Impact of surgical repair on type IV paraesophageal hernias (PEHs)

María Rita Rodríguez-Luna, Margherita Pizzicannella, Claudio Fiorillo, Abdullah Almuttawa, Alfonso Lapergola, Didier Mutter, Jacques Marrescaux, Bernard Dallemagne, Silvana Perretta

Risultato della ricerca: Contributo in rivistaArticolo in rivista


Background Paraesophageal hernias (PEHs; types II-III-IV) account for about 5% of all hiatal hernias (HHs). The peculiarity of PEHs is the presence of a herniated sac which contains a more or less important part of the stomach, along with other abdominal organs in type IV PEHs. Surgical treatment is more complex since it requires a reduction not only of the herniated content but also of the "container," namely the sac adherent to mediastinal structures. Since type III and IV PEHs are mostly grouped together as large PEHs, there is a lack of articles in the literature with regards to clear surgical outcomes, as well as management algorithms in type IV PEHs. This study aims to compare outcomes in type IV vs. type III PEHs after surgical repair. Methods A retrospective study of patients who underwent laparoscopic PEH hernia repair (LPEHR) was conducted in a single institution between 2006 and 2020. Patient baseline characteristics and surgical outcomes were analyzed. Results A total of 103 patients were included in the analysis. Patients presenting with type IV PEHs (12/103) were significantly older than patients with type III PEHs (91/104) (75.25 +/- 7.15 vs. 66.91 +/- 13.58 respectively (p = 0.039), and more fragile with a higher Charlson Comorbidity Index (CCI) (4.25 +/- 1.48 vs. 2.96 +/- 1.72, p = 0.016). Operative time was significantly longer (243 +/- 101.73 vs. 133.38 +/- 61.76, p = 0.002), and postoperative morbidity was significantly higher in type IV PEH repair (50% vs. 8.8% type III, p = 0.000). Conclusion Patients with type IV PEHs appear to be older and frailer. The higher incidence of postoperative complications in patients with type IV PEHs should advocate for a precise indication for surgical treatment, which should be performed in centers of expertise.
Lingua originaleEnglish
pagine (da-a)5467-5475
Numero di pagine9
RivistaSurgical Endoscopy
Stato di pubblicazionePubblicato - 2022
Pubblicato esternamente


  • Complications
  • Gastric volvulus
  • Type IV
  • Outcomes
  • Paraesophageal hernia
  • Nissen fundoplication


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