Published online Dec 6, 2019. doi: 10.12998/wjcc.v7.i23.4020
Peer-review started: September 3, 2019
First decision: September 23, 2019
Revised: October 19, 2019
Accepted: November 23, 2019
Article in press: November 23, 2019
Published online: December 6, 2019
Parahiatal hernias (PHHs) are rare occurring disease, with a reported incidence of 0.2%-0.35% in patients undergoing surgery for hiatal hernia. We found only a handful of cases of primary PHHs in the literature. The aim of this paper is to present a case of a primary PHH and perform a systematic review of the literature.
We report the case of a 60-year-old Caucasian woman with no history of thoraco-abdominal surgery or trauma, which accused epigastric pain, starting 2 years prior, pseudo-angina and bloating. Based on imagistic findings the patient was diagnosed with a PHH and an associated type I hiatal hernia. Patient underwent laparoscopic surgery and we found an opening in the diaphragm of 7 cm diameter, lateral to the left crus, through which 40%-50% of the stomach had herniated in the thorax, and a small sliding hiatal hernia with an anatomically intact hiatal orifice but slightly enlarged. We performed closure of the defect, suture hiatoplasty and a “floppy” Nissen fundoplication. Postoperative outcome was uneventful, with the patient discharged on the fifth postoperative day. We performed a review of the literature and identified eight articles regarding primary PHH. All data was compiled into one tabled and analyzed.
Primary PHHs are rare entities, with similar clinical and imagistic findings with paraesophageal hernias. Treatment usually includes laparoscopic approach with closure of the defect and the esophageal hiatus should be dissected and analyzed. Postoperative outcome is favorable in all cases reviewed and no recurrence is cited in the literature.
Core tip: We present the management of a case with primary parahiatal hernia associated with type I hiatal hernia, from the imagistic findings that led us to the preoperative diagnosis to its surgical treatment. We also performed a review of the literature, which emphasizes the uniqueness and rarity of this disease. Frequently, the presentation is in an acute setting with the most cited complications being incarceration/perforation of the stomach and mezenteroaxial volvulus. Treatment includes closure of the defect and postoperative outcome is favorable in all cases we reviewed, with no cited recurrence.