Laparoscopic repair of parahiatal hernia: surgical techniques and literature reviews.

Abstract

Purpose: Parahiatal hernia (PHH) is a rare type of diaphragmatic hernia that protrudes through a defect adjacent to, but distinct from, the esophageal hiatus. Current literature on PHH is extremely limited. In this study, we present our experience with laparoscopic repair of PHH and provide a comprehensive review of existing literature.

Methods: We retrospectively reviewed clinical data from eight patients diagnosed with PHH at Qilu Hospital, Shandong University, between October 2021 and March 2024. Collected data included patient demographics, hernia characteristics, and perioperative details. The primary outcomes assessed were the safety and feasibility of the procedure, along with postoperative complications such as pleural effusion, hemorrhage, fistula, and mesh infection.

Results: Laparoscopic surgery was successfully performed in all patients. Two patients underwent simultaneous sleeve gastrectomy. Concurrent hiatal hernia was diagnosed in two patients, while seven patients required esophageal hiatus repair due to an enlarged hiatus following PHH repair. The mean hernia ring width was 3.69 ± 1.22 cm. Mesh reinforcement was employed in six patients. The mean operative time was 205.63 ± 62.36 min, and the mean hospital stay was 7.75 ± 1.49 days. With a median follow-up of 11.5 (interquartile range: 7.75-29.5) months, no major complications, recurrences, or mortality were reported.

Conclusion: Laparoscopic repair of PHH is a safe and effective procedure. Nonetheless, the techniques for defect closure, hiatus repair, mesh placement, and fundoplication should be customized based on the individual patient's characteristics.