b) GE junction and fundus of stomach herniates into the chest
c) Fundus of stomach migrates to the chest and GE junction remains in its original postion
d) Fundus of stomach migrates to the chest with other organs
Q2. Which of the following is a good candidtate for laparoscopic
repair of paraesophageal hernia?
a) Previous open surgery for hiatus hernia
b) Previous laparoscopic surgery for hiatus hernia
c) Obese patients
d) Type II hernia with symptoms
A type I hernia is known as a sliding Hiatus Hernia and is characterized by upward displacement of the GE junction into the posterior mediastinum. The stomach remains in its usual longitudanal postion.
Type II—a “true” paraesophageal hernia PEH—is defined by a normally positioned intraabdominal GE junction with upward herniation of the stomach alongside it. A type III hernia is known as a “mixed” hernia and is characterized by displacement of both the GE junction and a large portion of the stomach cephalad into the posterior mediastinum.
The difference between a type I or sliding HH and a type III or mixed PEH is that with a type III hernia, a portion of the stomach lies cephalad to the GE junction.
In a type IV hernia, the esophageal hiatus has dilated to such an extent that the hernia sac also contains other organs such as the spleen, colon, or small bowel .
PEHs initially develop on the left anterior aspect of the esophageal hiatus
Yeo: Shackelford's Surgery of the Alimentary Tract, 6th ed.
Not all patients are good candidates for laparoscopic PEH repair. Those who have previously undergone open HH repair or laparoscopic PEH repair and obese patients are poor candidates for the laparoscopic approach. This group of patients is probably best approached transthoracically.
In such cases the advantages include complete mobilization of the the esophagus with dissection of the sac.