title: "Acute intrathoracic stomach!" How should we deal with complicated type IV paraesophageal hernias?
abstract: OBJECTIVE
  Management of emergently admitted patients due to a complicated large paraesophageal hernia with acute symptoms of an "intrathoracic stomach" is controversial. The aim of this study was to clarify whether emergency surgery in such cases should be the procedure of choice.
  
  
  METHODS
  The retrospective analysis of patients who were hospitalized due to emerging acute symptoms of an "intrathoracic stomach" between January 2009 and May 2013 was used as method. Patients were categorized into three groups: emergency operation within 24 h after admission, semi-elective operation within the first 7 days after admission and elective operation.
  
  
  RESULTS
  Twenty-four patients were identified. Only three (12.5 %) patients required laparoscopic emergency surgery and two incurred a perioperative complication. In consequence of persistent or early recurrent complaints a laparoscopic operation was required prior to discharge semi-elective in 6/24 (25 %) patients without complications. The remaining 15/24 (62.5 %) patients were free of complaints after conservative therapy, but all of them decided upon elective operation after informed consent. One minor complication occurred.
  
  
  CONCLUSIONS
  The majority of patients with acute symptoms due to an intrathoracic stomach can primarily be treated conservatively and timing of elective repair should be performed after resuscitation in a center of laparoscopic antireflux surgery.
authors: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria, gernot.koehler@bhs.at.
authors: G
authors: G
authors: Köhler
authors: O O
authors: OO
authors: Koch
authors: S A
authors: SA
authors: Antoniou
authors: K
authors: K
authors: Emmanuel
authors: R
authors: R
authors: Pointner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D018662:Fundoplication; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000000981:diagnostic imaging / Q000601:surgery*; D013526:Surgical Mesh; D014057:Tomography, X-Ray Computed