Characteristics and outcomes of laparoscopic surgery in patients with large hiatal hernia. A single center study

• Published in: International journal of surgery case reports Vol. 48; pp. 142 - 144
• Main Authors: Romano, Angela, D’Amore, Davide, Esposito, Giuseppe, Petrillo, Marianna, Pezzella, Modestino, Romano, Francesco Maria, Izzo, Giuseppe, Cosenza, Angelo, Torelli, Francesco, Volpicelli, Antonio, Di Martino, Natale
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2018; Elsevier
• Subjects: Giant hiatal hernia; Hiatoplasty; Laparoscopy; Upper GI; Upper GI; Giant hiatal hernia; Laparoscopy; Hiatoplasty
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2018.04.036

•Hiatal hernia can be diagnosed by various modalities. Only investigations which will alter the clinical management of the patient should be performed.•Repair of a type I hernia in the absence of reflux disease is not necessary.•All symptomatic paraesophageal hiatal hernias should be repaired, particularly those with acute obstructive symptoms or which have undergone volvulus.•Laparoscopic hiatal hernia repair is as effective as open transabdominal repair, with a reduced rate of perioperative morbidity and with shorter hospital stays. It is the preferred approach for the majority of hiatal hernias.
Giant hiatal hernia is characterized by the presence of more than 1/3 of the stomach in the chest, through the diaphragmatic hiatus, with or without other intra-abdominal organs. It is a rare pathology, representing the 5–10% of all hiatal hernias. The advent of laparoscopic surgery led to new surgical techniques, which include the simple reduction with the excision of the hernial sac and the execution of a posterior hiatoplasty, with or without mesh, and the execution of a Collis-Nissen gatroplasty in case of short esophagus.
We followed 24 cases of giant hiatal hernia with more than 1/3 stomach located in the chest, analyzing the results reached by the miniinvasive procedure, and the long-term pathophysiologic results of the disease.
Laparoscopic hiatal hernia repair results in less postoperative pain compared with the open approach. The smaller incisions of minimally-invasive surgery are less likely to be complicated by incisional hernias and wound infection. Postoperative respiratory complications are reduced.
Results from multiple studies are similar, with shorter hospital stay and less morbidity resulting from the minimally invasive approach.