Laparoscopic Operation for Giant Hiatal Hernia

Abstract

Type III hiatal hernia (giant hiatal hernia) is a mixture of type I (sliding hernia) and type II (paraesophageal hernia) hiatal hernias and sometimes causes severe complications if stomach necrosis has occurred. Therefore, surgical treatment is recommended. We discuss the available treatments for type III hiatal hernia and describe our procedure for laparoscopic antireflux surgery. We performed Nissen or Toupet fundoplication, depending on the esophageal function of each patient. Crural repair should be performed with calibration using a 56-Fr bougie to avoid postoperative dysphagia. As much as possible of the hernia sac should be removed to prevent hernia recurrence. Some authors have reported that laparoscopic antireflux surgery for type III hiatal hernia is a technically challenging and controversial procedure. However, the outcomes at our hospital have been excellent, and the level of patient satisfaction has been high.