Large Paraesophageal Hernias in Children. Early Experience with Laparoscopic Repair
Bibliographic record
Abstract
BACKGROUND: Large paraesophageal hernias (LPEH) in children are unusual. The aim of this study is to report the management of LPEH and our initial experience with the laparoscopic approach. METHODS: Since September 2005, four children aged 4-17 years underwent laparoscopic repair of LPEH at the Children's Hospital of Eastern Ontario. Three children had previous fundoplications and two of these had a gastrostomy. Closure of the hiatal defect included crural sutures and prosthetic material, either polytetrafluoroethylene-polypropylene mesh or porcine small intestinal submucosal patch. The charts were retrospectively analyzed. RESULTS: The operative time was 300-540 minutes, with one conversion and two mediastinal pleural tears. Postoperative chest X-ray showed neither mediastinal nor intrapleural air. The median hospital stay was 3 days. Contrast X-ray showed no recurrent hernia and an intact fundoplication. CONCLUSION: LPEH in children is usually a complication of previous fundoplication. Laparoscopic repair is technically demanding but feasible. Adequate crural repair using mesh may reduce the incidence of recurrence. In view of the rarity of LPEH in children, a combined multicenter study is needed to evaluate the results of laparoscopic repair.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".