Laparoscopic Management of Hiatal Hernias in Difficult Cases

Oscar M Crespin, M, D, Brant K Oelschlager, M, D, Carlos A Pellegrini, M, D. University of Washington Medical Center.


Hiatal hernia is a common disorder, characterized by a protrusion of any abdominal structure other than the esophagus into the thoracic cavity through a widening of the hiatus of the diaphragm.
Reduction of the stomach from the chest to abdominal cavity; resection of the sac; obtain at least 3 cm of intra-abdominal esophageal length; closure of the hiatus and recreation of antireflux valve are the goals for hiatal hernia repair.

Methods and objectives:

The aim of this video presentation is to show 3 cases were it was difficult to achieve this goals and how we resolved it.
The first case was an elderly and frail patient, the second case was a patient with short esophagus and the third case was a reoperation of a hiatal hernia with an unclosable hiatus.


We consider that gastropexy, Collis "wedge" gastrosplasty and relaxing incisions are good options for elderly and frail patients, short esophagus and unclosable hiatus respectively.


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