MASSIVE INCARCERATED HIATAL-HERNIAS

A massive incarcerated hiatal hernia is a frequent finding in elderly people. The aim of this report has been to review from 1987 to 1992 th e clinical aspects, therapeutic options and results of surgical treatm ent in a series of twenty-eight patients (23 females and 5 males) with a large incarcerated hiatal hernia. Age averaged 66 +/- 10 years; thi rteen patients (46.5%) had a sliding type of hernia, 8 (28.5%) a mixed one, and 7 (25%) a paraesophageal hernia. In 9 patients (32%) there w as a chronic volvulus of the incarcerated stomach. Twenty-seven patien ts underwent elective repair; one patient developed a perforated gastr ic ulcer into the pericardial sac with pneumopericardium and died befo re surgery. The surgical technique included reduction of the hernia, c losure of the hiatus and an antireflux procedure (Nissen 25, Toupet 1 and Dor 1). There was no mortality and the morbidity (18%) was not dir ectly related to the surgical procedure. In our serie there were no ca ses of acute volvulus requiring emergency surgery. Our results suggest that surgical correction of massively incarcerated hiatal hernias is well tolerated in the elderly, it relieves symptoms, and avoids potent ial serious complications.