CLINICAL-FEATURES OF TYPE-III (MIXED) PARAESOPHAGEAL HERNIA

Objectives: The clinical presentation of patients with a paraesophagea l hernia is poorly understood, The aim of this study was to evaluate t he progression of symptoms in patients with type III paraesophageal he rnia, Methods: We evaluated 25 patients (mean age 66 yr) with a type I II paraesophageal hernia, who then had laparoscopic surgical repair, T he patients characterized their symptoms as 1) chronic or 2) prompting evaluation (progressive or new), We defined postprandial distress as chest or epigastric pain, shortness of breath, or nausea or vomiting d uring or shortly after meals, Results: We identified three distinct ty pes of chronic symptoms: heartburn only (36%), heartburn and postprand ial distress (32%), and postprandial distress only (32%), Twenty-three patients (92%) reported postprandial distress as the symptom promptin g evaluation compared with only 10 patients (40%) reporting heartburn, Eight patients (32%) never had heartburn, Postprandial distress was t heir only symptom, Laparoscopic repair of the paraesophageal hernia re solved postprandial distress in 74% and improved symptoms in the remai ning 26% of patients (mean follow-up 12 months), Conclusions: Postpran dial distress is the most prominent symptom in patients with a type II I paraesophageal hernia, Most patients had chronic symptoms of a slidi ng hiatal hernia but later featured more pronounced postprandial distr ess, However, one-third of the patients never experienced significant heartburn, A type III paraesophageal hernia should be suspected in pat ients, with or without heartburn, who develop new or progressive sympt oms of postprandial distress.