[Diaphragmatic hernias, excluding hiatal hernias with gastroesophageal reflux].
Large, mixed hiatal hernias are usually found between the ages of 60 and 70 years, with a female predominance (60%). The natural history is progression toward the appearance of symptoms, although 30%-40% of patients are initially asymptomatic. Symptoms develop quietly. The indication for surgical treatment of hiatal hernias amounts to considering the risks of leaving it in place. The literature reports a morbidity and mortality rate related to the complications of these hernias, leading to emergency interventions, which have an incidence of 1.16%.with a 27% mortality rate. Morbidity appears different depending on the approach used: laparoscopy or laparotomy (4.3% versus 16%). The debate continues on whether to monitor or treat these hernias, with a lack of consensus on the indications and the technique. However, the laparoscopic approach shows a gain in the length of the hospital stay, an easier approach to the hiatus in the diaphragm, and a lower morbidity and mortality rate. Fundoplication is advised, as well as placing prosthetic mesh if the orifice is larger than 8 cm. There is no indication for lengthening the esophagus (Collis-Nissen fundoplication).
Service de Chirurgie Digestive, CHU Jean Verdier, Avenue du 14 Juillet - Bondy.
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Ruer
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Champault
D003964:Diaphragm / Q000033:anatomy & histology; D006548:Hernia, Diaphragmatic / Q000175:diagnosis / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods