1
|
Patrzyk M, Hummel R, Kersting S. [Surgical strategy for hiatal hernias]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:336-344. [PMID: 38372742 DOI: 10.1007/s00104-024-02054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
The indications for surgical treatment of hiatus hernias differentiate between type I and types II, III and IV hernias. The indications for a type I hernia should include a proven reflux disease but the indications for surgical treatment of types II, III and IV hernias are mandatory due to the symptoms with problems in the passage of food and due to the sometimes very severe possible complications. The primary aims of surgery are the repositioning of the herniated contents and a hiatoplasty, which includes a surgical narrowing of the esophageal hiatus by suture implantation. In addition, depending on the clinical situation other procedures, such as hernia sac removal, mesh implantation, gastropexy and fundoplication can be considered. There are various approaches to the repair, all of which have individual advantages and disadvantages. An adaptation to the specific needs situation of the patient and the expertise of the surgeon is therefore essential.
Collapse
Affiliation(s)
| | | | - Stephan Kersting
- Klinik für Allgemeine Chirurgie, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland.
| |
Collapse
|
2
|
Nguyen HQ, Dang TK, Tran HT, Phan HL, Ho DKD. Multiple Complicated Concurrent Hernias in a Single Patient: A Case Report. Cureus 2024; 16:e56582. [PMID: 38646287 PMCID: PMC11031192 DOI: 10.7759/cureus.56582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple complicated concurrent hernias with obturator hernia and paraesophageal hernia unusually occur in clinical settings. The obturator hernias belong to a rare pelvic hernia that accounts for a minority of all abdominal hernias. Besides, paraesophageal hernias occur commonly in elderly female patients. Clinical manifestations of these hernias are usually unspecific and the diagnosis is based on computed tomography (CT). In this paper, we presented a case of multiple complicated hernias in an 81-year-old woman. She was admitted to our hospital due to intestinal obstruction that was caused by a simultaneous obturator and paraesophageal hernia. She was successfully treated by laparoscopic hernia repair. Postoperative progression was favorable. She was then discharged from the hospital after four hospital days.
Collapse
Affiliation(s)
- Huy Q Nguyen
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Toan K Dang
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Hien T Tran
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Huy L Phan
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| | - Dang Khoa D Ho
- Department of General Surgery, People's Hospital 115, Ho Chi Minh, VNM
| |
Collapse
|
3
|
Alvarez LA, Debski AM, Egli AE, Hatlovic MA, Rosenthal OD, Gardner S. Hiatal Hernia of Stomach and Lesser Omentum in a Cadaver: Is It a Type III or IV? Cureus 2024; 16:e55431. [PMID: 38567228 PMCID: PMC10986317 DOI: 10.7759/cureus.55431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Hiatal hernias, protrusions of abdominal viscera through the esophageal hiatus, are classified into four types. Types I and II involve ascent of the stomach without affecting the gastroesophageal junction. Types III and IV involve the gastroesophageal junction. Type IV specifically may have stomach as well as other abdominal organ involvement, such as pancreas or omentum. Among these types, type IV is the most complex and rare form, accounting for only 0.1% of all cases of hiatal hernias. This report presents a case of a type IV hiatal hernia involving the lesser omentum and a significant portion of the stomach in an 86-year-old male cadaver with a history of mediastinal surgery. To our knowledge, this presentation in a cadaver has not previously been reported in the literature. This case highlights classification inconsistencies in the literature, particularly regarding type IV hiatal hernias. It is unclear given the current classification system, whether this presentation would be considered a type III or type IV hiatal hernia as it fits both criteria and there are several interpretations of the criteria of a type IV hiatal hernia. Inconsistencies in the classification system may impede standardization of care. This report highlights the need for a more precise classification system that better accounts for anatomical changes and clinical presentation.
Collapse
Affiliation(s)
- Luis A Alvarez
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| | - Alyssa M Debski
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| | - Anna E Egli
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| | - Morgan A Hatlovic
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| | - Oren D Rosenthal
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| | - Seth Gardner
- Department of Anatomy, Lake Erie College of Osteopathic Medicine Bradenton, Bradenton, USA
| |
Collapse
|
4
|
Brandalise A, Herbella FAM, Luna RA, Szachnowicz S, Sallum RAA, Domene CE, Volpe P, Cavazzolla LT, Furtado ML, Claus CMP, Farah JFDM, Crema E. BRAZILIAN HERNIA AND ABDOMINAL WALL SOCIETY STATEMENT ON LARGE HIATAL HERNIAS MANAGEMENT. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 36:e1787. [PMID: 38324849 PMCID: PMC10841492 DOI: 10.1590/0102-672020230069e1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 02/09/2024]
Abstract
Large hiatal hernias, besides being more prevalent in the elderly, have a different clinical presentation: less reflux, more mechanical symptoms, and a greater possibility of acute, life-threatening complications such as gastric volvulus, ischemia, and visceral mediastinal perforation. Thus, surgical indications are distinct from gastroesophageal reflux disease-related sliding hiatal hernias. Heartburn tends to be less intense, while symptoms of chest pain, cough, discomfort, and tiredness are reported more frequently. Complaints of vomiting and dysphagia may suggest the presence of associated gastric volvulus. Signs of iron deficiency and anemia are found. Surgical indication is still controversial and was previously based on high mortality reported in emergency surgeries for gastric volvulus. Postoperative mortality is especially related to three factors: body mass index above 35, age over 70 years, and the presence of comorbidities. Minimally invasive elective surgery should be offered to symptomatic individuals with good or reasonable performance status, regardless of age group. In asymptomatic and oligosymptomatic patients, besides obviously identifying the patient's desire, a case-by-case analysis of surgical risk factors such as age, obesity, and comorbidities should be taken into consideration. Attention should also be paid to situations with greater technical difficulty and risks of acute migration due to increased abdominal pressure (abdominoplasty, manual labor, spastic diseases). Technical alternatives such as partial fundoplication and anterior gastropexy can be considered. We emphasize the importance of performing surgical procedures in cases of large hiatal hernias in high-volume centers, with experienced surgeons.
Collapse
Affiliation(s)
- André Brandalise
- Centro Médico de Campinas, Robotic Surgery Program - Campinas (SP), Brazil
| | | | - Renato Abrantes Luna
- Universidade Federal do Estado do Rio de Janeiro, Faculty of Medicine and Surgery, Hospital Federal dos Servidores do Estado - Rio de Janeiro (RJ), Brazil
| | - Sergio Szachnowicz
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | | | - Paula Volpe
- Centro Integrado de Medicina Avançada - São Paulo (SP), Brazil
| | - Leandro Totti Cavazzolla
- Universidade Federal do Rio Grande do Sul, University Hospital, General Surgery Unit - Porto Alegre (RS), Brazil
| | - Marcelo Lopes Furtado
- Sociedade Brasileira de Hérna e Parede Abdominal, Hospital Pintagueiras, Videolaparoscopic Surgery Service - Jundiaí, São Paulo (SP), Brazil
| | - Christiano Marlo Paggi Claus
- Universidade Positivo, Postgraduate Program in Minimally Invasive Surgery, Department of Surgical Clinic - Curitiba (PR), Brazil
| | | | - Eduardo Crema
- Universidade Federal do Triângulo Mineiro, Digestive Surgical Unit - Uberaba (MG), Brazil
| |
Collapse
|
5
|
Nurminen NMJ, Järvinen TKM, Kytö VJ, Salo SAS, Egan CE, Andersson SE, Räsänen JV, Ilonen IKP. Malpractice claims after antireflux surgery and paraesophageal hernia repair: a population-based analysis. Surg Endosc 2024; 38:624-632. [PMID: 38012443 PMCID: PMC10830758 DOI: 10.1007/s00464-023-10572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The complication rate of modern antireflux surgery or paraesophageal hernia repair is unknown, and previous estimates have been extrapolated from institutional cohorts. METHODS A population-based retrospective cohort study of patient injury cases involving antireflux surgery and paraesophageal hernia repair from the Finnish National Patient Injury Centre (PIC) register between Jan 2010 and Dec 2020. Additionally, the baseline data of all the patients who underwent antireflux and paraesophageal hernia operations between Jan 2010 and Dec 2018 were collected from the Finnish national care register. RESULTS During the study period, 5734 operations were performed, and the mean age of the patients was 54.9 ± 14.7 years, with 59.3% (n = 3402) being women. Out of all operations, 341 (5.9%) were revision antireflux or paraesophageal hernia repair procedures. Antireflux surgery was the primary operation for 79.9% (n = 4384) of patients, and paraesophageal hernia repair was the primary operation for 20.1% (n = 1101) of patients. A total of 92.5% (5302) of all the operations were laparoscopic. From 2010 to 2020, 60 patient injury claims were identified, with half (50.0%) of the claims being related to paraesophageal hernia repair. One of the claims was made due to an injury that resulted in a patient's death (1.7%). The mean Comprehensive Complication Index scores were 35.9 (± 20.7) and 47.6 (± 20.8) (p = 0.033) for antireflux surgery and paraesophageal hernia repair, respectively. Eleven (18.3%) of the claims pertained to redo surgery. CONCLUSIONS The rate of antireflux surgery has diminished and the rate of paraesophageal hernia repair has risen in Finland during the era of minimally invasive surgery. Claims to the PIC remain rare, but claims regarding paraesophageal hernia repairs and redo surgery are overrepresented. Additionally, paraesophageal hernia repair is associated with more serious complications.
