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Morgagni hernias have been recognized with increasing frequency as a source of abdominal pain and dyspnea in adults. Morgagni hernias are rarely accompanied by paraesophageal hernias. We report a case of Morgagni hernia associated with paraosephageal hernia, both repaired laparoscopically. On the 65-year-old woman patient, diaphragmatic defect and paraesophageal hernia were closed with primary sutures, and Hill-type gastropexy was performed successfully. The procedure lasted 115 min. The patient was discharged 5 days after surgical treatment and there were no complications following the operation. Primary closure with direct sutures is rapid, simple, and effective and can be combined with other laparoscopic procedures, as in our case. It can be performed by surgeons trained in intracorporeal suturing and knotting in all kinds of hospitals. The laparoscopic approach to Morgagni hernias minimizes trauma and shortens postoperative hospital stay, and patients have a comfortable postoperative period.

Exploratory thoracotomy was necessary to establish the diagnosis of a rare incarcerated parahiatal hernia. Symptomatology, signs, and radiographic findings are compared with those of paraesophageal hernias.

Long-term follow-up studies have confirmed the efficacy and durability of properly performed operations for gastroesophageal reflux; however, a significant number of patients develop trouble-some postoperative symptoms. Recurrent acid reflux and heartburn, dysphagia, gas bloat, diarrhea, and sliding and/or paraesophageal hernias may require medical or surgical intervention. Whereas some of these problems are transient, most require complete re-evaluations, and many require reoperations, ideally performed by surgeons with experience of these complex cases.

In 1933, Akerlung1offered a simple classification of esophageal hiatus hernias. The three basic types are (1) short esophagus with thoracic stomach; (2) normal esophagus with paraesophageal hernia; (3) normal esophagus with pulsion type hernia. Harrington's2excellent reports on the embryology, anatomy, and therapy of the various hiatal hernias have stimulated interest in their clinical recognition. The erroneous concept that hiatus hernia is a benign, structural curiosity incapable of serious portent is rapidly declining. The least common of the hiatal hernias is that type associated with true short esophagus. Certainly it is less commonly recognized by the clinician and the roentgenologist than are the more obvious paraesophageal hernias. Endoscopists have called attention to short esophagus for years and, for the most part, have inherited the management of the disease. With the general lack of interest and failure in recognition, there has been associated unawareness of the serious possibilities