Congenital Hiatal Hernia: A Surgical Approach

Abstract

Background : 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 .