1. Laparoscopic management of giant paraesophageal herniation
Robert J Wiechmann, MD, Mark K Ferguson, MD, Keith S Naunheim, MD, Paul McKesey, Steven J Hazelrigg, MD, Tibetha S Santucci, RN, Robin S Macherey, RN, Rodney J Landreneau, MD 
The Annals of Thoracic Surgery 
Volume 71, Issue 4, Pages (April 2001)
DOI: /S (00)

2. Fig 1
Anatomic characteristics of the “sliding” hiatus hernia. The phreno-esophageal ligament is attenuated, resulting in cephalic migration of the gastroesophageal junction into the chest. This is commonly associated with functional disturbance in the integrity of the lower esophageal sphincter and pathologic gastroesophageal reflux. (Reprinted with permission from Nyhus LM, Baker RJ, Fisher JE, eds. Mastery of Surgery. Boston: Little, Brown and Co., Inc, 1996.)
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

3. Fig 2
Anatomic characteristics of a primary paraesophageal hiatal hernia demonstrating preservation of the posterior phreno-esophageal ligament attachments and a true peritoneal lined herniation of the gastric fundus through an anterior expansion of the esophageal hiatal opening. (Reprinted with permission from Nyhus LM, Baker RJ, Fisher JE, eds. Mastery of Surgery. Boston: Little, Brown and Co., Inc, 1996.)
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

4. Fig 3
Contrast radiograph demonstrating classic giant paraesophageal hernia with organo-axial rotation of the stomach.
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

5. Fig 4
(A) Large paraesophageal hernia with stomach and omentum migrating into the intrathoracic hernia sac. (Reprinted with permission from Nyhus LM, Baker RJ, Fisher JE, eds. Mastery of Surgery. Boston: Little, Brown and Co., Inc, 1996.) (B) Contrast radiograph demonstrating herniation of stomach and transverse colon within the paraesophageal hernia sac (type IV hiatal hernia).
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

6. Fig 5
Barium radiograph demonstrating prolapse of the previously intrathoracic gastric fundus back into the abdomen resulting in gastric volvulus and closed loop obstruction of the fundus and antrum of the stomach. (Reprinted with permission from Nyhus LM, Baker RJ, Fisher JE, eds. Mastery of Surgery. Boston: Little, Brown and Co., Inc, 1996.)
The Annals of Thoracic Surgery  , DOI: ( /S (00) )

7. Fig 6
Approximate location of abdominal trochar access sites used by our group for laparoscopic antireflux surgery. (Reprinted with permission from Landreneau RJ, Keenan RJ, Ferson PF. Gastroesophageal reflux disease. In: Cameron JL, ed. Current Surgical Therapy, 5th ed. St. Louis: Mosby Year Book, 1995:29.)
The Annals of Thoracic Surgery  , DOI: ( /S (00) )