WOFAPS 2025 8th World Congress of Pediatric Surgery

Gülbin Yazgan, Sabri Cansaran, Ayşenur Celayir

University of Health Sciences, Turkey. Istanbul Zeynep Kamil Maternity and Children Diseases Health Training and Research Center, Department of the Pediatric Surgery

Aim:Hiatal hernia is a rare pathology in the pediatric population. This study aimed to evaluate the clinical characteristics and surgical outcomes of pediatric patients diagnosed with hiatal hernia at our center..

Methods:The medical records of children who underwent surgery for hiatal hernia between January 2018 and January 2025 were retrospectively reviewed. Demographic data, associated pathologies, presenting symptoms, diagnostic methods, and treatment processes were analyzed.

Results: Nine patients were identified, including five females and four males, all of whom were born at term. The median age at presentation was 15 months, ranging from 1 to 56 months. Four patients had neurological comorbidities. One patient, previously operated on at another center, developed recurrence, and one had a prior bilateral Morgagni hernia repair.

Presenting symptoms included upper respiratory tract infection and/or pneumonia in four patients, bloody vomiting with respiratory symptoms in two patients, feeding difficulties in two patients, and combined respiratory and feeding problems in one patient. In-depth history revealed a mean symptom duration of 6 months (range 1–19 months). Chest radiographs consistently showed the stomach herniated into the thorax with an air-fluid level. Echocardiography was normal in eight cases, while one patient (11%) had a ventricular septal defect (VSD). Anemia was found in four patients (44%), diagnosed at 11, 19, 30, and 56 months.

All patients underwent primary hiatal hernia repair with Nissen fundoplication—eight via laparotomy, one laparoscopically. Oral feeding was resumed after a mean of 3 days (range: 1–7 days). Except for one patient with 10 days of postoperative vomiting following recurrence surgery, no complications occurred. The mean follow-up was 3 years (range: 1–5 years), with no further problems.

Conclusion:The rarity of hiatal hernia in pediatric patients may lead to delayed diagnosis. Chronic anemia due to reflux-induced esophagitis should be considered along with prolonged respiratory and feeding problems. Plain radiographs showing stomach air-fluid level in the thorax are valuable for diagnosis. Early diagnosis and surgical intervention are important for complication-free recovery.