Congenital Hiatal Hernia: A Surgical Approach
Keywords:Congenital Hiatal Hernia, lower esophageal sphincter, Nissen fundoplication, Belsey Mark IV procedure
AbstractBackground : Congenital Hiatal Hernia is herniation of a viscus or a part of it through the esophageal hiatus to an intra-thoracic position. Aim : To review our experience in surgical management of Congenital Hiatal Hernia in view of published literature . Study design : Retrospective and Comparative. Patients and Method : during a sixteen –year period (2000-2016) in a single thoracic surgery center , Detailed history taking and thorough physical examination were performed . The investigations included chest radiographs , contrast swallow studies , and rigid esophagoscopy mainly . Surgical techniques used to explore and repair hernia through laparotomy and left thoracotomy or both . Results : Twenty-six cases of Congenital Hiatal Hernia were operated, in M:F ratio of (1.16:1) , age range (25 days – 6 years ) Mean age of presentation (1.84 Year) . Chief presenting symptoms werew frequent vomiting (20 patients) , recurrent chest infections . The diagnosis depended primarily on contrast studies . Statistical analysis showed better outcome regarding hospitalization( 7.77 days compared with 9.125 ) and postoperative complication with Nissen procedure . 1 mortality included in this study caused by mediastinitis and septicemia . Conclusion : Early recognition of Congenital Hiatal Hernia is of high importance in reducing postoperative complications and improving outcome . although SAGES guidelines / No. 8 / 2013 stated (Hiatal hernias can effectively be repaired by a transabdominal or transthoracic approach (++++, strong) ) , Nissen fundoplication done to infant age group with excellent outcome , and our experience was better using Nissen fundoplication. The study recommend the need for carrying out a multicenter study on a national level., team management of Congenital Hiatal Hernia .
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