Surgical Technique and Difficult Situations from Hubertus Feussner

Abstract

Hiatal hernia is a common finding in almost all age groups with different anatomical variations and clinical appearance. From our point of view, a clear distinction between hernias requiring antireflux surgery and hernias with the need for anatomic repair (paraesophageal hernia, upside-down stomach) is mandatory, as they might differ in surgical indication as well as in terms of the applied surgical technique. It is paramount for antireflux surgery to augment the lower esophageal sphincter in order to eliminate reflux but also to repair an axial hernia if present. For paraesophageal hernia or for an upside-down stomach, the restoration of the normal anatomical conditions is the therapeutic goal to eliminate the symptoms associated with the malposition of the stomach (pain, postprandial retrosternal pressure, respiratory symptoms, anemia, in these cases). An antireflux procedure (fundoplication) can be omitted in most cases.