Embleton Didem Baskin, Tuncer Ahmet Ali, Arda Mehmet Surhan, Ilhan Huseyin, Cetinkursun Salih
Department of Pediatric Surgery, Afyon Kocatepe University Faculty of Medicine, Afyonkarahisar, Turkey.
Department of Pediatric Surgery, Osmangazi University Faculty of Medicine, Eskisehir, Turkey.
North Clin Istanb. 2018 Mar 16;6(2):171-175. doi: 10.14744/nci.2018.58672. eCollection 2019.
Hiatus hernia is frequent in adults and rare in children; congenital hiatus hernia is even rarer. In this study, we describe a group of infants with congenital hiatus hernia and discuss its management.
Records of patients (male: 3, female: 4) who were diagnosed with congenital hiatus hernia between 2010 and 2016 were extracted. Demographic data, presenting symptoms, diagnostic investigations, operative details, postoperative follow-up, and early and late postoperative complications were evaluated retrospectively.
Four patients were female and three were male. One patient was diagnosed prenatally while the mean age at diagnosis for others was 18.6 months. Four patients had type IV hernia, 2 had type III hernia, and one had type I hernia. The diagnosis was confirmed by chest X-ray, computerized tomography (CT) and/or upper gastrointestinal series. The hiatal repair was done in all patients either by laparotomy or laparoscopy. During the procedure, 2 patients had Nissen fundoplication and 3 patients had Thal fundoplication. Recurrence of hernia occurred in the 2 patients who had Thal fundoplication.
Recurrence of sliding hernias with Thal fundoplication seem more frequent in the series. If the esophagogastric junction is present in the thorax, mediastinal dissection of the esophagus may be required to achieve a good abdominal esophagus structure, which will prevent a recurrence.
食管裂孔疝在成人中常见，在儿童中罕见；先天性食管裂孔疝则更为罕见。在本研究中，我们描述了一组先天性食管裂孔疝患儿并讨论其治疗方法。
提取2010年至2016年间被诊断为先天性食管裂孔疝的患者（男3例，女4例）的记录。回顾性评估人口统计学数据、临床表现、诊断检查、手术细节、术后随访以及术后早期和晚期并发症。
4例为女性，3例为男性。1例在产前被诊断，其他患者的平均诊断年龄为18.6个月。4例为IV型疝，2例为III型疝，1例为I型疝。通过胸部X线、计算机断层扫描（CT）和/或上消化道造影确诊。所有患者均通过开腹手术或腹腔镜手术进行食管裂孔修补。术中，2例患者行nissen胃底折叠术，3例患者行thal胃底折叠术。行thal胃底折叠术的2例患者出现疝复发。
在该系列研究中，采用thal胃底折叠术的滑动疝复发似乎更为常见。如果食管胃交界位于胸腔内，可能需要对食管进行纵隔解剖以获得良好的腹段食管结构，从而预防复发。
