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Type II hiatal hernias: do they exist or are they actually parahiatal hernias?
Surg Endosc. 2023 03; 37(3):1956-1961.SE

Abstract

BACKGROUND

Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist?

METHODS

We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021.

RESULTS

We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts.

CONCLUSION

Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Ceron REC
Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA.
Yates RB
Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA.
Wright AS
Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA.
Rodriguez HA
Tecnológico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico.
Lopez RG
Department of Surgery, Piedmont Atlanta Hospital, Atlanta, GA, USA.
Pellegrini CA
Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA.
Oelschlager BK
Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA. brant@uw.edu.

MeSH

HumansHernia, HiatalLaparoscopyEsophagusDiaphragmEsophagogastric Junction

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

36261642

Citation

Ceron, Rocio E Carrera, et al. "Type II Hiatal Hernias: Do They Exist or Are They Actually Parahiatal Hernias?" Surgical Endoscopy, vol. 37, no. 3, 2023, pp. 1956-1961.
Ceron REC, Yates RB, Wright AS, et al. Type II hiatal hernias: do they exist or are they actually parahiatal hernias? Surg Endosc. 2023;37(3):1956-1961.
Ceron, R. E. C., Yates, R. B., Wright, A. S., Rodriguez, H. A., Lopez, R. G., Pellegrini, C. A., & Oelschlager, B. K. (2023). Type II hiatal hernias: do they exist or are they actually parahiatal hernias? Surgical Endoscopy, 37(3), 1956-1961. https://doi.org/10.1007/s00464-022-09641-9
Ceron REC, et al. Type II Hiatal Hernias: Do They Exist or Are They Actually Parahiatal Hernias. Surg Endosc. 2023;37(3):1956-1961. PubMed PMID: 36261642.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Type II hiatal hernias: do they exist or are they actually parahiatal hernias? AU - Ceron,Rocio E Carrera, AU - Yates,Robert B, AU - Wright,Andrew S, AU - Rodriguez,H Alejandro, AU - Lopez,Rebecca G, AU - Pellegrini,Carlos A, AU - Oelschlager,Brant K, Y1 - 2022/10/19/ PY - 2022/05/17/received PY - 2022/09/13/accepted PY - 2022/10/20/pubmed PY - 2023/3/21/medline PY - 2022/10/19/entrez KW - Hiatal hernia KW - Paraesophageal hernia KW - Parahiatal hernia KW - Type II hiatal hernia SP - 1956 EP - 1961 JF - Surgical endoscopy JO - Surg Endosc VL - 37 IS - 3 N2 - BACKGROUND: Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist? METHODS: We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021. RESULTS: We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts. CONCLUSION: Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/36261642/Type_II_hiatal_hernias:_do_they_exist_or_are_they_actually_parahiatal_hernias DB - PRIME DP - Unbound Medicine ER -