Collapse
Affiliation(s)
- Nelli M J Nurminen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Tommi K M Järvinen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ville J Kytö
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Silja A S Salo
- Gastrointestinal Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Caitlin E Egan
- Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
| | | | - Jari V Räsänen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| | - Ilkka K P Ilonen
- Department of General Thoracic and Esophageal Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland
| |
Collapse
|
6
|
Rodier S, Henning J, Kukreja J, Mohammedi T, Shah P, Damani T. Robotic Primary and Revisional Hiatal Hernia Repair is Safe and Associated with Favorable Perioperative Outcomes: A Single Institution Experience. J Laparoendosc Adv Surg Tech A 2023; 33:932-936. [PMID: 37417969 DOI: 10.1089/lap.2023.0218] [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: 07/08/2023] Open
Abstract
Background: Robotic hiatal hernia (HH) repair has been demonstrated to be feasible and safe. Recent conflicting reports have emerged on the higher incidence of perioperative complications with robotic HH repair when compared with laparoscopic repair. Materials and Methods: A retrospective review of a prospective database at an academic medical center for all robotic HH repairs performed by a high-volume foregut surgeon from 2018 to 2021 was performed. Outcome measures included operative time, estimated blood loss (EBL), length of stay (LOS), conversion rate, need for esophageal lengthening procedure, intra- and perioperative complications, and 30-day in-hospital mortality. Results: One hundred four patients were included in the analysis. Fifteen percent of patients had a type I HH, 2% had a type II, 73% had a type III, and 10% had a type IV HH. Eighty-four percent of cases were primary and 16% were revisional. Fifty-four percent of patients had mesh placed and 4.4% had an esophageal lengthening procedure. Mean EBL was 15 mL and mean operative time was 151 minutes. Median LOS was 2 days (interquartile range 1-2 days). There were zero conversions. Intraoperative complication rate was 1% and 30-day complication rate was 4%. The 30-day in-hospital mortality was zero. Conclusion: In this retrospective analysis of 114 consecutive robotic HH repairs performed, with 83% type III or IV HHs and 16% revisional hiatal cases, our results demonstrate favorable perioperative outcomes, with lower EBL, shorter LOS, lower complication rate, zero conversions, and comparable operative times compared with historical laparoscopic data.
Collapse
Affiliation(s)
- Simon Rodier
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Justin Henning
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Janvi Kukreja
- Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA
| | - Taher Mohammedi
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Paresh Shah
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Tanuja Damani
- Department of Surgery, NYU Langone Health, New York, New York, USA
| |
Collapse
|
7
|
Harada H, Hayami M, Makuuchi R, Ida S, Kumagai K, Ohashi M, Nunobe S. A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers. Langenbecks Arch Surg 2023; 408:159. [PMID: 37093285 DOI: 10.1007/s00423-023-02901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE In laparoscopic surgery for upper gastric and esophagogastric junction (EGJ) cancer, it is important to achieve optimal exposure of the esophageal hiatus to secure an appropriate workspace. In recent years, hepatic left lateral segment (HLLS) inversion has been used to achieve an optimal surgical field. We present a simple technique to perform a modified HLLS inversion. METHODS As a simple modified method, suturing a 2-0 straight needle to the peritoneum of the round ligament and pulling it to the outside of the abdominal cavity, the falciform, left triangular, and coronary ligaments were dissected. The HLLS was inverted by moving it to the right through the space of the transected falciform ligament. By ligating the thread through the round ligament, the HLLS was sandwiched between the rest of the liver and abdominal wall. The short-term surgical outcomes of patient who underwent simple modified HLLS inversion were retrospectively reviewed. RESULTS This study investigated consecutive 24 patients who underwent laparoscopic proximal and total gastrectomies using the simple modified HLLS inversion technique between June 2021 and April 2022. This series of procedures could be completed in approximately 16 min. A Nathanson liver retractor was used in three patients due to difficulties in completing the HLLS inversion in our institution. Postoperative serum liver enzyme levels indicated there was a small effect on the liver. CONCLUSIONS The simple modified HLLS inversion technique may be a safe and useful procedure and can provide an enhanced surgical field during laparoscopic surgery for upper gastric and EGJ cancers.
Collapse
Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| |
Collapse
|
8
|
Ceron REC, Yates RB, Wright AS, Rodriguez HA, Lopez RG, Pellegrini CA, Oelschlager BK. Type II hiatal hernias: do they exist or are they actually parahiatal hernias? Surg Endosc 2023; 37:1956-1961. [PMID: 36261642 DOI: 10.1007/s00464-022-09641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Type II hiatal hernias (HH) are characterized by a portion of the gastric fundus located above the esophageal hiatus adjacent to the esophagus while the gastroesophageal junction (GEJ) remains fixed below the esophageal hiatus. This type of HH has been called the "true" paraesophageal hernia (PEH) because the fundus appears to the side of the esophagus. In our experience, Type II HHs are occasionally identified on radiographic testing, however they are rarely, if ever, confirmed intraoperatively. This led to our question: Does Type II HH exist? METHODS We searched for evidence of type II HH in three locations: 1. Retrospective review of all first-time PEH repairs (excluding Type I HHs and re-operative cases) performed at the University of Washington Medical Center from 1994 to 2021; 2. Operative videos available on YouTube and WebSurg websites; and 3. Abstracts from the SAGES annual meetings from 2005 to 2021. RESULTS We found no evidence of Type II HH in any of our three searches. We performed 846 PEH repairs: 760 Type III, 75 Type IV, and 11 parahiatal. Upon website video review, we found only one possible type II hernia, though it too was likely a para-hiatal hernia. No video or case presentations of a type II HH were identified within SAGES annual meeting abstracts. CONCLUSION Type II HHs do not exist as they are currently defined. Although uncommon, parahiatal hernia can easily be misinterpreted as Type II HH. We should consider changing the hiatal hernia classification system to prevent ongoing clinical confusion.
Collapse
Affiliation(s)
- Rocio E Carrera Ceron
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA
| | - Robert B Yates
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA
| | - Andrew S Wright
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA
| | | | - Rebecca G Lopez
- Department of Surgery, Piedmont Atlanta Hospital, Atlanta, GA, USA
| | - Carlos A Pellegrini
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA
| | - Brant K Oelschlager
- Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA, 98195, USA.
| |
Collapse
|
9
|
Fadaee N, Gaszynski R, Merrett N, Gray A. Laparoscopic fundoplication performed in community hospital settings: A protocol for systematic review. Medicine (Baltimore) 2023; 102:e32502. [PMID: 36607888 PMCID: PMC9829280 DOI: 10.1097/md.0000000000032502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the institution type providing care. This review aimed to address this knowledge gap by reviewing the available evidence examining patient-reported outcomes of LF in non-metropolitan centers. OBJECTIVES To investigate patient-reported outcomes of LF performed in regional or community-based hospitals. DATA SOURCES Four electronic databases, and citations of relevant articles. STUDY ELIGIBILITY CRITERIA Only studies that separately reported patient-reported outcomes of LF performed in regional or community hospitals were included; papers deemed to be unclear about the type of facility in which LF surgeries were performed, or in which data from LF surgeries performed in regional/community hospitals was combined with data from major metropolitan hospitals, were excluded. STUDY APPRAISAL Only studies that were graded as fair or good using Quality Assessment Tool for Observational Cohort and Cross-sectional studies were eligible for inclusion in this review. Seven studies were then eligible for inclusion, all of which were observational cohort studies with 6 of the studies reporting on a single intervention arm. RESULTS Seven observational cohort studies were included in the review, with a combined total of 1071 patients who underwent LF at non-metropolitan centers. Of these, data was collected for 742 patients, yielding an overall response rate of 69.3%. All 7 studies assessed patients' post-operative outcomes through questionnaires that were based on a modified Likert scale or a similar tool. Overall patient satisfaction was high (86%) and a significant majority of patients stated they would recommend the procedure to others (93.3%). Post-operative prevalence of reflux and dysphagia compared favorably to rates generally reported in the literature (11.9% and 17.6% respectively). Further research is required to ascertain the safety of performing these procedures in non-metropolitan hospitals. CONCLUSION Current evidence suggests that patient-reported outcomes are favorable for patients undergoing LF in community settings, and are broadly comparable to those undergoing LF in tertiary-level centers.
Collapse
Affiliation(s)
- Neesa Fadaee
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Rafael Gaszynski
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Neil Merrett
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Andrew Gray
- Department of Upper GI & HPB Surgery, Monash Medical Centre, Clayton, VIC, Australia
- * Correspondence: Andrew Gray, Department of Upper GI & HPB Surgery, Monash Medical Centre, Clayton, VIC, Australia (e-mail: )
| |
Collapse
|
10
|
Wakabayashi M, Kobori S, Aoki K, Yoshida H, Minoshima K, Kimura T, Domoto Y, Hosaka M, Ushiku H, Funatsu K, Aisaki K. Postoperative diaphragmatic hernia with upside-down stomach: a case report. J Int Med Res 2022; 50:3000605221115158. [PMID: 35915581 PMCID: PMC9350504 DOI: 10.1177/03000605221115158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 31-year-old man presented to our hospital’s Emergency Department with sudden epigastric
pain and vomiting. He had undergone endoscopic resection via the retroperitoneal route for
a retroperitoneal tumor located in the left diaphragmatic crus of the esophageal hiatus at
another hospital 8 months previously. Radiography and computed tomography showed inversion
of the stomach beyond the diaphragm into the thoracic cavity, with the gastroesophageal
junction serving as the fulcrum point. This finding led to a diagnosis of postoperative
diaphragmatic hernia accompanied by an upside-down stomach (UDS). The prolapsed stomach in
the thoracic cavity was reduced to the abdominal cavity using laparoscopic surgery. The
postoperative course was favorable, and the patient was discharged from the hospital on
postoperative day 7. No recurrence has been observed in the past 5 years. The pathological
condition of a UDS observed in esophageal hiatal hernias may be found in postoperative
diaphragmatic hernias. Laparoscopic surgery for a postoperative diaphragmatic hernia with
a UDS is considered a useful surgical procedure. Laparoscopic surgery can simultaneously
confirm the viability of the herniated organs, reduce the organs to the abdominal cavity,
and close and reinforce the diaphragm.
Collapse
Affiliation(s)
- Masakazu Wakabayashi
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Shuichi Kobori
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kana Aoki
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Hayato Yoshida
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kou Minoshima
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Tomohiro Kimura
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Yoshinori Domoto
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Miki Hosaka
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Hideki Ushiku
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kentarou Funatsu
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| | - Kazuo Aisaki
- Department of Surgery, Sagamihara Kyodo Hospital, 4-3-1 Hashimotodai, Midori-ku, Sagamihara-shi, Kanagawa 252-5188, Japan
| |
Collapse
|
11
|
Braghetto I, Molina JC, Korn O, Lanzarini E, Musleh M, Figueroa M, Rojas J. Observational medical treatment or surgery for giant paraesophageal hiatal hernia in elderly patients. Dis Esophagus 2022; 35:6604852. [PMID: 35687053 DOI: 10.1093/dote/doac030] [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: 01/10/2022] [Revised: 04/30/2022] [Indexed: 12/11/2022]
Abstract
Giant paraesophageal hernias (GPHH) occur frequently in the elderly and account for about 5-10% of all hiatal hernias. Up to now controversy persists between expected medical treatment and surgical treatment. To assess if an indication for surgical repair of GPHH is possible in elderly patients. A prospective study that includes patients over 70 years of age hospitalized from January 2015 to December 2019 with GPHH. Patients were separated into Group A and Group B. Group A consisted of a cohort of 23 patients in whom observation and medical treatment were performed. Group B consisted of 44 patients submitted to elective laparoscopic hiatal hernia repair. Symptomatic patients were observed in both groups (20/23 in Group A and 38/44 in Group B). Charlson's score >6 and ASA II or III were more frequent in Group A. Patients in Group A presented symptoms many years before their hospitalization in comparison to Group B (21.8+7.8 vs. 6.2+3.5 years, respectively) (P=0.0001). Emergency hospitalization was observed exclusively in Group A. Acute complications were frequently observed and hospital stays were significantly longer in Group A, 14 patients were subjected to medical management and 6 to emergency surgery. In-hospital mortality occurred in 13/20 patients (65%) versus 1/38 patients (2.6%) in Group B (P=0.0001). Laparoscopic paraesophageal hiatal hernia repair can be done safely, effectively, and in a timely manner in elderly patients at specialized surgical teams. Advanced age alone should not be a limiting factor for the repair of paraesophageal hernias.
Collapse
Affiliation(s)
- Italo Braghetto
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Juan Carlos Molina
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Owen Korn
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Enrique Lanzarini
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Maher Musleh
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Manuel Figueroa
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| | - Jorge Rojas
- Department of Surgery, University of Chile, Hospital "Dr. José J. Aguirre" Faculty of Medicine, Santos Dumont 999, Santiago 3830000, Chile
| |
Collapse
|
12
|
Pontula A, Hartwig MG. Commentary: Are we wrapping up the debate on repair of giant paraesophageal hernia? JTCVS Tech 2021; 10:505-506. [PMID: 34977795 PMCID: PMC8691764 DOI: 10.1016/j.xjtc.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 08/21/2021] [Accepted: 08/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arya Pontula
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Matthew G. Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| |
Collapse
|
13
|
Alicuben ET, Luketich JD, Levy RM. Laparoscopic repair of giant paraesophageal hernia. JTCVS Tech 2021; 10:497-502. [PMID: 34977793 PMCID: PMC8691125 DOI: 10.1016/j.xjtc.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/02/2021] [Accepted: 04/23/2021] [Indexed: 10/29/2022] Open
|
14
|
Raja S. Commentary: Building a better mouse trap: Refining the minimally invasive giant paraesophageal hernia repair. JTCVS Tech 2021; 10:503-504. [PMID: 34977794 PMCID: PMC8691727 DOI: 10.1016/j.xjtc.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
15
|
Anshuman P, Om T, Tamonas C, Shashi K. Concomitant Paraesophageal Parahiatal Hernia: a Rare Entity. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02644-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
16
|
Van Den Dop LM, De Smet GHJ, Mamound A, Lange J, Wijnhoven BPL, Hueting W. Use of Polypropylene Strips for Reinforcement of the Cruroplasty in Laparoscopic Paraesophageal Hernia Repair: A Retrospective Cohort Study. Dig Surg 2021; 38:290-299. [PMID: 34350869 DOI: 10.1159/000518182] [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: 02/26/2021] [Accepted: 06/24/2021] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Laparoscopic paraesophageal hernia repair is an effective treatment for symptomatic paraesophageal hernias. To reduce recurrence rates, the use of prosthetics for the crural repair has been suggested. Mesh-related complications are rare but known to be disastrous. To address another form of crural repair, polypropylene strips are suggested. This study aimed to assess peri- and postoperative complications of reinforcement of cruroplasty with polypropylene strips. METHODS From 2013 to 2020, patients with a primary or recurrent type 2, 3, or 4 paraesophageal hernia that underwent cruroplasty with polypropylene strips were retrospectively reviewed. Intra- and postoperative complications were graded according to the Clavien-Dindo classification. The incidence of symptomatic recurrent hiatal hernia (CT or endoscopy proven) and hospital stay were assessed. RESULTS One hundred fifty-eight patients were included. Mean age was 65 years (standard deviation 10.4), and 119 patients were female (75.3%). Almost 50% of surgeries took place between 2018 and 2020. Median follow-up was 7 months (interquartile range 17.5). Mean operation time in the primary hernia group was 159 min (standard deviation 39.0), and length of stay was 4.4 days. In 3/158 patients (2.0%), intraoperative complications occurred. Two patients developed a grade 4 and seven patients a grade 3 postoperative complication. No mortality was recorded. Twelve recurrences (8.2%) were detected in the primary hernia group and one (9.1%) in the recurrent hernia group. CONCLUSION There were no mesh-related complications seen and symptomatic recurrence rate was low, but longer follow-up is needed.
Collapse
Affiliation(s)
| | - Gijs H J De Smet
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Aziz Mamound
- Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
| | - Johan Lange
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Willem Hueting
- Department of Surgery, Alrijne Ziekenhuis, Leiderdop, The Netherlands
| |
Collapse
|
17
|
Khalil H, Parmar C, Sufi P. Conservative Managing of Bezoar in Giant Hiatus Hernia Causing Gastric Outlet Obstruction During the COVID-19 Pandemic. Obes Surg 2021; 31:2780-2782. [PMID: 33580395 PMCID: PMC7880517 DOI: 10.1007/s11695-021-05250-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 11/09/2022]
|
18
|
Bruenderman EH, Martin RCG, Kehdy FJ. Outcomes after Laparoscopic Gastropexy as an Alternative for Paraesophageal Hernia Repair. JSLS 2021; 24:JSLS.2020.00059. [PMID: 33293783 PMCID: PMC7688338 DOI: 10.4293/jsls.2020.00059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Outcomes after laparoscopic gastropexy (LG), performed as an alternative to formal paraesophageal hernia (PEH) repair in patients with giant PEH, have been rarely studied. This manuscript evaluates complications and long-term quality-of-life after LG. Methods: An IRB-approved protocol was used to identify patients who underwent LG to alleviate symptoms of acute or chronic gastric obstruction secondary to a paraesophageal hernia. Postoperative outcomes and quality-of-life data were retrospectively collected via chart review and prospectively via phone interview. Results: Twenty-six patients underwent LG, with a median age of 76 (52 – 91). Median follow-up was 28 (3 to 55) months. Gastropexy was the chosen intervention due to comorbid conditions (23, 88%), gastric inflammation (2, 8%), or intraoperative instability (1, 4%). Nine (35%) suffered postoperative complications, and 2 (8%) required reoperation. At the time of follow-up, 7 (27%) had died, 3 (11%) could not be reached. Sixteen (62%) completed the follow-up survey. Fourteen (88%) reported symptom resolution. Ten (62%) still required antireflux medication. Median Gastroesophageal Reflux Disease-Health Related Quality of Life score was 4.5 (0 to 19). Fourteen (88%) denied current dietary restrictions. All reported satisfaction with the operation. Conclusion: Laparoscopic PEH repair remains the standard of care for the management of giant PEH. However, a subcategory of patients with high operative risk could be candidates for a shorter operative intervention. As our data infers, LG is a reasonable alternative in this patient population. While the continued use of antisecretory medications is sometimes required, LG restores the ability to tolerate full meals without restrictions and results in excellent patient satisfaction.
Collapse
Affiliation(s)
| | | | - Farid J Kehdy
- Department of Surgery, University of Louisville, Louisville, KY
| |
Collapse
|
19
|
Adhikari S, Raja S. Commentary: A century of giant paraesophageal hernia (GPEH) repair: A century of controversy! JTCVS Tech 2020; 3:373-374. [PMID: 34317935 PMCID: PMC8305720 DOI: 10.1016/j.xjtc.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Saurav Adhikari
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Siva Raja
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
20
|
Hietaniemi H, Ilonen I, Järvinen T, Kauppi J, Andersson S, Sintonen H, Räsänen J. Health-related quality of life after laparoscopic repair of giant paraesophageal hernia: how does recurrence in CT scan compare to clinical success? BMC Surg 2020; 20:109. [PMID: 32434571 PMCID: PMC7238581 DOI: 10.1186/s12893-020-00772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life. Methods All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life. Results The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%). Conclusions Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.
Collapse
Affiliation(s)
- Henriikka Hietaniemi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland. .,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland.
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Tommi Järvinen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Saana Andersson
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| |
Collapse
|
21
|
Salfity H, Hartwig MG. The Robotic Method of Repairing Dysphagia. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:225-228. [PMID: 32412319 DOI: 10.1177/1556984520921957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hai Salfity
- 3065 Department of Surgery, Division of Cardiothoracic Surgery, Duke University Hospital, Durham, NC, USA
| | - Matthew G Hartwig
- 3065 Department of Surgery, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
22
|
Kamarajah SK, Boyle C, Navidi M, Phillips AW. Critical appraisal of the impact of surgical repair of type II-IV paraoesophageal hernia (POH) on pulmonary improvement: A systematic review and meta-analysis. Surgeon 2020; 18:365-374. [PMID: 32046901 DOI: 10.1016/j.surge.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/30/2019] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Paraoesophageal hernia (POH) comprising type II-IV hiatal hernia often presents with pulmonary symptoms such as shortness of breath. However, impact of surgical repair on improvement in pulmonary symptoms is unclear. OBJECTIVE This systematic review and meta-analysis aimed at characterising impact of POH repair on patient reported improvement in pulmonary symptoms. METHODS This systematic review identified studies reported pulmonary symptoms in patients with undergoing surgical repair for Type II-IV POH from 1st January 2001 to 1st December 2018. Primary outcome was improvement in pulmonary symptoms. Secondary outcomes were improvement in other patient-reported outcomes such as heartburn, regurgitation, chest pain, and dysphagia and intraoperative and postoperative outcomes. RESULTS This systematic review identified 27 studies (n = 4428 patients) reporting assessment of pulmonary symptoms. However, only 21 studies (n = 2902 patients) reported preoperative and postoperative pulmonary symptoms and hence these were included in the final meta-analysis. There was significant improvement in pulmonary symptoms following POH repair (OR: 8.40, CI95%: 4.91-14.35, p < 0.001), with improvement in all types of POH. Rates of overall and major complications were 16% and 5%, respectively. Rates of conversion, 30-day mortality, reoperation and recurrence were 2%, 1% 4% and 12% respectively. CONCLUSION This review demonstrates that POH repair is associated with improvement in pulmonary symptoms with acceptable low laparoscopic conversion rates, morbidity, mortality and recurrence rates.
Collapse
Affiliation(s)
- Sivesh K Kamarajah
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK; Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Charlie Boyle
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK
| | - Maziar Navidi
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK
| | - Alexander W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University NHS Foundation Trust Hospitals, Newcastle Upon Tyne, UK.
| |
Collapse
|
23
|
|
24
|
Abstract
The transthoracic approach to PEH repair has been displaced by the laparoscopic methods of repair for valuable reasons. Despite the pressures of performing minimally invasive surgery, the experienced esophageal surgeon will appreciate the benefits of the transthoracic repair in select circumstances as outlined in this article. In this writing, we discussed our indications, the salient anatomy and important steps in performing a successful transthoracic PEH repair.
Collapse
|
25
|
Abstract
The introduction of minimally invasive techniques to the field of foregut surgery has revolutionized the surgical approach to giant paraesophageal hernia repair. Laparoscopy has become the standard approach in patients with giant paraesophageal hernia because it has been shown to be safe and is associated with lower morbidity and mortality when compared with various open approaches. Specifically, it has been associated with decreased intraoperative blood loss, decreased complications, and reduced hospital length of stay. This is despite a rise in comorbid conditions associated with this patient population. This article describes our operative approach to laparoscopic giant paraesophageal hernia repair.
Collapse
|
26
|
Abstract
A hiatus hernia is defined as a transdiaphragmatic protrusion/migration of the intrabdominal contents through the esophageal hiatus of the diaphragm. The classification of hiatus hernias is based on anatomical morphological differentiation (types I-IV). The leading symptoms and psychological stress vary with respect to the symptoms, e. g. reflux and compression symptoms. Gastroscopy and multichannel intraluminal impedance pH measurement are obligatory preoperative functional diagnostics. A distinction is made between frequent type I hernia (antireflux surgery), symptomatic paraesophageal, thoracic and mixed hernia types (II-IV). Surgical indications exist in symptomatic type II-IV hernias. Hiatal mesh augmentation reduces recurrences. The complication potential of synthetic meshes must be taken into account. Biological implants show no advantages.
Collapse
|
27
|
Chernousov AF, Khorobrykh TV, Vetshev FP, Osminin SV, Korotkiy VI, Abdulkhakkimov NM, Chesarev AA, Salikhov R. [Treatment of reflux esophagitis in patients with cardiofundal, subtotal and total hiatal hernias]. Khirurgiia (Mosk) 2019:41-48. [PMID: 31317940 DOI: 10.17116/hirurgia201906141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM To analyze treatment of patients with reflux esophagitis and large hiatal hernia. MATERIAL AND METHODS There were 85 patients with reflux esophagitis and large hiatal hernia. Laparoscopic repair was performed in 33 patients, laparotomy - in 52 cases. All patients underwent fundo- or gastroplication by A.F. Chernousov, correction of large defect of hiatal orifice by cruroraphy was applied in 55 (64.7%) patients. RESULTS Postoperative morbidity was near 10% after laparoscopic and conventional surgery despite more difficult video-assisted endoscopic technique. Complications Clavien-Dindo grade I-II were noted in 4 (12.1%) patients after laparoscopic treatment and in 6 (11.5%) patients after laparotomy. Medication was effective in all cases. Two patients with subtotal hernias had complications Clavien-Dindo grade IIIB after endoscopic surgery: recurrent hiatal hernia followed by severe reflux esophagitis and dysphagia. These complications required redo surgery. Repair of hiatal orifice is always possible without mesh reinforcement. Posterior cruroraphy is feasible and effective in all patients. Incidence of intraoperative and postoperative complications is comparable in both approaches (p<0.05). Mean hospital-stay after laparotomy was 7.3 days, after laparoscopy - 5.8 days. CONCLUSION Endoscopic formation of antireflux cuff by A.F. Chernousov is appropriate and effective in patients with reflux esophagitis and large/giant hiatal hernias.
Collapse
Affiliation(s)
- A F Chernousov
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - T V Khorobrykh
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - F P Vetshev
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - S V Osminin
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - V I Korotkiy
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - N M Abdulkhakkimov
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - A A Chesarev
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| | - R Salikhov
- Chair of Faculty-Based Surgery #1, Sechenov First Moscow State Medical University of Ministry of Health of the Russian Federation, Moscow, Russia, Burdenko Clinic of Faculty-Based Surgery, Moscow, Russia
| |
Collapse
|
28
|
Abnormal High-Resolution Manometry Findings and Outcomes after Paraesophageal Hernia Repair. J Am Coll Surg 2018; 227:181-188.e2. [PMID: 29605727 DOI: 10.1016/j.jamcollsurg.2018.03.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Abnormal esophageal peristalsis diagnosed by high-resolution manometry is frequently found as part of the preoperative evaluation of patients with paraesophageal hernia (PEH). Currently, the clinical relevance of these findings is largely unknown. STUDY DESIGN From 2013 to 2016, two hundred and twelve patients undergoing PEH repair were prospectively recorded in an IRB-approved database. Preoperative high-resolution manometry was available for reanalysis according to the latest Chicago Classification (version 3.0) in 200 patients. Outcomes in patients with abnormal motility (AM) were compared with patients with normal motility (NM). RESULTS Abnormal motility was documented in 106 (53%) patients. Abnormal motility was associated with older age (72 vs 69 years) and increased age-adjusted Charlson Comorbidity Index (both, p = 0.04). Compared with preoperative symptoms, postoperative retrosternal pain in AM vs NM patients went from 79% to 5% vs 75% to 2%, regurgitation from 52% to 2% vs 59% to 0%, and dysphagia from 56% to 7% vs 67% to 7%. An esophagogram was performed at a median of 4 months and 3.5 months postoperatively. Postoperative reflux in AM vs NM went from 54% to 21% vs 57% to 16%, and abnormal esophageal motility, visually assessed during the esophagogram, was stable (52% to 56% vs 41% to 48% for AM vs NM, respectively). CONCLUSIONS Patients found to have AM according to the Chicago classification before surgical repair of PEH demonstrated similar symptomatic improvement compared with patients with NM. Selective motility disorders diagnosed by preoperative high-resolution manometry should not preclude surgical repair of giant PEHs.
Collapse
|
29
|
Wickramasinghe S, Ruggiero B, Low L. Gastrothorax: A case of mistaken identity. Int J Surg Case Rep 2018; 44:66-69. [PMID: 29477923 PMCID: PMC5835008 DOI: 10.1016/j.ijscr.2018.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/13/2018] [Indexed: 11/18/2022] Open
Abstract
Patients with a recent history of anti-reflux surgery, who present with a tension pneumothorax could be presenting with a gastrothorax. They should always be treated with an intercostal catheter if they are in respiratory distress. Follow up imaging with a CT scan is needed to confirm diagnosis. Gastrothorax should be urgently managed with the insertion of a nasogastric tube and surgical decompression. Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications.
Introduction Acute wrap failure post fundoplication is a rare but recognized complication and can be due to patient factors, disease factors and surgical factors. Herniation of the stomach into the thorax can mimic a pneumothorax clinically and radiologically and thus lead to bad outcomes for patients. Presentation of case We report the case of a 20-year-old male who presented to the emergency department with progressively worsening upper abdominal pain, nausea and vomiting followed by acute onset dyspnoea, six days post a laparoscopic repair of a small hiatus hernia and a Nissen fundoplication. His chest x-ray was consistent with that of a left sided pneumothorax and was therefore, appropriately resuscitated and treated with an intercostal catheter (ICC). A subsequent CT scan of the chest revealed a left gastrothorax. The patient was taken to theatre for the surgical reduction of the paraoesophageal hernia. Discussion Patients with a recent history of anti-reflux surgery, who present with a pneumothorax and respiratory distress or a tension pneumothorax should always be treated with an ICC. However, follow up imaging with a CT scan is essential to confirm diagnosis. Good control of post- operative nausea and vomiting is essential in avoiding wrap failure and ensuing complications. Conclusion A high index of suspicion for a gastrothorax mimicking a pneumothorax is important in the setting of recent anti-reflux surgery.
Collapse
Affiliation(s)
- Shehan Wickramasinghe
- Upper Gastrointestinal and Hepatobiliary Surgical Unit, Monash Health, 246 Clayton Road, Victoria 3168, Australia.
| | - Boris Ruggiero
- Upper Gastrointestinal and Hepatobiliary Surgical Unit, Monash Health, 246 Clayton Road, Victoria 3168, Australia
| | - Liang Low
- Upper Gastrointestinal and Hepatobiliary Surgical Unit, Monash Health, 246 Clayton Road, Victoria 3168, Australia
| |
Collapse
|
30
|
Banki F. Short esophagus is a disease of the past and the prevention of recurrent hiatal hernia is the challenge of the future. J Thorac Cardiovasc Surg 2018; 155:1345-1347. [PMID: 29452479 DOI: 10.1016/j.jtcvs.2017.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Farzaneh Banki
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston (UTHealth) Memorial Hermann Southeast Esophageal Disease Center, Houston, Tex
| |
Collapse
|
31
|
Susmallian S, Raziel A. A Rare Case of Bochdalek Hernia with Concomitant Para-Esophageal Hernia, Repaired Laparoscopically in an Octogenarian. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:1261-1265. [PMID: 29184050 PMCID: PMC5716375 DOI: 10.12659/ajcr.906225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient: Male, 81 Final Diagnosis: Bochdalex hernia Symptoms: Chest pain • vomiting Medication: — Clinical Procedure: Laparoscopic repair of both diaphragmatic hernias Specialty: Surgery
Collapse
|
32
|
Rendón-Medina MA, Ávalos-Abreu RO, Saucedo-Saldivar J, Sánchez-Tellez E, Garcia-Puig M. Laparoscopic treatment in Type IV Giant Paraesophagic Hernia and intestinal occlusion a case report. Int J Surg Case Rep 2017; 44:98-102. [PMID: 29486398 PMCID: PMC5856679 DOI: 10.1016/j.ijscr.2017.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A Giant Hiatal Paraesophageal Hernia (GPEH) is a Hiatal Hernia (HH) that includes more than 30% of the stomach in the thorax. The gold standard form of repair today is the laparoscopic abdominal approach in elective scenarios. Laparoscopic HH repair advantages include, less postoperative pain, small incisions, reduced postoperative respiratory complications are reduced, shorter hospital stay. The objective of this paper is to describe a patient undergoing with upper intestinal obstruction and a GPEH Type IV, approached laparoscopically. CASE PRESENTATION We received a female patient 59 years old, she came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH. We decided to realize the procedure laparoscopically. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain. DISCUSSION We present a GPEH case associated with upper intestinal obstruction, with clinical findings that suggested ischemia. The approach of the treatment was abdominal laparoscopy. CONCLUSION In elective patients Laparoscopy is superior than abdominal approach. Randomized trials comparing laparoscopic versus open approach are needed to conclude that laparoscopic approach is superior to open approach, in potentially GPEH complicated patients.
Collapse
Affiliation(s)
- Marco Aurelio Rendón-Medina
- General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico.
| | - Rodolfo Omar Ávalos-Abreu
- General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico
| | - Jocelyn Saucedo-Saldivar
- General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico
| | - Erick Sánchez-Tellez
- General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico
| | - Marco Garcia-Puig
- General Surgery Service, General Hospital of Mexico "Dr. Eduardo Liceaga", Dr. Balmiis No. 148, Col. Doctores del. Cauhtemoc, C.P. 06720, Mexico City, Mexico
| |
Collapse
|
33
|
El Lakis MA, Kaplan SJ, Hubka M, Mohiuddin K, Low DE. The Importance of Age on Short-Term Outcomes Associated With Repair of Giant Paraesophageal Hernias. Ann Thorac Surg 2017; 103:1700-1709. [DOI: 10.1016/j.athoracsur.2017.01.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 12/12/2022]
|
34
|
Stringham JR, Phillips JV, McMurry TL, Lambert DL, Jones DR, Isbell JM, Lau CL, Kozower BD. Prospective study of giant paraesophageal hernia repair with 1-year follow-up. J Thorac Cardiovasc Surg 2017; 154:743-751. [PMID: 28502624 DOI: 10.1016/j.jtcvs.2017.03.138] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 02/13/2017] [Accepted: 03/06/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Evaluating giant paraesophageal hernia (GPEH) repair requires long-term follow-up. GPEH repair can have associated high recurrence rates, yet this incidence depends on how recurrence is defined. Our objective was to prospectively evaluate patients undergoing GPEH repair with 1-year follow-up. METHODS Patients undergoing elective GPEH repair between 2011 and 2014 were enrolled prospectively. Postoperatively, patients were evaluated at 1 month and 1 year. Radiographic recurrence was evaluated by barium swallow and defined as a gastroesophageal junction located above the hiatus. Quality of life was evaluated pre- and postoperatively with the use of a validated questionnaire. RESULTS One-hundred six patients were enrolled. The majority of GPEH repairs were performed laparoscopically (80.2%), and 7.5% were redo repairs. At 1-year follow-up, 63.4% of patients were symptom free, and radiographic recurrence was 32.7%. Recurrence rate was 18.8% with standard definition (>2 cm of stomach above the diaphragm). Quality of life scores at 1 year were significantly better after operative repair, even in patients with radiographic recurrence (7.0 vs 22.5 all patients, 13.0 vs 22.5 with recurrence; P < .001). Patients with small radiographic recurrences have similar satisfaction and symptom severity to patients with >2 cm recurrences. CONCLUSIONS GPEH repair can be performed with low operative mortality and morbidity. The rate of recurrence at 1 year depends on the definition used. Patient satisfaction and symptom severity are similar between patients with radiographic and greater than 2 cm hernia recurrences. Longer follow-up and critical assessment of our results are needed to understand the true impact of this procedure and better inform perioperative decision making.
Collapse
Affiliation(s)
- John R Stringham
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va
| | - Jennifer V Phillips
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va
| | - Timothy L McMurry
- Division of Public Health Sciences, University of Virginia Health Sciences Center, Charlottesville, Va
| | - Drew L Lambert
- Department of Radiology, University of Virginia Health Sciences Center, Charlottesville, Va
| | - David R Jones
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christine L Lau
- Division of Thoracic and Cardiovascular Surgery, University of Virginia Health Sciences Center, Charlottesville, Va
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo.
| |
Collapse
|
35
|
Repair of symptomatic paraesophageal hernias in elderly (>70 years) patients results in sustained quality of life at 5 years and beyond. Surg Endosc 2017; 31:3979-3984. [DOI: 10.1007/s00464-017-5432-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/20/2017] [Indexed: 01/01/2023]
|
36
|
Nomura T, Iwakiri K, Matsutani T, Hagiwara N, Fujita I, Nakamura Y, Kanazawa Y, Makino H, Kawami N, Miyashita M, Uchida E. Characteristics and Outcomes of Laparoscopic Surgery in Patients with Gastroesophageal Reflux and Related Disease: A Single Center Experience. J NIPPON MED SCH 2017; 84:25-31. [PMID: 28331141 DOI: 10.1272/jnms.84.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Laparoscopic anti-reflux surgery (LARS) is generally the treatment of choice for patients with gastroesophageal reflux disease (GERD). This report describes our experiences in performing LARS on patients with GERD, and focuses retrospectively on the pathophysiology of individual patients and the current status of Japanese patients who have undergone LARS. We demonstrate that patients with non-erosive reflux disease resistant to proton pump inhibitors (PPI-resistant NERD) and high-risk giant hernia, whom we are sometimes hesitant to treat surgically, can be safely and successfully treated with LARS (depending on the pathophysiology of individual patients). METHODS Between January 2007 and June 2015, 37 patients underwent LARS at Nippon Medical School Hospital. These patients were retrospectively subgrouped according to pathophysiology; 9 of them had PPI-resistant NERD (Group A), 19 had a giant hiatal hernia (Group B), and 9 had erosive esophagitis (Group N). Patient characteristics, intraoperative bleeding, operation duration, perioperative complications, and length of hospital stay were determined, along with symptomatic outcomes and patient satisfaction. RESULTS Patients in Group A were the youngest (average: 43.9 years), and those in Group B were the oldest (75.9 years) (P=0.002). The percentage of high-risk patients, as determined by performance status (P=0.047) and American Society of Anesthesiologists physical status classification (P=0.021), was highest in Group B, whereas the percentage of patients with mental disorders was highest in Group A (P=0.012). There were no significant differences among the groups in terms of intraoperative bleeding, surgery duration, or postoperative hospital stay. Thirty-three patients (89.2%), including all 19 in Group B, expressed excellent or good postoperative satisfaction levels. CONCLUSIONS The characteristics of the patients who underwent LARS at our hospital differed according to pathophysiology and from those in western countries. Satisfactory outcomes depended on the pathophysiology of individual patients.
Collapse
Affiliation(s)
- Tsutomu Nomura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Andolfi C, Jalilvand A, Plana A, Fisichella PM. Surgical Treatment of Paraesophageal Hernias: A Review. J Laparoendosc Adv Surg Tech A 2016; 26:778-783. [PMID: 27398823 PMCID: PMC6445204 DOI: 10.1089/lap.2016.0332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The management of paraesophageal hernia (PEH) can be challenging due to the lack of consensus regarding indications and principles of operative treatment. In addition, data about the pathophysiology of the hernias are scant. Therefore, the goal of this review is to shed light and describe the classification, pathophysiology, clinical presentation, and indications for treatment of PEHs, and provide an overview of the surgical management and a description of the technical principles of the repair.
Collapse
Affiliation(s)
- Ciro Andolfi
- Department of Surgery, University of Chicago, Chicago, Illinois
| | | | - Alejandro Plana
- Department of Surgery, University of Chicago, Chicago, Illinois
| | | |
Collapse
|
38
|
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.
Collapse
|
39
|
Laparoscopic paraesophageal hernia repair is safe in elderly patients. Surg Endosc 2016; 31:1186-1191. [DOI: 10.1007/s00464-016-5089-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
|
40
|
Hashimi S, Bremner RM. Complications Following Surgery for Gastroesophageal Reflux Disease and Achalasia. Thorac Surg Clin 2016; 25:485-98. [PMID: 26515948 DOI: 10.1016/j.thorsurg.2015.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Surgical procedures to treat reflux disease are common, but good outcomes rely on both a thorough preoperative workup and careful surgical techniques. Although complications are uncommon, surgeons should recognize these and possess the skills to overcome them in clinical practice.
Collapse
Affiliation(s)
- Samad Hashimi
- Department of Thoracic Disease and Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ 85013, USA
| | - Ross M Bremner
- Department of Thoracic Disease and Transplantation, Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, 500 W. Thomas Road, Suite 500, Phoenix, AZ 85013, USA.
| |
Collapse
|
41
|
Galvani CA, Loebl H, Osuchukwu O, Samamé J, Apel ME, Ghaderi I. Robotic-Assisted Paraesophageal Hernia Repair: Initial Experience at a Single Institution. J Laparoendosc Adv Surg Tech A 2016; 26:290-5. [PMID: 27035739 DOI: 10.1089/lap.2016.0096] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. MATERIALS AND METHODS Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. RESULTS Sixty-one patients underwent RA-PEHR with mesh, 72% were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57% of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26%, III 64%, and IV 13%. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6% and 23%, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66%) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42% of patients and only 23% of patients were symptomatic. CONCLUSIONS This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.
Collapse
Affiliation(s)
- Carlos A Galvani
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| | - Hannah Loebl
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| | - Obiyo Osuchukwu
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| | - Julia Samamé
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| | - Matthew E Apel
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| | - Iman Ghaderi
- Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona
| |
Collapse
|
42
|
Hagiwara C, Yajima K, Iwasaki Y, Oohinata R, Yuu K, Ishiyama S, Amaki M, Nakano D, Yamaguchi T, Matsumoto H, Takahashi K. Totally laparoscopic gastrectomy for early gastric cancer accompanied by huge hiatal hernia: A case report. Asian J Endosc Surg 2016; 9:61-4. [PMID: 26781529 DOI: 10.1111/ases.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/25/2015] [Accepted: 07/12/2015] [Indexed: 12/26/2022]
Abstract
We herein present a case in which we used a totally laparoscopic approach for early gastric cancer accompanied by a huge hiatal hernia. An 80-year-old Japanese woman was referred with a chief complaint of dysphagia. A clinical diagnosis of early gastric cancer, T1b (SM) N0M0, stage IA, accompanied by hiatal hernia, was made. Distal gastrectomy with D1 plus lymphadenectomy was carried out. After the gastrectomy, the hernial sac was excised and the hernial orifice was closed. Reconstruction using the Roux-en-Y method was selected. The postoperative course was uneventful and she was discharged on postoperative day 10.
Collapse
Affiliation(s)
- Chie Hagiwara
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Kazuhito Yajima
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yoshiaki Iwasaki
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ryouki Oohinata
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Ken Yuu
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Satoshi Ishiyama
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Misato Amaki
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Daisuke Nakano
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Tatsuro Yamaguchi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Hiroshi Matsumoto
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| |
Collapse
|
43
|
Davis M, Rodriguez J, El-Hayek K, Brethauer S, Schauer P, Zelisko A, Chand B, O'Rourke C, Kroh M. Paraesophageal Hernia Repair With Partial Longitudinal Gastrectomy in Obese Patients. JSLS 2015; 19:e2015.00060. [PMID: 26508825 PMCID: PMC4591904 DOI: 10.4293/jsls.2015.00060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Treatment of gastroesophageal reflux disease (GERD) with hiatal hernia in obese patients has proven difficult, as studies demonstrate poor symptom control and high failure rates in this patient population. Recent data have shown that incorporating weight loss procedures into the treatment of reflux may improve overall outcomes. METHODS We retrospectively reviewed 28 obese and morbidly obese patients who presented from December 2007 through July 2013 with large or recurrent type 3 or 4 paraesophageal hernia. All of the patients underwent combined paraesophageal hernia repair and partial longitudinal gastrectomy. Charts were retrospectively reviewed, and the patients were contacted to determine symptomatic relief. RESULTS Mean preoperative body mass index was 38.1 ± 4.9 kg/m(2). Anatomic failure of prior fundoplication occurred in 7 patients (25%). The remaining 21 had primary paraesophageal hernia, 3 of which were type 4. Postoperative complications included pulmonary embolism (n = 1), pulmonary decompensation (n = 2), and wound infection (n = 1). Mean hospital stay was 5 ± 3 days. Upper gastrointestinal esophagogram was performed in 21 patients with no immediate recurrence or staple line dehiscence. Mean excess weight loss was 44 ± 25%. All of the patients surveyed experienced near to total resolution of their preoperative symptoms within the first month. At 1 year, symptom scores decreased significantly. At 27 months, however, there was a mild increase in the scores. Return of severe symptoms occurred in 2 patients, both of whom underwent conversion to gastric bypass. CONCLUSIONS Combined laparoscopic paraesophageal hernia repair with longitudinal partial gastrectomy offers a safe, feasible approach to the management of large or recurrent paraesophageal hernia in well-selected obese and morbidly obese patients. Short-term results were promising; however, intermediate results showed increasing rates of reflux symptoms that required medical therapy or conversion to gastric bypass.
Collapse
Affiliation(s)
| | | | | | | | - Philip Schauer
- Department of Surgery, Bariatric and Metabolic Institute
| | - Andrea Zelisko
- Department of General Surgery, Akron General Medical Center, Akron, Ohio
| | - Bipan Chand
- Division of GI/Minimally Invasive Surgery, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Colin O'Rourke
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Matthew Kroh
- Department of Surgery, Digestive Disease Institute
| |
Collapse
|
44
|
Feasibility, safety, and short-term efficacy of the laparoscopic Nissen-Hill hybrid repair. Surg Endosc 2015; 30:551-558. [PMID: 26065538 DOI: 10.1007/s00464-015-4238-2] [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: 02/04/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND A novel antireflux procedure combining laparoscopic Nissen fundoplication and Hill repair components was tested in 50 patients with paraesophageal hernia (PEH) and/or Barrett's esophagus (BE) because these two groups have been found to have a high rate of recurrence with conventional repairs. METHODS Patients with symptomatic PEH and/or non-dysplastic BE underwent repair. Quality of life (QOL) metrics, manometry, EGD, and pH testing were administered pre- and postoperatively. RESULTS Fifty patients underwent repair. There was no mortality and four major complications. At 13-month follow-up, there was one (2%) clinical recurrence, and two (4%) asymptomatic fundus herniations. Mean DeMeester scores improved from 57.2 to 7.7 (p < 0.0001). Control of preoperative symptoms was achieved in 90% with 6% resumption of antisecretory medication. All QOL metrics improved significantly. CONCLUSIONS The hybrid Nissen-Hill repair for patients with PEH and BE appears safe and clinically effective at short-term follow-up. It is hoped that the combined structural components may reduce the rate of recurrence compared to existing repairs.
Collapse
|
45
|
Bjelovic M, Babic T, Spica B, Gunjic D, Veselinovic M, Bascarevic V. The use of autologous fascia lata graft in the laparoscopic reinforcement of large hiatal defect: initial observations of the surgical technique. BMC Surg 2015; 15:22. [PMID: 25849293 PMCID: PMC4359456 DOI: 10.1186/s12893-015-0008-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/10/2015] [Indexed: 12/15/2022] Open
Abstract
Background Even though there is no consensus, many authors believe that in the cases of large hiatal defects, structurally altered crura and/or absence of peritoneal lining, a crural reinforcement should be performed. Reinforcement could be performed with different techniques and different type of mesh, either synthetic or biologic. The disadvantages of mesh repair include the possibility of serious complications and increased costs especially in the usage of composite or biologic mesh. Methods The study includes 10 cases of reinforced primary suture line of the pillars with autologous fascia lata, in elective laparoscopic repair of the giant PEH with a large hiatal defect and friable crura. After intraopreative confirmation of the large hiatal defect (hiatal surface area of more than 8 cm2) and friable crura, an autologous fascia lata graft was harvested in the usual manner and placed in on-lay fashion to reinforce the pillar suture line. We analyzed surgical technique, complications, and initial follow-up of the patients. Results Average hiatal surface area (HSA) in our series was 10.6 cm2 (range 8.1 to 14.4 cm2). The average duration of operation was 203.9 min/3.4 hours (range 160–250 min). Except for a mild hematoma in the harvesting region that resolved spontaneously, there were no procedure related complications and 30 days mortality rate was zero. The average postoperative length of stay was 6.5 days (5–8 days). Out of 10 patients, 5 completed the annual follow-up visit, while 8 completed a 6- month follow-up visit. So far there is no hernia recurrence and/or problems with swallowing function. However, one patient has felt a mild discomfort in the harvested region that does not influence normal daily activities. Conclusions Autologous fascia lata graft hiatal reinforcement represents a technically feasible, easy, and available option for the on-lay reinforcement of large hiatal defects with friable crura in the laparoscopic repair of giant PEHs.
Collapse
Affiliation(s)
- Milos Bjelovic
- University of Belgrade, School of Medicine, Belgrade, Serbia. .,Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.
| | - Tamara Babic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Bratislav Spica
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dragan Gunjic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Veselinovic
- Department of Minimally Invasive Upper Digestive Surgery, Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Violeta Bascarevic
- Department of Plastic Surgery, Special Hospital Banjica, Belgrade, Serbia
| |
Collapse
|
46
|
Goyal VD, Sharma S, Mahajan S, Kumar A. Transthoracic repair of paraesophageal diaphragmatic hernia presenting with symptoms mimicking cardiac disease (chest pain and breathlessness). J Clin Diagn Res 2014; 8:ND20-1. [PMID: 25478401 DOI: 10.7860/jcdr/2014/10261.5007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/13/2014] [Indexed: 11/24/2022]
Abstract
We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery.
Collapse
Affiliation(s)
- Vikas Deep Goyal
- Assistant Professor, Department of Cardiothoracic and Vascular Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Sanjeev Sharma
- Professor, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Som Mahajan
- Assistant Professor, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| | - Ashwani Kumar
- Junior Resident, Department of Surgery, Dr. RPGMC , Kangra,Tanda (HP), India
| |
Collapse
|
47
|
Seetharamaiah R, Romero RJ, Kosanovic R, Gallas M, Verdeja JC, Rabaza J, Gonzalez AM. Robotic repair of giant paraesophageal hernias. JSLS 2014; 17:570-7. [PMID: 24398199 PMCID: PMC3866061 DOI: 10.4293/108680813x13654754534594] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
This report suggests that robotic repair of giant para-esophageal hernia has a lower recurrence rate than standard laparoscopic methods, but complications and mortality are similar to standard laparoscopic approaches. Background and Objectives: Giant paraesophageal hernia accounts for 5% of all hiatal hernias, and it is commonly seen in elderly patients with comorbidities. Some series report complication rates up to 28%, recurrence rates between 10% and 25%, and a mortality rate close to 2%. Recently, the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) has shown equivocal benefits when used for elective surgeries, whereas for complex procedures, the benefits appear to be clearer. The purpose of this study is to present our preliminary experience in robotic giant paraesophageal hernia repair. Methods: We retrospectively collected data from patients who had a diagnosis of giant paraesophageal hernia and underwent a paraesophageal hernia repair with the da Vinci Surgical System. Results: Nineteen patients (12 women [63.1%]) underwent surgery for giant paraesophageal hernia at our center. The mean age was 70.4 ± 13.9 years (range, 40–97 years). The mean American Society of Anesthesiologists score was 2.15. The mean surgical time and hospital length of stay were 184.5 ± 96.2 minutes (range, 96–395 minutes) and 4.3 days (range, 2–22 days), respectively. Nissen fundoplications were performed in 3 cases (15.7%), and 16 patients (84.2%) had mesh placed. Six patients (31.5%) presented with gastric volvulus, and 2 patients had other herniated viscera (colon and duodenum). There were 2 surgery-related complications (10.5%) (1 dysphagia that required dilatation and 1 pleural injury) and 1 conversion to open repair (partial gastric resection). No recurrences or deaths were observed in this series. Conclusion: In our experience robotic giant paraesophageal hernia repair is not different from the laparoscopic approach in terms of complications and mortality rate, but it may be associated with lower recurrence rates. However, larger series with longer follow-up are necessary to further substantiate our results.
Collapse
Affiliation(s)
- Rupa Seetharamaiah
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Rey Jesús Romero
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Radomir Kosanovic
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Michelle Gallas
- Center for Research & Grants, Baptist Health South Florida, Miami, FL, USA
| | - Juan-Carlos Verdeja
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Jorge Rabaza
- Department of General and Bariatric Surgery, Baptist Health South Florida, Miami, FL, USA
| | - Anthony Michael Gonzalez
- Department of General and Bariatric Surgery, Baptist Health South Florida, 7800 SW 87th Ave, Ste B210, Miami, FL 33173, USA.
| |
Collapse
|
48
|
Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients. Surg Endosc 2014; 29:1115-22. [DOI: 10.1007/s00464-014-3771-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
|
49
|
Assessment and reduction of diaphragmatic tension during hiatal hernia repair. Surg Endosc 2014; 29:796-804. [DOI: 10.1007/s00464-014-3744-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/06/2014] [Indexed: 10/25/2022]
|
50
|
Ho CKM, Cheung FKY, Yien RLC, Li MKW. Minimally-invasive approach to paraoesophageal hernia in high surgical-risk patients. SURGICAL PRACTICE 2014. [DOI: 10.1111/1744-1633.12057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carmen Kit-Man Ho
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | | | | | - Michael Ka-Wah Li
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| |
Collapse
|