The need for flexibility in the operative management of type III paraesophageal hernias

BackgroundA myriad of operation exist to treat type III paraesophageal hernias (T3PH). How does one choose?MethodsA retrospective review of a consecutive series of resident-preformed T3PH repair.ResultsThree patients with T3PH were operated on during a 6-year period. The presentation of each patient was unique. Three different surgical procedures were used to treat these patients depending on the patient’s condition at presentation, the location of the gastroesophageal junction, and the documentation of reflux. Transabdominal hernia reduction and a modified Hill procedure was used in 1 patient; a transthoracic hernia reduction was supplemented with a either a Belsy-Mark IV fundoplication or a Collis-Nissen gastroplasty in the other 2 patients. Patients were discharged home 7 (3–13) days postoperatively, and at a mean follow-up of 23 (2–60) months, all patients are asymptomatic and without radiographic recurrence.ConclusionOperative selection for T3PH should be flexible depending on the (1) urgency of symptoms, (2) location of the gastroesophageal junction, and (3) evidence for gastroesophageal reflux.