title: Paraesophageal hernia: surgery problems in emergency.
abstract: METHODS
  It has been demonstrated that paraesophageal hiatal hernia surgical repair can be performed by endoscopic means, but the procedure is not standardized and results have not been evaluated systematically so far. The Authors report a case of strangulated paraesophageal hiatal hernia occurred in a elderly man and treated with open approach. Eighteen months later, follow up has demonstrated the effectiveness of the repair and the total remission of the symptoms. Recurrences after paraesophageal hiatal hernias repair may decrease with usage of mesh in the hiatus; however uniform criteria for this procedure are lacking. After review of the literature inheriting this uncommon pathology, that present about 5% of the hiatal hernias, no conclusions could be drawn regarding the reliability of the laparoscopic procedure and the necessity for an additional antireflux repair. Moreover, uniform specific indications for the need of an esophageal lengthening procedure or preoperative assessment methods for shortened esophagus cases could not be detected.
  
  
  CONCLUSIONS
  Treatment based on standardized protocols for preoperative assessment and postoperative follow-up is required to clarify the current controversies inherent surgery indications and approach.
authors.affiliation: Università degli Studi di Catania, Azienda Ospedaliero Universitaria Policlinico "Gaspare Rodolico" Catania, Italia. andrecavallaro@tiscali.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Cavallaro
authors.forename: Vito
authors.initials: V
authors.lastname: Catania
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallaro
authors.forename: Antonio
authors.initials: A
authors.lastname: Zanghì
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cappellani
mesh_terms: D000368:Aged; D013505:Digestive System Surgical Procedures; D004630:Emergencies; D018662:Fundoplication / Q000379:methods*; D006551:Hernia, Hiatal / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D013536:Suture Techniques; D016896:Treatment Outcome