The incidence of hiatal hernia is on the rise due to population aging and improved awareness of the disease. Laparoscopic repair is the main treatment modality; however, there remains a lack of consensus on the selection of mesh materials and operative specifications. Based on high-level evidence, this expert consensus has formulated 11 recommendations regarding the indications for mesh application, material selection, and operative methods: For patients with giant hiatal hernias (defect area >10 cm², hiatal diameter ≥ 5 cm, or over 1/3 of the gastric body entering the thoracic cavity), complex hernias, recurrent hernias, or those with weak diaphragmatic crura, mesh-reinforced repair is recommended to reduce the risk of recurrence. Synthetic meshes are suitable for giant/complex hernias; biological meshes help reduce foreign body reactions; and bioabsorbable synthetic meshes combine mechanical strength with safety. The preferred shape of the mesh is U-shaped, and fixation methods (non-absorbable sutures, absorbable staplers, or medical adhesives) are selected based on hernia size and anatomical features. For suturing the diaphragmatic crura, non-absorbable sutures are recommended, with the choice between interrupted or continuous suturing techniques tailored to patient characteristics. The method of fundoplication is determined according to esophageal pH measurement and lower esophageal sphincter pressure, and non-absorbable sutures are recommended for plication.
Humans ; Hernia, Hiatal/surgery* ; Laparoscopy/methods* ; Surgical Mesh ; Herniorrhaphy/methods*

Hiatal hernia (HH) refers to a common digestive system disorder in which the stomach or other abdominal organs protrude into the thoracic cavity through the esophageal hiatus.With changes of people's lifestyles,accelerated aging,and rising rates of obesity and overweight,the incidence of HH in China has been steadily increasing.Early diagnosis and accurate classification of HH are critical for guiding treatment decisions. Conventional diagnostic methods-such as barium swallow X-ray,gastroscopy,computed tomography,and high resolution esophageal manometry-have limitations,including invasiveness,radiation exposure,high costs,or inadequate dynamic assessment.Gastric contrast-enhanced ultrasound,as a novel non-invasive imaging technique,has demonstrated unique advantages in the evaluation of HH in recent years.This article reviews the technical principles,clinical applications,and recent advancements of gastric contrast-enhanced ultrasound.
Humans ; Hernia, Hiatal/therapy* ; Contrast Media ; Ultrasonography ; Stomach/diagnostic imaging*

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ² test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.
Male ; Female ; Humans ; Hernia, Hiatal/complications* ; Retrospective Studies ; Robotics ; Herniorrhaphy/methods* ; Quality of Life ; Laparoscopy/methods* ; Recurrence ; Fundoplication/methods*

Objective: To examine the safety and effectiveness of laparoscopic individualized surgical treatment for chronic traumatic diaphragmatic hernia (CTDH). Methods: The clinical data and follow-up data of 29 CTDH cases admitted to the Qilu Hospital of Shandong University or the First Affiliated Hospital of Shandong First Medical University from June 2015 to January 2023 were retrospectively analyzed. There were 21 males and 8 females, aged (49.4±17.8) years (range: 19 to 79 years). The main clinical manifestations were symptoms of the digestive system and respiratory system, and only 4 cases were asymptomatic. All patients received laparoscopic treatment (conversion to open surgery was not excluded). Intraoperative exploration (location of the hernia, contents of the hernia, diameter of the hernia ring), surgical conditions (surgical repair plan, operation time, blood loss, postoperative complications) and postoperative follow-up were analyzed and discussed. Results: Laparoscopic repair was successfully completed in 27 cases, including simple suture in 6 cases, suture and patch repair in 17 cases, the anterior abdominal wall muscle flap reversal suture and patch repair of in 3 cases, and patch bridge repair in 1 case. The operation time was (112.8±44.7) minutes (range: 60 to 200 minutes). The amount of bleeding (M(IQR)) was 35 (58) ml (range: 10 to 300 ml). The other 2 patients were converted to laparotomy. Except for one patient with transverse colon strangulation necrosis who died of aggravated pulmonary infection after surgery, the remaining 28 patients were discharged successfully. The follow-up time was 36 (24) months (range: 1 to 60 months). During the follow-up period, only two patients had occasional left upper abdominal discomfort. Twenty-seven patients with left diaphragmatic hernia had no recurrence, and the symptoms of 1 patient with right diaphragmatic hernia were relieved. Conclusion: Customized laparoscopic surgical repair for CTDH according to the location and size of the diaphragmatic defect can achieve good surgical results.
Male ; Female ; Humans ; Hernia, Diaphragmatic, Traumatic/surgery* ; Retrospective Studies ; Laparoscopy/methods* ; Postoperative Complications ; Laparotomy ; Surgical Mesh

