Surgical
Treatment of Paraesophageal Hernia
Belák J.1, Vajó J.2, Jurgová T.2, Sauka C.1, Brandebur O., Kudláč M.1, Chyla M.1
1 II. chirurgická klinika LF UPJŠ a FN L. Pasteura, Košice, Slovenská republika, 2 Klinika radiodiagnostiky a nukleárnej medicíny, Košice, Slovenská republika, |
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Summary:
Four types of hernia may occur in the area of esophageal hiatus. Type I is represented by hiatus slipping
hernia. Type II is represented by hernia, which is generally known as paraesophageal hernia. In this type of
hernia, cardia and distal stomach remain under diaphragm. The weakened tissue in phreno-esophageal membrane
is the place, where stomach fundus penetrates into thorax above the diaphragm. The authors present 10
patients with paraesophageal hernia, who were operated on at the 2nd Surgery Clinic of Medical Faculty, UPJŠ,
Faculty Hospital L. Pasteur in Košice. These were adult patients, five man and five women. In four patients, so
called „upside-down stomach“ was the case. Hernias were operated on in all cases by laparotomy, after reposition
of the stomach into abdominal cavity the area of hiatus and diaphragm was reconstructed. One patient was
operated on under emergency conditions for bleeding from stomach ulcer. Immediate postoperation results were
good, the postoperation course was favorable in all patients, no complications occurred. In conclusion, the authors
are of the opinion that every diagnosed paraesophageal hernia should be indicated for surgical intervention. An
anti-reflux operation should be executed in symptoms of gastro-esophageal reflux. The question of operation
approach (thoracotomy or laparotomy) is a matter of continuous discussion, each of them having its advocates.
However, in recent years laparoscopic solution of paraesophageal hernia is getting increasing attention.
Key words:
paraesophageal hernia – upside-down stomach – surgical therapy
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