title: [Surgical results of type III and IV hiatal hernia with left thoracotomy].
abstract: OBJECTIVE
  The goal of the study is to report the short- and long-term outcome of a left approach in the management of type III and IV hiatal hernia.
  
  
  METHODS
  We have retrospectively reviewed all the records of patients treated for type III and IV hiatal hernia with a left transthoracic approach. All the patients were evaluated before and after the surgery on clinical presentation, symptoms and functional assessment. We have specifically focused the evaluation on surgical results, mortality, morbidity and long term functional assessment.
  
  
  RESULTS
  Sixty-five patients were included in this study. Type III hiatal hernia (86%) were majority compared to type IV(14%). Surgical techniques included Nissen fundoplication (37%), Collis Nissen elongation gastroplasty (20%) and Belsey-Mark IV (15%). Morbidity was low and there was no hospital mortality. Mean follow-up was 42 months. Long-term reassessment demonstrated a significant improvement of symptoms. Erosive esophagitis persisted in one patient (P < 0.001). Pressure at the level of lower esophageal sphincter was normal in all patients. 24-hours pH-metry was normal in 92% of patients. Anti-acid medication was reduced significantly (P < 0.001).
  
  
  CONCLUSIONS
  Obesity, short esophagus, massive hiatal hernia, associated oesophageal diseases or previous failed surgery constituted the indications of choice for transthoracic approach. This procedure gives satisfactory functional and anatomical long term results with healing of mucosal damage.
authors.affiliation: Departamento de Cirugía Torácica y de Enfermedades del esófago, Hospital Sainte Marguerite, Asistencia Pziblica Hospitales de Marsella, Universidad de la Mediterranée, Marsella, Francia. alewitte@hotmail.com
authors.forename: Alejandro Witte
authors.initials: AW
authors.lastname: Pfister
authors.forename: Xavier Benoît
authors.initials: XB
authors.lastname: Djourno
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Avaro
authors.forename: Moussa
authors.initials: M
authors.lastname: Ouattara
authors.forename: Delphine
authors.initials: D
authors.lastname: Trousse
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Pascal A
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D015391:Gastroplasty; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult