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Techniques of Hiatal Hernia Repair

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Laparo-endoscopic Hernia Surgery

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Abstract

Hiatal hernias are currently classified into type I–IV hernias (◘ Fig. 38.1). In type I hernias, also called sliding hernias, the gastroesophageal junction is situated above the diaphragm. They are the most common type of hiatal hernia with 80–85% of all hiatal hernias. Type II–IV hernias are less common and characterized by a paraesophageal involvement. Especially type II hernias are rare and characterized as pure paraesophageal hernias. Type III hernias are a combination of type I and type II hernias, the gastroesophageal junction, and the fundus herniate through the diaphragm. If an intra-abdominal organ other than the stomach herniates, a type IV hernia is present. Surgical treatment in type I hiatal hernia is only indicated for concomitant gastroesophageal reflux disease. Hiatal hernias with paraesophageal involvement should be operated if they are symptomatic because of the risk of progression and the risk for complications such as incarceration. The aim of the surgical therapy is the constant reposition of the hernia sac content and the repair of the hiatus. Hiatal hernia repair can either be performed transabdominally or by transthoracic access with an open or minimally invasive approach. The laparoscopic approach is associated with reduced perioperative morbidity and shorter hospital stay while showing equal symptomatic outcome compared to the open abdominal and the transthoracic approach. The minimally invasive abdominal access is thus the preferred approach for most hiatal hernias. Besides the access, the dissection of the hernia sac, the type of cruroplasty, the use of mesh augmentation, and the addition of a fundoplication are factors that have to be considered for an ideal hiatal hernia repair. The chapter gives an evidence-based overview on the mentioned technical considerations, and recommendations are made according to the SAGES Guidelines and the latest literature (◘ Tables 38.1 and 38.2).

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Author information

Authors and Affiliations

  1. Department of General Surgery, Heidelberg University Hospital, Heidelberg, Germany

    Beat Müller-Stich

  2. Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Philip C. Müller

  3. Tauernklinikum GmbH, Stefan-Zweig-Straße, Zell am See, Austria

    Rudoph Pointner

  4. Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK

    Stavros A. Antoniou

  5. Department of General Surgery, University Hospital of Heraklion, Heraklion, Greece

    Stavros A. Antoniou

  6. Department of Surgery, University Hospital Wuerzburg, Wuerzburg, Germany

    Burkhard H. A. von Rahden

  7. Norton thoracic institute, Dignity health, Phoenix, AZ, USA

    Sumeet K. Mittal

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  1. Beat Müller-Stich
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  2. Philip C. Müller
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  3. Rudoph Pointner
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  4. Stavros A. Antoniou
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  5. Burkhard H. A. von Rahden
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  6. Sumeet K. Mittal
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Correspondence to Beat Müller-Stich .

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Editors and Affiliations

  1. Em.Director of Surgical Department, Marienhospital Stuttgart, Stuttgart, Germany

    Reinhard Bittner

  2. Academic Teaching Hospital of Charitè Medical School, Vivantes Hospital, Department of Surgery and Center for Minimally Invasive Surgery, Berlin, Germany

    Ferdinand Köckerling

  3. Department of General Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA

    Robert J. Fitzgibbons, Jr.

  4. Louisiana State University School of Medicine, Department of Surgery, Our Lady of the Lake Physician Group, Department of Surgery, Baton Rouge, Louisiana, USA

    Karl A. LeBlanc

  5. Norton Thoracic Institute, Dignity Health, Creighton University School of Medicine (Phoenix campus), Phoenix, Arizona, USA

    Sumeet K. Mittal

  6. Minimal Access, Metabolic and Bariatric Surgery, Max Super Specialty Hospital Saket, New Delhi, India

    Pradeep Chowbey

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Müller-Stich, B., Müller, P.C., Pointner, R., Antoniou, S.A., von Rahden, B.H.A., Mittal, S.K. (2018). Techniques of Hiatal Hernia Repair. In: Bittner, R., Köckerling, F., Fitzgibbons, Jr., R., LeBlanc, K., Mittal, S., Chowbey, P. (eds) Laparo-endoscopic Hernia Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-55493-7_38

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