Request PDF on ResearchGate | On Jan 1, , D. Collet and others published Hernies hiatales et autres pathologies diaphragmatiques. Le traitement chirurgical vidéolaparoscopique des hernies hiatales par roulement est réalisable sans difficultés techniques majeures. Il est possible même chez. Although congenital and posttraumatic diaphragmatic hernias were described as far back as the 16th century, hiatal hernia was not recognized as a significant.

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This review addresses the historical evolution of hiatal hernia HH repair and reports in a chronological fashion the major milestones in HH surgery before the laparoscopic era. The medical literature and the collections of the History of Medicine Division of the National Library of Medicine were searched. Secondary references from all sources were studied. The senior author’s experience and personal communications are also reported.

The first report of HH was published in by Bowditch. Rokitansky in demonstrated that esophagitis was due to gastroesophageal reflux, and Hirsch in diagnosed an HH using x-rays. Eppinger diagnosed an HH in a live patient, and Friedenwald and Feldman related the symptoms to the presence of an HH. InAkerlund proposed the term hiatus hernia and classified HH into the 3 types that we use today.

The first elective surgical repair was reported in by Soresi. The physiologic link between HH and gastroesophageal reflux was made at the second half of the 20 th century by Allison and Barrett. In the midst of a physiologic revolution, Nissen and Belsey developed their famous operations.

InCollis published his innovative operation. Thal described his technique inand inHill published his procedure. Donahue and Demeester significantly improved Nissen’s operation, and they were the first to truly understand its physiologic mechanism. Hiatal hernia surgery has evolved from anatomic repair to physiological restoration. Although congenital and posttraumatic diaphragmatic hernias were described as far back as the 16th century, hiatal hernia was not recognized as a significant clinical entity until the first half of the 20 th century.

Surprising as it seems to modern surgeons, the relationship between hiatal hernia and gastroesophageal reflux remained unnoticed until the s. In the second half of the 20 th century, an appreciation of the pathophysiology of gastroesophageal reflux changed hiatal hernia surgery from simple restoration of anatomy to more physiologic operations.

At the dawn of the new millennium, technological advances in both diagnosis and therapy have made treatment of hiatal hernia and gastroesophageal reflux a major component of surgical practice.

This review addresses the historical evolution of hiatal hernia repair and reports in a chronological fashion the major milestones in hiatal hernia surgery before the laparoscopic era. Ambrose PareRivierius LazariGiovanni Batista MorgagniVincent Alexander Bochdalekand many other distinguished physicians make up an impressive list of pioneers whose names have been associated with the first descriptions of posttraumatic and congenital diaphragmatic hernias.

This is probably attributable to the classic autopsy techniques of the time in which the esophagus was usually cut just above the diaphragm and taken out with the heart and lungs, losing all connections with its intra-abdominal segment and stomach. Cooper considered herniation the result of malformation or injury. InHenry Ingersoll Bowditch 5 reviewed all cases of diaphragmatic hernia published between and Hermies all, it descended through the diaphragm as usual but turned back toward the left to enter the abnormal aperture caused by the hernia and to join the stomach in gernies chest.

Henry Ingersoll Bowditch reviewed the early series of hiatal hernias described at postmortem examination in and probably should be credited with the first description of what is now referred to as hegnies paraesophageal hernia.

Courtesy of the National Library of Medicine. While the recognition of hiatal hernia as a common anatomic abnormality would hernie to wait for the widespread adoption of x-rays, the damage done to the esophagus by gastroesophageal reflux was postulated in medical literature as early as Charles Michel Billard 6 in Paris published the first case of esophagitis in a child in Carl Rokitansky, 7 a pathologist in Vienna indemonstrated that esophagitis of hiatalles lower esophagus was due to gastroesophageal reflux.

His report, however, had little impact on clinical medicine at that time.

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Many clinicians such as Friedrich Albert von Zenker 8 and Sir Morrel Mackenzie 9 felt reflux of gastric juice into the esophagus to be only an agonal occurrence with no clinical significance.


When Heinrich Quincke 10 in Germany attributed 3 cases of esophageal ulceration to the regurgitation of gastric hermies ina histales controversy developed. This controversy persisted for over half a century! Wilder Tileston 11 clearly described the typical symptoms of esophagitis in hiataes In his study, he reviewed 41 cases and he added 3 of his own.

Although many of these patients had esophageal ulceration, as well as frequent vomiting and pyloric stenosis, the importance of his contribution lies in that Tileston gave a description of the typical symptomatology of esophagitis, and he felt that these symptoms were caused by insufficiency of the cardia.

Joseph Sheehan 12 described the esophagoscopic findings of esophagitis inand Porter Vinson 13 was the first to note the association between esophagitis and stricture 1 year later. The term peptic hiataes was introduced in by Hamperl 14 on the basis of his pathologic studies almost 80 years after Rokitansky’s work.

One year later, Asher Winklestein 15 introduced the term in the English literature. The advent of radiography was the first important step in the hiatalew and management of hiatal hernia.

Around the turn of the century, a first-year medical student at Harvard Medical School later to become a professor named Walter Cannon begun a research project with a fellow second-year medical student, Albert Moser, studying deglutition with x-rays using bismuth capsules.

The project had been suggested by the professor of physiology Henry Pickering Bowditch. They presented their work before the American Physiologic Society in Theirs was the first study of the anatomy hiatalea physiology of the cardia by means of contrast material. An huatales number of cases began to appear and at the turn of the century; it seemed like a new disease entity had emerged. Four years later, Eppinger diagnosed a hiatal hernia in a live patient.

