title: The need for flexibility in the operative management of type III paraesophageal hernias.
abstract: BACKGROUND
  A myriad of operation exist to treat type III paraesophageal hernias (T3PH). How does one choose?
  
  
  METHODS
  A retrospective review of a consecutive series of resident-preformed T3PH repair.
  
  
  RESULTS
  Three 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.
  
  
  CONCLUSIONS
  Operative 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.
authors.affiliation: Dwight D. Eisenhower Veterans Administration Medical Center, 4101 South 4th Street Trafficway, Leavenworth, KS, USA. tmclean@dnamail.com
authors.forename: Thomas R
authors.initials: TR
authors.lastname: McLean
authors.forename: Chris C
authors.initials: CC
authors.lastname: Haller
authors.forename: Stephen
authors.initials: S
authors.lastname: Lowry
mesh_terms: D000328:Adult; D000465:Algorithms; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D015391:Gastroplasty; D006551:Hernia, Hiatal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies