Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review

• Published in: World journal of emergency surgery Vol. 15; no. 1; p. 37
• Main Authors: Ceccarelli, Graziano, Pasculli, Alessandro, Bugiantella, Walter, De Rosa, Michele, Catena, Fausto, Rondelli, Fabio, Costa, Gianluca, Rocca, Aldo, Longaroni, Mattia, Testini, Mario
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 01-06-2020; BioMed Central; BMC
• Subjects: Abdomen; Aged; Aged, 80 and over; Emergencies; Emergency medicine; Emergency surgery; Endoscopy; Endoscopy, Gastrointestinal; Gastroesophageal reflux; Giant hiatal hernia; Health aspects; Hernia; Hernia, Hiatal - diagnostic imaging; Hernia, Hiatal - surgery; Hiatal hernias; Humans; Ischemia; Laparoscopy; Laparoscopy - methods; Literature reviews; Male; Middle Aged; Mortality; Nausea; Ostomy; Paraesophageal hernia; Patients; Review; Robotic surgery; Robotic Surgical Procedures - methods; Robotics; Robots; Stomach; Surgery; Thorax; Tomography, X-Ray Computed; United States > US; Robotic surgery; Giant hiatal hernia; Laparoscopy; Paraesophageal hernia; Emergency surgery
• DOI: 10.1186/s13017-020-00316-1
• EISSN: 1749-7922

Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature.
During 10 years (December 2009-December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review.
The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences.
Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations.