Skip to main content
SpringerLink
Log in

Paraesophageal Hernia: The Bane of Hiatus Hernia

  • Chapter
  • First Online:
Anaesthesia for Uncommon and Emerging Procedures

  • 1156 Accesses

Abstract

A hiatal hernia (HH) is an enlargement of the space between the diaphragmatic crura, allowing the abdominal viscera to protrude into the mediastinum. HH are of two types—sliding hernia and the paraesophageal hernia (PEH) of which the sliding type is most common with PEH comprising 5–10% of all HH needing surgical repair. PEH presents in the median age of 67–75 years and may be asymptomatic in most patients. Surgery is indicated only in symptomatic patients who may present with obstruction, reflux, bleeding, dyspepsia, dysphagia, nausea, vomiting, regurgitation, or epigastric pain. Radiography, upper GI endoscopy and barium swallow are the mainstay of evaluation for patients with HH. Various surgical techniques have been described for the correction of PEH. Laparoscopic repair is currently the standard surgical option in most centres. Anaesthetic management of a patient with HH involves a thorough preoperative evaluation of the patient with special attention to nutritional status, smoking habits, associated comorbidities and aspiration risk. The need for one lung ventilation and placement of esophageal dilators or bougies in order to facilitate surgical repair intraoperatively requires adequate preoperative preparation. Strict intraoperative monitoring for early identification and management of complications of laparoscopic repair is of utmost importance to reduce postoperative morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Oleynikov D, Jolley JM. Paraesophageal hernia. Surg Clin North Am. 2015;95:555–65.

    PubMed  Google Scholar 

  2. Gangopadhyay N, Perrone JM, Soper NJ, et al. Outcomes of laparoscopic paraesophageal hernia repair in elderly and high-risk patients. Surgery. 2006;140:491–8.

    PubMed  Google Scholar 

  3. Patti MG, Di Corpo M, Schlottmann F, editors. Foregut surgery: achalasia, gastroesophageal reflux disease and obesity. Cham: Springer International Publishing; 2020. https://doi.org/10.1007/978-3-030-27592-1.

    Book  Google Scholar 

  4. Kahrilas PJ, Lin S, Chen J, et al. The effect of hiatus hernia on gastro-esophageal junction pressure. Gut. 1999;44:476–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. Dallemagne B, Kohnen L, Perretta S, et al. Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg. 2011;253:291–6.

    PubMed  Google Scholar 

  6. Tsuboi K, Tsukada K, Nakabayashi T, et al. Paraesophageal hiatus hernia, which has progressed for 8 years: report of a case. Hepato-Gastroenterology. 2002;49:992–4.

    PubMed  Google Scholar 

  7. Low DE, Simchuk EJ. Effect of paraesophageal hernia repair on pulmonary function. Ann Thorac Surg. 2002;74:333–7; discussion 337

    PubMed  Google Scholar 

  8. Awais O, Luketich JD. Management of giant paraesophageal hernia. Minerva Chir. 2009;64:159–68.

    CAS  PubMed  Google Scholar 

  9. Sihvo EI, Salo JA, Räsänen JV, et al. Fatal complications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg. 2009;137:419–24.

    PubMed  Google Scholar 

  10. Jassim H, Seligman JT, Frelich M, et al. A population-based analysis of emergent versus elective paraesophageal hernia repair using the Nationwide Inpatient Sample. Surg Endosc. 2014;28:3473–8.

    PubMed  PubMed Central  Google Scholar 

  11. Kohn GP, Price RR, DeMeester SR, et al. Guidelines for the management of hiatal hernia. Surg Endosc. 2013;27:4409–28.

    PubMed  Google Scholar 

  12. Eren S, Gümüş H, Okur A. A rare cause of intestinal obstruction in the adult: Morgagni’s hernia. Hernia. 2003;7:97–9.

    PubMed  Google Scholar 

  13. Morcos SK. Review article: effects of radiographic contrast media on the lung. Br J Radiol. 2003;76:290–5.

    CAS  PubMed  Google Scholar 

  14. Eren S, Ciriş F. Diaphragmatic hernia: diagnostic approaches with review of the literature. Eur J Radiol. 2005;54:448–59.

    PubMed  Google Scholar 

  15. Swanstrom LL, Jobe BA, Kinzie LR, et al. Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg. 1999;177:359–63.

    CAS  PubMed  Google Scholar 

  16. Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.

    CAS  PubMed  Google Scholar 

  17. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery. J Am Coll Nutr. 2004;23:227–32.

    PubMed  Google Scholar 

  18. Blank RS, Collins SR, Huffmyer JL, et al. Anesthesia for esophageal surgery. In: Slinger P, editor. Principles and practice of anesthesia for thoracic surgery. Cham: Springer International Publishing; 2011. p. 609–49.

    Google Scholar 

  19. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. Developed in collaboration with the American College of Surgeons, American Society of Anesthesiologists, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Anesthesiologists, and Society of Vascular Medicine Endorsed by the Society of Hospital Medicine. J Nucl Cardiol. 2015;22:162–215.

    PubMed  Google Scholar 

  20. Lebenthal A, Waterford SD, Fisichella PM. Treatment and controversies in paraesophageal hernia repair. Front Surg. 2015;2:13.

    PubMed  PubMed Central  Google Scholar 

  21. Meyer CP, Rios-Diaz AJ, Dalela D, et al. The association of hypoalbuminemia with early perioperative outcomes—A comprehensive assessment across 16 major procedures. Am J Surg. 2017;214:871–83.

    PubMed  Google Scholar 

  22. Huhmann MB, August DA. Nutrition support in surgical oncology. Nutr Clin Pract. 2009;24:520–6.

    PubMed  Google Scholar 

  23. Kim S, McClave SA, Martindale RG, et al. Hypoalbuminemia and clinical outcomes: what is the mechanism behind the relationship? Am Surg. 2017;83:1220–7.

    PubMed  Google Scholar 

  24. Clark LN, Helm MC, Higgins R, et al. The impact of preoperative anemia and malnutrition on outcomes in paraesophageal hernia repair. Surg Endosc. 2018;32:4666–72.

    PubMed  Google Scholar 

  25. Bell BR, Bastien PE, Douketis JD, et al. Prevention of venous thromboembolism in the Enhanced Recovery After Surgery (ERAS) setting: an evidence-based review. Can J Anaesth. 2015;62:194–202.

    PubMed  Google Scholar 

  26. Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med. 2018;43:225–62.

    PubMed  Google Scholar 

  27. Schlitzkus LL, Summers JI, Schenarts PJ. Rapid reversal of novel anticoagulant and antiplatelet medications in general surgery emergencies. Surg Clin N Am. 2018;98:1073–80.

    PubMed  Google Scholar 

  28. Khan S, Gatt M, Horgan A, Anderson I, MacFie J. Issues in professional practice: guidelines for implementation of enhanced recovery protocols. 1st ed. London: Association of Surgeons of Great Britain and Ireland (ASGBI); 2009. p. 1–19.

    Google Scholar 

  29. Maggard Gibbons M, Ulloa JG, Macqueen IT, et al. Management of antiplatelet therapy among patients on antiplatelet therapy for coronary or cerebrovascular disease or with prior percutaneous cardiac interventions undergoing elective surgery: a systematic review. Washington, DC: Department of Veterans Affairs (US); 2017.

    Google Scholar 

  30. Kazakova T, Hammond B, Talarek C, et al. Anesthetic management for paraesophageal hernia repair. Thorac Surg Clin. 2019;29:447–55.

    PubMed  Google Scholar 

  31. Bussières JS, Somma J, Del Castillo JLC, et al. Bronchial blocker versus left double-lumen endotracheal tube in video-assisted thoracoscopic surgery: a randomized-controlled trial examining time and quality of lung deflation. Can J Anaesth. 2016;63:818–27.

    PubMed  Google Scholar 

  32. Remístico PPJ, Araújo S, de Figueiredo LC, et al. Impact of alveolar recruitment maneuver in the postoperative period of videolaparoscopic bariatric surgery. Rev Bras Anestesiol. 2011;61:163–8, 169–176, 88–94.

    PubMed  Google Scholar 

  33. Jarral OA, Athanasiou T, Hanna GB, et al. Is an intra-esophageal bougie of use during Nissen fundoplication? Interact Cardiovasc Thorac Surg. 2012;14:828–33.

    PubMed  PubMed Central  Google Scholar 

  34. Gupta R, Gan TJ. Peri-operative fluid management to enhance recovery. Anaesthesia. 2016;71(Suppl 1):40–5.

    PubMed  Google Scholar 

  35. Manning MW, Dunkman WJ, Miller TE. Perioperative fluid and hemodynamic management within an enhanced recovery pathway. J Surg Oncol. 2017;116:592–600.

    CAS  PubMed  Google Scholar 

  36. Sethi AK, Kochhar A, Ahmad Z. Chapter 13: Enhanced recovery after surgery. In: Yearbook of anaesthesiology, vol. 6. New York: Springer; 2017. p. 152–63.

    Google Scholar 

  37. Rodriguez HA, Minneman JA, Oh JS, et al. Paraesophageal hernia. In: Renton D, Lim R, Gallo AS, et al., editors. The SAGES manual of acute care surgery. Cham: Springer International Publishing; 2019. p. 219–33.

