Hiatal / Paraesophageal Hernia Repair

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Evolution of 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.

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