title: Congenital paraesophageal hernia: The Montreal experience.
abstract: BACKGROUND
  Congenital paraesophageal hernia (CPEH) is the least common congenital diaphragmatic hernia. We performed an extensive review to further define this entity.
  
  
  METHODS
  A retrospective study of children with CPEH (types II-IV hiatal hernias) treated at two children's hospitals over a 25-year period (1988-2013) was performed.
  
  
  RESULTS
  Fourteen patients were diagnosed at a median age of 35 days (range 0-500), with one prenatal diagnosis. The most common symptoms were emesis in type II hernias (50%), and respiratory distress in types III and IV hernias (75% and 50%, respectively). Gastroesophageal reflux was concomitantly diagnosed in 50%, while concurrent congenital anomalies existed in 36%. A correct initial diagnosis was made in only 29% of cases. The diagnosis was most often established by UGI study (64%). The method of repair was laparoscopy in 21%, and laparotomy in 71%. An antireflux procedure was done in 13 (93%) patients. Long-term follow up data was available for 86% of patient. During follow-up, one patient recurred and one required sequential pneumatic esophageal dilations. There were no mortalities.
  
  
  CONCLUSIONS
  CPEH is a rare entity often associated with gastroesophageal reflux disease and other congenital anomalies. Prognosis is excellent, but awareness of this anomaly may lead to earlier diagnosis.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Yousef
authors.affiliation: Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lemoine
authors.affiliation: Division of Pediatric General Surgery, Centre Hospitalier Universitaire Sainte Justine, Montreal, Quebec, Canada.
authors.forename: Dickens
authors.initials: D
authors.lastname: St-Vil
authors.affiliation: Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: Sherif.Emil@McGill.ca.
authors.forename: Sherif
authors.initials: S
authors.lastname: Emil
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
keywords: Children; Congenital paraesophageal hiatal hernia; Gastroesophageal reflux; Surgery