InEppinger summarized the literature of diaphragmatic hernia identifying cases, of which only 11 involved the esophageal hiatus. In that same year, Julius Friedenwald and Maurice Feldman 20 described the typical symptoms for the first time ie, heartburn and related these to the presence of a hiatal hernia. They believed that the cause of the hernia was the failure of the muscle surrounding the diaphragm to closely encircle the esophagus. InAke Akerlund 21 in Stockholm reported 30 more cases, proposed the term hiatus herniaand classified hiatal hernias into 3 types.

They are most often true nontraumatic hernias and can be classified in 3 groups: Hiwtales the prevailing opinion at the time, he concluded that hiatal hiaatles must be a common affliction. InMax Ritvo, 23 a Boston radiologist, published a series of 60 cases drawn from herniea studies he had performed. The acceptance of hiatal hernia as a distinct entity was not universal. Technique for Radical Cure.

This lack of interest is not easily explained, hiataless diaphragmatic hernias give rise to so many complicated and serious symptoms, which if not properly attended to, will lead the patient to an unfortunate life and premature death. In spite of being melodramatic, Soresi’s report details the original abdominal approach to the hiatus.

Frequently Asked Questions: Hiatal Hernias – Massachusetts General Hospital, Boston, MA

His operation consisted of reduction of the hernia and closure of the opening of the diaphragm. If the esophagus or the aorta are found in the gap the stitch is somewhat modified: The needle goes through the most superficial layer of the organ that is included in the gap, but the surgeon must be exceedingly careful not to enter the lumen of the organ. Following Soresi’s report, interest in hiiatales surgical treatment of hiatal hernia grew.

Stuart Harrington 27,28 and his colleagues at The Mayo Clinic published their experience treating 27 patients in The Mayo clinic group refined the criteria for patient selection, choosing to observe patients whose hiatal hernias were discovered radiographically during the course of a general examination. Patients felt to have symptomatic diaphragmatic hernias were usually approached transabdominally.

The operation was basically the one that Soresi had used 10 years earlier. He reported zero mortality, and his recurrence rate was The correction of hiatus hernia by paralyzing the left hemidiaphragm was tried by other surgeons over the next 2 decades.

The results were unpredictable and the method was finally abandoned. Sweet, using many of the principles developed in jernies treatment of inguinal hernias, reduced the hernia, crushed the phrenic nerve, and plicated the hernia sac.


Hiatal hernia

He then narrowed the hiatus with heavy silk sutures until he could get his index finger between the esophagus and the hhernies of the hiatus. Sweet suggested that in some cases an additional suture of fascia lata obtained from the left thigh should be used to reinforce the repair. This technique may be the predecessor of the current use of pledgeted sutures.

Hiayales also reported that in some cases the esophagus was congenitally short, preventing reduction of the stomach into the abdomen. In these cases, he suggested that no attempt to alter hiataes location of the cardia and stomach needed to be made. Two years later, he reported a series of consecutive cases of hiatal herniorrhaphies with good short-term results.

Although it seems surprising to today’s surgeons, a physiologic link between hiatal hernia and gastroesophageal reflux had yet to be made as the second half of the 20 th century began. Surgical procedures were based solely on anatomic observations. Herbies surgeons believed that symptoms in patients with hiatal hernias emanated from pinching of the stomach as it traversed the hiatus.

The surgeons of the first half of the 20th century had focused on correcting an anatomic defect. To their dismay, many patients had successful restoration of anatomy but persisting symptoms. Philip Allison in Leeds and Hsrnies Barrett in London played a major role in changing the established perception of the sliding hernia from that of an anatomic mechanical condition to a functional physiologically based disorder and established that reflux esophagitis and its complications were the physiologic consequences hhiatales anatomic abnormalities.

Allison should be credited for initiating the modern era of antireflux surgery. He believed these crural fibers functioned as a pinchcock to prevent reflux. His transthoracic surgical technique consisted of 1 reduction of the herniated cardia back into the abdomen; 2 retention of the cardia to that position by suturing the phrenoesophageal ligament and peritoneum to the abdominal aspect of the herneis and 3 approximation and light suture of the crural fibers behind the esophagus.

Allison emphasized the importance of light suture hsrnies that the muscle fibers of the hiatus could continue to function. Allison classified hiatal hernia into 2 types: Allison supported the surgical treatment of sliding hernias for 2 reasons.

There was 1 death, and 30 of 32 surviving patients had excellent short-term results.

He was courageous enough to report this to the American Surgical Association meeting in Whereas Allison focused on reduction of the hiatal hernia and proper closure of the diaphragmatic sling, Norman Barrett 33 focused on restoration of the cardioesophageal angle as the critical element in the prevention of hiaatales Fig. Long before fiberoptic endoscopies could confirm it, he postulated yiatales presence of a fold of mucosa at the gastroesophageal junction that functioned as a flap valve.

Restoration of the hernes angle was therefore the key objective of an antireflux operations, a hiatqles that became central to subsequent operations developed hrrnies Belsey and Hill. Apart from his classic report on the columnar lined esophagus and its ulcerative complications, Barrett also emphasized the frequency of sliding hiatus hernia, the occurrence of paraesophageal hernia, and he discussed the way in which acid reflux is prevented.

Barrett’s contributions stimulated surgeons to design procedures aimed at improving the function of the cardia rather than simply focusing on hernia reduction. The confluence of 2 streams of thought, the anatomic focusing on herniation and the physiologic focusing on acid reflux, were critical to the development of modern hiatal hernia surgery.

The identification of the lower esophageal sphincter and use of manometry were reported in In the midst of this physiologic revolution, Rudolph Nissen and Ronald Belsey developed the operations used by most surgeons in the 21st century. The development of the Nissen fundoplication has been falsely described as an example of progress in surgery by accident.