Alejandro Rodriguez, MD, Rebecca G Lopez, MD, Dustin G Cummings, MD, Andrew S Wright, MD, Carlos A Pellegrini, MD, Brant K Oelschlager, MD. University of Washington
Background: Type II paraesophageal hernias (PEH) are defined as hernias in which the gastroesophageal junction remains within the abdomen while a portion of fundus herniates into the mediastinum through an attenuated phrenoesophageal membrane. This variety of hernia is described as comprising 8-20% of all PEHs in large published series. However, while Type II hernias are occasionally suspected on pre-operative diagnostic testing, in our experience this is rarely confirmed on intra-operative findings. This led to our question: do Type II PEHs even exist?
Methods: We reviewed all PEH repairs performed at the University of Washington Medical Center from 1994-2017, excluding Type I and re-operative cases. In addition, we searched for confirmatory evidence of Type II hernias via YouTube and WebSurg websites. Lastly, abstracts from the SAGES annual meetings from 2005 to 2017 were screened for reports of type II PEH.
Results: We performed 571 PEH repairs: 2 Type II, 524 Type III and 45 Type IV. However, the 2 Type II’s had findings to suggest they may have originally been a parahiatal hernia. Four patients were initially thought to have a Type II hernia pre-operatively, but in fact had a parahiatal hernia (a hernia of fundus or body of the stomach through a separate defect in the diaphragm rather than through the hiatus). A YouTube search yielded 68 search results; of these none represented a true Type II, with 1 video demonstrating a parahiatal hernia. A similar search of WebSurg website revealed one case of a true Type II hernia, though it too may have evolved from a parahiatal. No video or case presentations of a Type II hernia were identified within SAGES annual meeting abstracts.
Conclusions: Type II PEH are much less common than reported, and probably less common than the rare parahiatal hernia. Parahiatal hernias may be frequently misidentified as a Type II PEH based on pre-operative imaging, and may have begun as parahiatal hernias that evolved into a single hiatal defect.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86867
Program Number: P442
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster