背景:II型食管裂孔疝(HH)的特征是胃底的一部分位于与食管相邻的食管裂孔上方,而胃食管交界处(GEJ)保持固定在食管裂孔下方。这种类型的HH被称为“真正的”食管旁疝(PEH),因为眼底出现在食管的一侧。根据我们的经验,在射线照相测试中偶尔会发现II型HHs,然而他们很少,如果有的话,术中证实。这导致了我们的问题:II型HH存在吗?
方法:我们在三个位置搜索了II型HH的证据:1。1994年至2021年在华盛顿大学医学中心进行的所有首次PEH修复(不包括I型HH和再次手术病例)的回顾性审查;2。YouTube和WebSurg网站上提供的操作视频;和3.从2005年到2021年的SAGES年度会议摘要。
结果:我们在三次搜索中都没有发现II型HH的证据。我们进行了846PEH维修:760III型,75IV型,和11个产旁。网站视频审查,我们只发现了一种可能的II型疝气,虽然很可能是食管裂孔旁疝.SAGES年度会议摘要中未发现II型HH的视频或案例介绍。
结论:不存在目前定义的II型HH。虽然不常见,裂孔旁疝很容易被误解为II型HH。我们应该考虑改变食管裂孔疝分类系统,以防止持续的临床混淆。
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?
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.
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.
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.