Document Detail

Massive hiatal hernia with incarceration: a report of 53 cases.
MedLine Citation:
PMID:  6600388     Owner:  NLM     Status:  MEDLINE    
Between 1960 and 1980, 53 patients with massive incarcerated hiatal hernia were treated surgically. In 24 of the 53 patients, there was an associated organoaxial volvulus. The following symptoms and signs, which are almost peculiar to massive, incarcerated hernias, were observed: postprandial precordial distress in 43 patients, upper gastrointestinal bleeding (manifest or occult) in 24 patients, severe dyspnea in 13 patients, and complete obstruction associated with organoaxial volvulus in 4. In only 1 of the 53 patients was the hernia of the true paraesophageal type with the esophagogastric junction remaining in its normal, intraabdominal location. The remainder were all believed to be advanced stages of an ordinary sliding hiatal hernia. Operative treatment consisted of gastroplasty and partial fundoplication in 36 patients, standard Belsey repair in 14, and transabdominal Nissen repair in 3. Gastroplasty and partial fundoplication were used much more frequently during the 1970s, when it was realized that there is a significant incidence of chronic peptic esophagitis and shortening in these patients. Postoperative complications were few in spite of the advanced age of many of the patients. There was one operative death. Only 1 patient was lost to follow-up, and of the 51 patients remaining for analysis, follow-up has extended from 1 to 16 years, with a mean of 6.2 years. No patient has developed recurrent precordial pain, evidence of upper gastrointestinal bleeding, iron deficiency anemia, or severe dyspnea. Seven patients have residual dysphagia; this condition is minimal in 5, and is significant in 2 who require interval esophageal dilation. Nine patients have symptomatic reflux, which is minimal in 5 patients, moderate in 2 patients, and severe in 2 others who were subsequently reoperated on. Contrary to popular concept, our observations indicate that almost all of these patients represent advanced degrees of sliding hiatal hernia with intrathoracic displacement of the esophagogastric junction. This implies a need for an adequate antireflux reconstruction in all patients undergoing operation, as well as an awareness that unanticipated cicatricial changes may be present in the distal esophagus and may prejudice the success of some of the standard hiatal repairs.
F G Pearson; J D Cooper; R Ilves; T R Todd; W R Jamieson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  35     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1983 Jan 
Date Detail:
Created Date:  1983-02-14     Completed Date:  1983-02-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  45-51     Citation Subset:  AIM; IM    
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MeSH Terms
Dyspnea / physiopathology
Esophageal Diseases / surgery
Esophagitis, Peptic / complications,  surgery
Esophagogastric Junction / surgery
Follow-Up Studies
Gastrointestinal Hemorrhage / physiopathology
Hernia, Diaphragmatic / surgery*
Hernia, Hiatal / complications,  surgery*
Middle Aged
Stomach Volvulus / complications,  surgery
Surgery, Plastic

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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