Evolution of Technology

Endoscopic Hiatal Hernia Repair Systems

Most recently, the endoscopic hiatal hernia repair has been developed, which involves specialized cameras and staplers. Going through the mouth (transoral route), surgeons travel down the esophagus and into the stomach to perform the repair, avoiding external incisions altogether.

With few small or no incisions, patients have quicker recovery times and less post operative pain. With respect to the hiatal hernia repair, advancements in surgical technology including instrumentation, delivery systems, stapling devices, and surgical mesh have revolutionized the treatment of hiatal hernia as well as many other disease processes.

Evolution of Procedure

Hiatal / Paraesophageal Hernia Repair

The surgical repair of hiatal and paraesophageal hernias involves returning the herniated organs back into the abdominal cavity. Additionally, the enlarged opening in the diaphragm (hiatus) must be repaired to prevent recurrence of the hernia. Many techniques have been described, and most involve wrapping a portion of the stomach (fundus) around the esophagus to prevent recurrence (fundoplication). Additionally, surgeons have employed the use of surgical meshes to strengthen the repair of the diaphragm.

The techniques for hiatal hernia repair have evolved significantly as advances in technology have been made. Although the first description of a hiatal hernia in the literature was in 1846, the first hiatal hernia repair was not performed until 1919 when Angelo Soresi performed an open hiatal hernia repair. The traditional technique of open hiatal hernia repair involves making a large midline abdominal incision where the entire abdomen is exposed. More recently, technological advances in laparoscopic surgery have made complex repairs like the laparoscopic hiatal hernia repair possible. In the laparoscopic hiatal hernia repair, the surgeon uses small incisions to gain access to the abdominal cavity. Using CO2 insufflation and long instruments, surgeons can perform repair of the hiatal hernia without making the large open abdominal incision.

Evolution of Diagnosis

Hiatal / Paraesophageal Hernia

Hiatal hernias occur due to a loss of tension at the point where the esophagus enters the abdomen and becomes the stomach (phrenoesophageal membrane). This allows the gastroesophageal junction (GEJ) to migrate superiorly into the chest. Hiatal hernias occur in four types: Type I (sliding hernia; most common), Type II (GEJ remains in abdomen but top segment of stomach herniates into the chest), Type III (contains both GEJ and stomach in the chest) and Type IV (other abdominal organs herniating into the chest). Hiatal hernia types II through IV are also referred to as paraesophageal hernias.