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Tsuboi K, Hoshino M, Omura N, Yamamoto SR, Akimoto S, Masuda T, Sakashita Y, Fukushima N, Takeuchi H, Yano F, Eto K. The pathological conditions and surgical outcomes depending on the degree of hernia in the intra-thoracic stomach. Esophagus 2022:10.1007/s10388-022-00979-6. [PMID: 36562858 DOI: 10.1007/s10388-022-00979-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In recent years, the number of patients requiring surgery for intra-thoracic stomach (ITS) has been increasing due to the effects of obesity and gibbus due to aging. The aim of this study is to assess the effects of the degree of hernia on the pathological conditions and surgical outcomes in ITS patients. METHODS ITS was defined as cases in which over 50% of the stomach had deviated into the mediastinum by esophagogastric fluoroscopy and/or computed tomography, with 65 patients who underwent laparoscopic surgery as the initial surgery included. We compared the pathological conditions and surgical outcomes by dividing the subjects into 3 groups: Group A: 50%- < 75%; Group B: 75%- < 100%; and Group C: 100% (upside-down stomach), depending on the degree of deviation into the mediastinum of the stomach. RESULTS The breakdown of patients was 33 in Group A, 21 in Group B, and 11 in Group C. Regarding the preoperative pathological conditions, Group C had a high body mass index (BMI) and a low score for factor V according to upper gastrointestinal endoscopy (p = 0.0109, p = 0.0062, respectively). While the surgical results indicated that the operation time was extended depending on the degree of hernia (p = 0.0051), there was no marked difference in other surgical outcomes or the postoperative course among the three groups, with a high degree of satisfaction. CONCLUSIONS In the case of ITS, although the operation time was extended depending on the degree of the hernia, the surgical outcomes were the same, and overall good results were obtained.
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Affiliation(s)
- Kazuto Tsuboi
- Department of Surgery, Fuji City General Hospital, 50, Takashima-Cho, Fuji, Shizuoka, 417-8567, Japan. .,Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Masato Hoshino
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Omura
- Department of Surgery, Nishisaitama-Chuo National Hospital, Saitama, Japan.,Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Se-Ryung Yamamoto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Akimoto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Masuda
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuki Sakashita
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Naoko Fukushima
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hideyuki Takeuchi
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumiaki Yano
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Ceccarelli G, Pasculli A, Bugiantella W, De Rosa M, Catena F, Rondelli F, Costa G, Rocca A, Longaroni M, Testini M. Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review. World J Emerg Surg 2020; 15:37. [PMID: 32487136 PMCID: PMC7268602 DOI: 10.1186/s13017-020-00316-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
- Graziano Ceccarelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Alessandro Pasculli
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - Walter Bugiantella
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Michele De Rosa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Fausto Catena
- Department of Emergency and Trauma Surgery, Parma University Hospital, Viale Antonio Gramsci 11, 43126, Parma, Italy
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Gianluca Costa
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Aldo Rocca
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Via Francesco de Sanctis 1, 86100, Campobasso, Italy
| | - Mattia Longaroni
- General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Yasheng D, Wulamu W, Li YL, Tuhongjiang A, Abudureyimu K. Laparoscopic repair of complete intrathoracic stomach with iron deficiency anemia: A case report. World J Clin Cases 2020; 8:1180-1187. [PMID: 32258090 PMCID: PMC7103977 DOI: 10.12998/wjcc.v8.i6.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/10/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Giant paraesophageal hiatal hernias (HH) are very infrequent, and their spectrum of clinical manifestations is large. Giant HH mainly occurs in elderly patients, and its relationship with anemia has been reported. For the surgical treatment of large HH, Nissen fundoplication is the most common antireflux procedure, and the reinforcement of HH repair with a patch (either synthetic or biologic) is still debatable.
CASE SUMMARY We report on a case of giant paraesophageal HH in a middle-aged male patient with reflux symptoms and severe anemia. After performing a series of tests and diagnostic approaches, results showed a complete intrathoracic stomach associated with severe iron deficiency anemia. The patient underwent successful laparoscopic hernia repair with mesh reinforcement and Nissen fundoplication. Postoperatively, reflux symptoms were markedly relieved, and the imaging study showed complete reduction of the hernia sac. More importantly, anemia was resolved, and hemoglobin, serum iron and ferritin level were returned to the normal range. The patient kept regular follow-up appointments and remained in a satisfactory condition.
CONCLUSION This case report highlights the relationship between large HH and iron deficiency anemia. For the surgical treatment of large HH, laparoscopic repair of large HH combined with antireflux procedure and mesh reinforcement is recommended.
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Affiliation(s)
- Duolikun Yasheng
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Wubulikasimu Wulamu
- Department of Gastrointestinal Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, Guangdong Province, China
| | - Yi-Liang Li
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Airexiati Tuhongjiang
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Kelimu Abudureyimu
- Department of Minimally Invasive Surgery, Hernia and Abdominal Wall Surgery, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
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Umemura A, Suto T, Fujiwara H, Ikeda K, Nakamura S, Hayano M, Nitta H, Takahara T, Hasegawa Y, Katagiri H, Kanno S, Sasaki A. Cardiopulmonary Impairments Caused by a Large Hiatal Hernia with Organoaxial Gastric Volvulus Showing Upside-Down Stomach: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1530-1535. [PMID: 31624225 PMCID: PMC6818643 DOI: 10.12659/ajcr.918191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Patient: Female, 74 Final Diagnosis: Hiatal hernia with gastric volvulus Symptoms: Dyspena Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan.,Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Hisataka Fujiwara
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Kenichiro Ikeda
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan.,Ikeda Clinic, Morioka, Iwate, Japan
| | - Seika Nakamura
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Megumi Hayano
- Department of Surgery, Morioka Municipal Hospital, Morioka, Iwate, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Takeshi Takahara
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Yasushi Hasegawa
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | | | - Shoji Kanno
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Iwate, Japan
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5
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Omura N, Tsuboi K, Yano F. Minimally invasive surgery for large hiatal hernia. Ann Gastroenterol Surg 2019; 3:487-495. [PMID: 31549008 PMCID: PMC6749952 DOI: 10.1002/ags3.12278] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 12/19/2022] Open
Abstract
The majority of large hiatal hernias are paraesophageal hiatal hernias (PEH). Once prolapse of the stomach to the chest cavity reaches a high degree, it is called an intrathoracic stomach. More than 25 years have elapsed since laparoscopic surgery was carried out as minimally invasive surgery for PEH. The feasibility and safety thereof has nearly been established. PEH may cause serious complications such as strangulation and perforation. The outcome of elective repair of PEH is better than emergent repair, so we should carry out elective repair as much as possible. Although not a major clinical problem, following PEH repair the rate of anatomical recurrence increases with age. In order to reduce the recurrence rate, mesh reinforcement by crural repair has been widely performed. Although this improves the short-term outcomes, the long-term outcomes are unclear. For PEH repair, fundoplication and gastropexy are believed desirable. We should select the procedure associated with a lower incidence of dysphagia and so on following surgery. While relaxing incision is useful for primary tension-free closure, it has not contributed to improvement in the recurrence rate.
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Affiliation(s)
- Nobuo Omura
- Department of SurgeryNational Hospital Organization Nishisaitama‐Chuo National HospitalTokyoJapan
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Kazuto Tsuboi
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Fumiaki Yano
- Department of SurgeryThe Jikei University School of MedicineTokyoJapan
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Wang WP, Ni PZ, Chen LQ. Laparoscopic surgical treatment of esophageal hiatal hernia. Shijie Huaren Xiaohua Zazhi 2016; 24:3087-3097. [DOI: 10.11569/wcjd.v24.i20.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Types II, III and IV esophageal hiatal hernia (EHH) which presents obvious symptoms or leads to potentially fatal complications requires surgical treatment. Laparoscopy has been used to repair EHH in the last two decades globally and proved to be minimally invasive compared to conventional open surgery. This review summarizes current status and prospectives of laparoscopic application in EHH treatment. The published articles on minimally invasive laparoscopic surgical treatment of EHH in PubMed, Cochrane Library and EMBASE databases were retrieved and analyzed. From 1992 to 2015, 86 English articles involving a total of 4771 patients receiving laparoscopic treatment for EHH were retrieved. Perioperative information including safety and feasibility of procedure, postoperative complications, and short/long-term outcome after laparoscopic repair was retrospectively analyzed. Laparoscopic surgical treatment of EHH is a safe, feasible and minimally invasive procedure with fast recovery after repair, low postoperative morbidity and recurrence.
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Namikawa T, Fukudome I, Munekage E, Munekage M, Maeda H, Kitagawa H, Mibu K, Nagata Y, Kobayashi M, Hanazaki K. Laparoscopy-assisted distal gastrectomy for multiple adenocarcinomas in intrathoracic upside-down stomach. Asian J Endosc Surg 2016; 9:57-60. [PMID: 26781528 DOI: 10.1111/ases.12217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/29/2015] [Accepted: 07/08/2015] [Indexed: 02/05/2023]
Abstract
Herein we report on a case of two adenocarcinomas arising from an upside-down stomach in an elderly patient. An 83-year-old man was referred to our hospital with gastric cancer. Esophagogastroduodenoscopy showed two superficial depressed lesions in the stomach that were confirmed on biopsy as constituting a moderately differentiated tubular adenocarcinoma. CT and an upper gastrointestinal barium study revealed that the entire stomach and parts of the duodenum were located in the mediastinum. The patient underwent laparoscopy-assisted distal gastrectomy and regional lymph node dissection with Billroth I reconstruction, followed by reduction of the migrated stomach. The hiatal defect was closed by primary suturing of the right and left crura at the anterior space of the esophagus. The patient's postoperative course was good, and follow-up after discharge was uneventful. To the best of our knowledge, this is the first case report of multiple adenocarcinomas in an upside-down stomach treated by laparoscopy-assisted distal gastrectomy.
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Affiliation(s)
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | - Eri Munekage
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Hiromichi Maeda
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | | | - Kiyo Mibu
- Nursing Department, Kochi Medical School Hospital, Nankoku, Japan
| | - Yusuke Nagata
- Department of Surgery, Izumino Hospital, Kochi, Japan
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8
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Geißler B, Birk E, Anthuber M. [Report of 12 years experience in the surgical treatment of 286 paraesophageal hernias]. Chirurg 2015. [PMID: 26223669 DOI: 10.1007/s00104-015-0066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In contrast to axial hiatus hernias, paraesophageal hernias are rare but can lead to chronic iron deficiency anemia and severe acute complications. Treatment is manifold and consistent standards are lacking. OBJECTIVES The aim of this study was to describe our experiences of 286 patients with paraesophageal hernias, who underwent surgery from 2003 to 2014 at a tertiary referral center. The study was particularly concerned with morbidity, mortality, quality of life and recurrence rates. MATERIAL AND METHODS In 12 years a total of 286 paraesophageal hernias were surgically treated, 255 with a minimally invasive procedure and 31 with an open approach. In 138 patients (48 %) the suture-based hiatoplasty was reinforced by means of a lightweight mesh, which was fixed with fibrin glue in 90 cases. Abdominal fixation of the stomach consisted of a gastropexy and anterior (n = 244) or posterior (n = 42) fundoplication. RESULTS Complications arose in 8.4 % of the patients. The mean hospital stay was 5.3 (± 2.8) days for elective surgery and 24.7 (± 17.8) days for emergency operations. The gastrointestinal quality of life index according to Eypasch significantly increased from mean preoperative values of 92.8 (± 22.5) to 109.6 (± 20.2) in the postoperative course (p < 0.001). Of the patients 20 (7 %) suffered a recurrence requiring surgery, including 7 early and 13 late recurrences. During the immediate postoperative period radiographically detected recurrences were promptly revised. The strategy of late recurrences in the long-term course was based on patient symptoms and asymptomatic hernias were treated conservatively while symptomatic hernias were surgically treated. Symptomatic late recurrences developed in 4.6 % of the patients, including 7.4 % (11 out of 148) without and 1.4 % (2 out of 138) with primary mesh repair. CONCLUSION The repair of paraesophageal hernias in 286 patients provided excellent patient satisfaction and symptom improvement with low perioperative morbidity and mortality. Mesh reinforcement reduced the recurrence rate. The quality of life index is a suitable clinical course parameter for evaluation of paraesophageal hernias.
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Affiliation(s)
- B Geißler
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - E Birk
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - M Anthuber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
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Prassas D, Rolfs TM, Schumacher FJ. Laparoscopic repair of giant hiatal hernia. A single center experience. Int J Surg 2015; 20:149-52. [PMID: 26159290 DOI: 10.1016/j.ijsu.2015.06.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Giant hiatal hernia is a rare clinical entity with possibly serious complications, diagnosed mostly among older patients. The laparoscopic repair of such hernias is a therapeutic option, performed mostly in specialized centers by experienced surgeons. METHODS From 1997 to 2012 fifty-five patients with giant hiatal hernia (median age of 72) were primarily treated by laparoscopic surgery at the surgical department of the Catholic Clinic Oberhausen. Demographic data, operating times, conversion rate, morbidity and mortality were recorded prospectively. Follow-up was conducted by means of a mailed questionnaire. RESULTS Intraoperative complications occurred in 1,8% of the cases (n = 1). In this single case the procedure was converted to an open procedure due to technical difficulties imposed by hepatomegaly. The median operating time was 96 min (range, 30 to 350). Our rate of postoperative complications was 14,5% (n = 8). The median postoperative hospital stay was nine days. 14,5% (n = 8) of our patients underwent a redo-surgery for symptomatic recurrence. The median follow-up was 64 months by means of a self-designed questionnaire. 34,5% (19/55) of the questioned patients responded to our survey. The difference between pre- and postoperative symptom intensity was found to be significant for heartburn (p < 0,001) and retrosternal/epigastric pain (p = 0,028). The difference was not found to be statistically significant for dysphagia (p = 0,8) and bloating (p = 0,3). 85% of the questioned patients stated they would have the operation again, if necessary. 80% reported an improvement of their overall quality of life. DISCUSSION The laparoscopic repair of large hiatal hernias is a safe approach with an intraoperative complication rate of 1,8%, low post-operative morbidity (14,5%) and very low mortality (1,8%). There is a high patient satisfaction (85%) and a good postoperative quality of life (80%). CONCLUSION The laparoscopic approach for repair of large hiatal hernias is a relatively safe method with significant long-term efficacy in terms of symptom control and quality of life.
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Affiliation(s)
- Dimitrios Prassas
- Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany.
| | - Thomas-Marten Rolfs
- Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany
| | - Franz-Josef Schumacher
- Katholisches Klinikum Oberhausen, Department of Surgery, Teaching Hospital of the University of Duisburg-Essen, Germany
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10
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Treatment results of laparoscopic surgery in Japanese patients with upside-down stomach. Esophagus 2014. [DOI: 10.1007/s10388-014-0436-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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11
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Schiergens TS, Thomas MN, Hüttl TP, Thasler WE. Management of acute upside-down stomach. BMC Surg 2013; 13:55. [PMID: 24228771 PMCID: PMC3830558 DOI: 10.1186/1471-2482-13-55] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 11/12/2013] [Indexed: 12/02/2022] Open
Abstract
Background Upside-down stomach (UDS) is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. Symptoms may vary heavily as they are related to reflux and mechanically impaired gastric emptying. UDS is associated with a risk of incarceration and volvulus development which both might be complicated by acute gastric outlet obstruction, advanced ischemia, gastric bleeding and perforation. Case presentation A 32-year-old male presented with acute intolerant epigastralgia and anterior chest pain associated with acute onset of nausea and vomiting. He reported on a previous surgical intervention due to a hiatal hernia. Chest radiography and computer tomography showed an incarcerated UDS. After immediate esophago-gastroscopy, urgent laparoscopic reduction, repair with a 360° floppy Nissen fundoplication and insertion of a gradually absorbable GORE® BIO-A®-mesh was performed. Conclusion Given the high risk of life-threatening complications of an incarcerated UDS as ischemia, gastric perforation or severe bleeding, emergent surgery is indicated. In stable patients with acute presentation of large paraesophageal hernia or UDS exhibiting acute mechanical gastric outlet obstruction, after esophago-gastroscopy laparoscopic reduction and hernia repair followed by an anti-reflux procedure is suggested. However, in cases of unstable patients open repair is the surgical method of choice. Here, we present an exceptionally challenging case of a young patient with a giant recurrent hiatal hernia becoming clinically manifest in an incarcerated UDS.
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Affiliation(s)
- Tobias S Schiergens
- Department of Surgery, University of Munich, Campus Grosshadern, Munich, Germany.
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12
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Hirota M, Nakajima K, Souma Y, Mikata S, Iwase K, Demura K, Takahashi T, Yamasaki M, Miyata H, Kurokawa Y, Takiguchi S, Mori M, Doki Y. Assistive esophagoscopy during laparoscopic surgery for intra-thoracic stomach. Esophagus 2013. [DOI: 10.1007/s10388-013-0367-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
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