ABSTRACT
Hiatal hernias are common disorders in the western population.1 The overall incidence of hiatal hernias has been reported to lie between ten and over 20 per cent.2 Hiatal hernias are categorized into four groups, as determined by Hill and Tobias in 1968.3 Type I hiatal hernias, also known as sliding hiatal hernias, account for the most common group (80 per cent) and are characterized by a sliding herniation of the gastroesophageal junction through the hiatus into the chest. Para-esophageal hernias (PEHs) account for the remaining three groups: type II represent a herniation of the fundus of the stomach through the hiatus with a fixed gastroesophageal junction in the normal position; type III are the most common PEHs, and represent a combination of type I and type II with a displaced gastroesophageal junction as well as herniation of parts of the stomach into the chest; type IV are composed of a large PEH combined with a large hiatal defect containing not only the stomach but also other intra-abdominal organs, such as colon or spleen. PEHs are observed more commonly in the elderly population. In our series of 117 patients undergoing laparoscopic PEH repair, the median age was 68 years (range 39-95); 12 patients were over the age of 80 years. Sixty per cent of patients were female.
