoracic and Cardiovascular Surgery
|February 6, 1998
Summary
Paraesophageal hernias often present as advanced sliding hiatus hernias with gastroesophageal reflux disease and acquired short esophagus. Surgical repair, typically transthoracic with fundoplication, yields good outcomes in most patients.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Thoracic Surgery
Background:
- Paraesophageal hernias are advanced sliding hiatus hernias with intrathoracic displacement of the esophagogastric junction.
- Gastroesophageal reflux disease (GERD) is common, often leading to acquired short esophagus, influencing surgical repair choices.
Purpose of the Study:
- To analyze the clinical presentation, surgical management, and outcomes of patients with massive, incarcerated paraesophageal hiatus hernia.
- To evaluate the incidence of GERD, esophagitis, and acquired short esophagus in these patients.
Main Methods:
- Retrospective analysis of 94 patients undergoing surgery for massive, incarcerated paraesophageal hiatus hernia between 1960 and 1996.
- Clinical data, endoscopic findings, and esophageal manometry results were reviewed.
- Surgical repair involved transthoracic approach with fundoplication and, in most cases, gastroplasty.
Main Results:
- The majority of patients (91/94) had findings consistent with sliding hiatus hernia.
- High incidence of symptomatic reflux (83%), peptic esophagitis (36%), and acquired short esophagus (80% required gastroplasty).
- At a mean follow-up of 94 months, 80% of patients had excellent outcomes (asymptomatic), and 13% had good outcomes (inconsequential symptoms).
Conclusions:
- Paraesophageal hernias are frequently associated with sliding hiatus hernia, GERD, and acquired short esophagus.
- Transthoracic repair with fundoplication and gastroplasty is effective for managing these complex hernias.
- Acquired esophageal shortening should be recognized and addressed during initial repair to prevent recurrence.
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