Hernias, Diaphragmatic, Congenital/surgery* ; Humans ; Liver/diagnostic imaging*

The occurrence of hiatal hernia after total gastrectomy with Roux-en-Y reconstruction is rare. We report the case of a 76-year-old man who presented with dyspnea, vomiting, and fever around 8 days after total gastrectomy with Roux-en-Y reconstruction. Abdominal computed tomography revealed a hiatal hernia containing part of the small intestine in the left thoracic cavity. Emergent reduction and repair of the hiatal hernia were performed later. Operative findings revealed that the Roux limb was incarcerated in the left pleural cavity. Esophagojejunostomy leakage, perforation of the small intestine with transient ischemic change, and pyothorax were also found. Thus, feeding jejunostomy, thoracoscopic decortication, and diversion T-tube esophagostomy were performed. Considering that the main cause of hiatal hernia is blunt dissection with division of the phrenoesophageal membrane, approximating the crus with 1 or 2 figure-8 sutures, according to the size of the defect, to prevent the incidence of hiatal hernia after total gastrectomy may be performed.
Aged ; Dyspnea ; Empyema, Pleural ; Esophagostomy ; Extremities ; Fever ; Gastrectomy ; Hernia ; Hernia, Hiatal ; Humans ; Incidence ; Intestine, Small ; Jejunostomy ; Membranes ; Pleural Cavity ; Stomach Neoplasms ; Sutures ; Thoracic Cavity ; Vomiting

Adolescent ; Colon ; diagnostic imaging ; pathology ; Hernias, Diaphragmatic, Congenital ; diagnostic imaging ; pathology ; Humans ; Ileum ; diagnostic imaging ; pathology ; Male ; Thoracic Cavity ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

To investigate risk factors of death in newborns with congenital diaphragmatic hernia (CDH). A total of 126 newborns with CDH from June 2012 to September 2018 were enrolled. Concomitant malformations were recorded by descriptive analysis. Newborns received surgical treatment (=120) for CDH were divided into survival group and fatal group. The risk factors of death were analyzed by univariate and multivariate logistic regression and the ROC curve with generated with relevant variables. There were 55 CDH newborns with concomitant malformations (43.7%), including 20 cases (15.9%) with multi-malformation. Logistic regression analysis showed that premature rupture of membranes (PROM), postoperative atelectasis, long duration of postoperative mechanical ventilation, postoperative high oxygenation index (OI) were related to death (all <0.05), and the delayed surgery was a protective factor (<0.05). In ROC analysis of postoperative OI in predicting death, the area under the curve (AUC) was 0.841, with the cutoff value of 5.74, the sensibility and specificity of OI was 81.0% and 75.0%, respectively(<0.01). Newborns with CDH have a high rate of malformations. The risk factors of death were PROM, postoperative atelectasis, postoperative long duration of mechanical ventilation and higher postoperative OI, and delayed surgery may reduce mortality.
Hernias, Diaphragmatic, Congenital ; diagnosis ; mortality ; surgery ; Humans ; Infant ; Infant Death ; Infant, Newborn ; Logistic Models ; ROC Curve ; Retrospective Studies ; Risk Factors ; Sensitivity and Specificity

The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.
Classification ; Deglutition ; Esophageal Achalasia ; Esophagogastric Junction ; Esophagus ; Female ; Fundoplication ; Hernia, Hiatal ; Humans ; Hypertrophy ; Laparoscopy ; Manometry ; Middle Aged ; Peristalsis ; Protestantism ; Relaxation ; Tomography, X-Ray Computed

A traumatic diaphragmatic hernia is a rare combined problem involving injuries to the thorax and abdomen that may not be diagnosed at the time of injury. Surgical management is mandatory when the patient displays any signs of bowel strangulation due to the herniation because a herniated bowel has a very high risk of necrosis or perforation. Four patients were diagnosed with delayed traumatic diaphragmatic hernia 14 to 96 months after injury. In two patients, the diaphragmatic injury was missed at the time of injury. Reduction and diaphragm repair surgery were performed. One diaphragm was repaired with artificial mesh. Traumatic diaphragmatic injury is caused by a blunt or penetrating injury to the abdomen or thorax. After migration of the intra-abdominal contents into the chest, a narrow herniation defect can disturb the bowel circulation and passage of bowel contents. Early detection and reduction, and repair surgery are mandatory for patients with a delayed presentation of complicated traumatic diaphragmatic hernia. Any patient with injury around the thorax or upper abdomen should be examined carefully considering the possibility of diaphragmatic hernia. Even if diaphragmatic injuries are not found in the initial evaluation, a radiology examination in a short period of time can correct the missed diagnosis of traumatic diaphragmatic hernia.
Abdomen ; Delayed Diagnosis ; Diagnosis ; Diaphragm ; Hernia, Diaphragmatic ; Hernia, Diaphragmatic, Traumatic ; Humans ; Necrosis ; Thorax