title: Laparoscopic treatment of type III and IV hiatal hernia - authors' experience.
abstract: BACKGROUND
  There are four types of hiatal hernias, and diagnosis is established on the basis of gastroscopy in the majority of cases. Type III represents a mixed type in which the abdominal esophagus as well as the gastric cardia and fundus protrude into the thorax through the pathologically widened esophageal hiatus. Type IV, the so-called upside down stomach, can be considered an evolutionary form of type III, and refers to herniation of nearly the whole stomach (except for the cardia and pylorus) into the thorax. Types III and IV of hiatal hernias represent a group of rare diaphragmatic defects; thus, most centers do not possess considerable experience in their treatment. Frequently, laparoscopic treatment is implemented, although, according to some authors, conversion to laparotomy, thoracotomy, or thoracolaparotomy is necessary in selected cases.
  
  
  OBJECTIVE
  To analyze the outcomes of laparoscopic treatment of the largest hiatal hernias, i.e. type III and IV hernias.
  
  
  METHODS
  A total of 25 patients diagnosed with type III and IV hiatal hernia were included in further analysis.
  
  
  RESULTS
  As many as 19 out of 25 patients (76%) assessed the outcome of the surgery as evidently positive and reported marked improvement in the quality of life.
  
  
  CONCLUSIONS
  The laparoscopic technique constitutes an excellent and safe method of repair of even the most complex defects in the esophageal hiatus. Therefore, the minimally invasive technique combined with an anti-reflux procedure should be the method of choice in patients with type III and IV hernia.
authors.affiliation: 2 Department of General Surgery, Medical College Jagiellonian University, Krakow, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Migaczewski
authors.affiliation: 2 Department of General Surgery, Medical College Jagiellonian University, Krakow, Poland.
authors.forename: Agata
authors.initials: A
authors.lastname: Grzesiak-Kuik
authors.affiliation: 2 Department of General Surgery, Medical College Jagiellonian University, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Pędziwiatr
authors.affiliation: 2 Department of General Surgery, Medical College Jagiellonian University, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budzyński
keywords: Nissen fundoplication; laparoscopy; type III and IV hiatal hernia
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