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Massive Para-esophageal hernias

Giant para-esophageal  hernias constitute a relevant challenge for gastroenterologist and surgeons with many unanswered questions. Should the presence of a giant para-esophageal hernia prompt to surgical repair even in asymptomatic or mild symptomatic patients? Given the high recurrence rate reported after primary repair, should we modify the surgical technique by using mesh or by elongating the esophagus with a Collis gastroplasty?

Should we routinely add a fundoplication to prevent (or cure) reflux? Giant para-esophageal hernia is a frequent conditions in elderly patients: what is the best treatment for octagenarians and nonageanrians with this condition?

Andre Duranceau, a former editor of Diseases of the Esophagus and Professor of Thoracic Surgery at the University of Montreal, reviews the literature and combine it with his vast experience on this disease in the article “Massive Para-esophageal hernias” in the June issue of the Journal.