    Google Scholar 

  38. Vasudevan V, Reusche R, Nelson E, et al. Robotic paraesophageal hernia repair: a single-center experience and systematic review. J Robot Surg. 2018;12:81–6.

    PubMed  Google Scholar 

  39. El Khoury R, Ramirez M, Hungness ES, et al. Symptom relief after laparoscopic paraesophageal hernia repair without mesh. J Gastrointest Surg. 2015;19:1938–42.

    PubMed  Google Scholar 

  40. Dahlberg PS, Deschamps C, Miller DL, et al. Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg. 2001;72:1125–9.

    CAS  PubMed  Google Scholar 

  41. Rajan GR, Foroughi V. Mainstem bronchial obstruction during laparoscopic fundoplication. Anesth Analg. 1999;89:252–4.

    CAS  PubMed  Google Scholar 

  42. Singhal T, Balakrishnan S, Hussain A, et al. Management of complications after laparoscopic Nissen’s fundoplication: a surgeon’s perspective. Ann Surg Innov Res. 2009;3:1.

    PubMed  PubMed Central  Google Scholar 

  43. Kaur R, Kohli S, Jain A, et al. Pneumothorax during laparoscopic repair of giant paraesophageal hernia. J Anaesthesiol Clin Pharmacol. 2011;27:373–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Oelschlager BK, Pellegrini CA, Hunter J, et al. Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg. 2006;244:481–90.

    PubMed  PubMed Central  Google Scholar 

  45. Oelschlager BK, Pellegrini CA, Hunter JG, et al. Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg. 2011;213:461–8.

    PubMed  Google Scholar 

  46. Perez AR, Moncure AC, Rattner DW. Obesity adversely affects the outcome of antireflux operations. Surg Endosc. 2001;15:986–9.

    CAS  PubMed  Google Scholar 

  47. Braghetto I, Korn O, Csendes A, et al. Postoperative results after laparoscopic approach for treatment of large hiatal hernias: is mesh always needed? Is the addition of an antireflux procedure necessary? Int Surg. 2010;95:80–7.

    PubMed  Google Scholar 

  48. Pirrera B, Alagna V, Lucchi A, et al. Transversus abdominis plane (TAP) block versus thoracic epidural analgesia (TEA) in laparoscopic colon surgery in the ERAS program. Surg Endosc. 2018;32:376–82.

    PubMed  Google Scholar 

  49. Swanstrom L, Wayne R. Spectrum of gastrointestinal symptoms after laparoscopic fundoplication. Am J Surg. 1994;167:538–41.

    CAS  PubMed  Google Scholar 

  50. Watson DI, de Beaux AC. Complications of laparoscopic antireflux surgery. Surg Endosc. 2001;15:344–52.

    CAS  PubMed  Google Scholar 

  51. Baty V, Rocca P, Fontaumard E. Acute gastric volvulus related to adhesions after laparoscopic fundoplication. Surg Endosc. 2002;16:538.

    CAS  PubMed  Google Scholar 

  52. Joseph SJ, Ebstein AMM, Sapp A. Effectiveness of transoral incisionless fundoplication compared to Toupet fundoplication for chronic or refractory gastroesophageal reflux disease: a systematic review protocol. JBI Database System Rev Implement Rep. 2019;17:507–12.

    PubMed  Google Scholar 

  53. Garvey EM, Ostlie DJ. Hiatal and paraesophageal hernia repair in pediatric patients. Semin Pediatr Surg. 2017;26:61–6.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, JSS Academy of Higher Education and Research, Mysore, India

    Nalini Kotekar & U. Krishna Chaitanya

  2. Kamakshi Hospitals, Mysore, India

    Anshul Shenkar

  3. Department of Surgery, JSS Academy of Higher Education and Research, Mysore, India

    N. Ravishankar

Authors
  1. Nalini Kotekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anshul Shenkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. U. Krishna Chaitanya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Ravishankar
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

    Basavana G. Goudra

  2. Department of Anesthesiology, Washington University in Saint Louis, St. Louis, MO, USA

    Preet Mohinder Singh

  3. Department of Anesthesiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Michael S. Green

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kotekar, N., Shenkar, A., Krishna Chaitanya, U., Ravishankar, N. (2021). Paraesophageal Hernia: The Bane of Hiatus Hernia. In: Goudra, B.G., Singh, P.M., Green, M.S. (eds) Anaesthesia for Uncommon and Emerging Procedures . Springer, Cham. https://doi.org/10.1007/978-3-030-64739-1_42

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-64739-1_42

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-64738-4

  • Online ISBN: 978-3-030-64739-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation