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Geerts JH, de Haas JWA, Nieuwenhuijs VB. Lessons learned from revision procedures: a case series pleading for reinforcement of the anterior hiatus in recurrent hiatal hernia. Surg Endosc 2024; 38:2398-2404. [PMID: 38565689 PMCID: PMC11078792 DOI: 10.1007/s00464-024-10703-3] [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: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Hiatal Hernia (HH) is a common structural defect of the diaphragm. Laparoscopic repair with suturing of the hiatal pillars followed by fundoplication has become standard practice. In an attempt to lower HH recurrence rates, mesh reinforcement, commonly located at the posterior site of the esophageal hiatus, has been used. However, effectiveness of posterior mesh augmentation is still up to debate. There is a lack of understanding of the mechanism of recurrence requiring further investigation. We investigated the anatomic location of HH recurrences in an attempt to assess why HH recurrence rates remain high despite various attempts with mesh reinforcement. METHODS A retrospective case series of prospectively collected data from patients with hiatal hernia repair between 2012 and 2020 was performed. In total, 54 patients with a recurrent hiatal hernia operation were included in the study. Video clips from the revision procedure were analyzed by a surgical registrar and senior surgeon to assess the anatomic location of recurrent HH. For the assessment, the esophageal hiatus was divided into four equal quadrants. Additionally, patient demographics, hiatal hernia characteristics, and operation details were collected and analyzed. RESULTS 54 patients were included. The median time between primary repair and revision procedure was 25 months (IQR 13-95, range 0-250). The left-anterior quadrant was involved in 43 patients (80%), the right-anterior quadrant in 21 patients (39%), the left-posterior quadrant in 21 patients (39%), and the right-posterior quadrant in 10 patients (19%). CONCLUSION In this study, hiatal hernia recurrences occured most commonly at the left-anterior quadrant of the hiatus, however, posterior recurrences were not uncommon. Based on our results, we hypothesize that both posterior and anterior hiatal reinforcement might be a suitable solution to lower the recurrence rate of hiatal hernia. A randomized controlled trial using a circular, bio-absorbable mesh has been initiated to test our hypothesis.
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Aili A, Maimaitiming M, Li Y, Maisiyiti A, Wang Z, Tusuntuoheti Y, Abudureyimu K. Laparoscopic hiatal hernia repair for treating patients with massive hiatal hernia and iron-deficiency anaemia. BMC Surg 2023; 23:293. [PMID: 37752453 PMCID: PMC10521551 DOI: 10.1186/s12893-023-02184-3] [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: 09/22/2022] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Massive hiatal hernias may result in extraoesophageal symptoms, including iron-deficiency anaemia. However, the role played by hiatal hernias in iron-deficiency anaemia is not clearly understood. We examined the prevalence of anaemia in patients with massive hiatal hernias and the frequency of anaemia resolution after laparoscopic hiatal hernia repair at long term follow-up. METHODS Patients who underwent laparoscopic hiatal hernia repair from June 2008 to June 2019 were enrolled in this study. We collected the patients' demographic and clinical data from their medical records, and compared the pre-surgical and post-surgical findings (at 1 week and 3 months post-surgery). All patients with adequate documentation underwent post-surgical follow-up to evaluate improvements in clinical symptoms and signs. RESULTS A total of 126 patients with massive hiatal hernias underwent laparoscopic hiatal hernia repair. Of these, 35 (27.8%) had iron-deficiency anaemia. Anaemia was resolution in all the patients and they had significantly reduced GERD-Q scores at 3 months postoperatively (P<0.01) .The mean follow-up period was 60 months. Iron-deficiency anaemia resolution after hiatal hernia repair was achieved in 93.9% of the patients. CONCLUSION Anaemia is common in patients with massive hiatal hernias, and most of our patients were symptomatic because of their anaemia. Moreover, in patients with massive hiatal hernias, iron-deficiency anaemia resolution is likely after laparoscopic hiatal hernia repair.
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Affiliation(s)
- Aikebaier Aili
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Maimaitiaili Maimaitiming
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yiliang Li
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Alimujiang Maisiyiti
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Zhi Wang
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yusujiang Tusuntuoheti
- The graduate student institute of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Kelimu Abudureyimu
- Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China.
- Xinjiang Clinical Research Center for Gastroesophageal Reflux Disease and Bariatric Metabolic Surgery, Xinjiang Uygur Autonomous Region, Urumqi, China.
- Research Institute of General and Minimally Invasive Surgery, Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Urumqi, China.
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Wang Q, Lu J, Sui Y, Fan J, Ren J, Wang Z, Chen X. Predicting reflux symptom recurrence: The impact of gastroesophageal junction indicators and body mass index among outpatients. Exp Ther Med 2023; 26:351. [PMID: 37324506 PMCID: PMC10265715 DOI: 10.3892/etm.2023.12050] [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: 12/20/2022] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
The present study aimed to evaluate the efficacy of the prediction model in predicting reflux symptom recurrence among outpatients with reflux esophagitis (RE). A total of 261 outpatients diagnosed with RE complicated by anatomical alterations at the gastroesophageal junction and reflux symptoms were included in the study. Through follow-up, patients were divided into a General group (149 cases) and a Recurrent group (112 cases). Receiver operating characteristic curves of the related factors and prediction model were analyzed to compare the efficacy of each element in predicting reflux recurrence. A prediction model was constructed for predicting reflux recurrence using the axial length of the hiatal hernia (HH), the diameter of the esophageal hiatus, Hill classification, and body mass index (BMI) as risk factors. The cutoff values of the aforementioned factors for predicting reflux recurrence were: an axial length of HH >2 cm, esophageal hiatus diameter ≥3 cm, Hill grade >III, and BMI >25.1 kg/m2. The multivariate prediction model constructed using the aforementioned four indicators together with chronic atrophic gastritis and Helicobacter pylori infection had the area under the curve of 0.801 (95% confidence interval: 0.748-0.854), and the cutoff value of 46.8 had a sensitivity and specificity of 71.4% and 75.8%, respectively. The predictive model in the present study can be used for the primary assessment of reflux recurrence in patients with RE.
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Affiliation(s)
- Qing Wang
- Department of Gastroenterology, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Junhui Lu
- Department of Gastroenterology, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Yue Sui
- Department of Gastroenterology, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Jing Fan
- Department of Gastroenterology, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Jinnan Ren
- Department of Gastroenterology, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Zhenzhen Wang
- Department of Gastroenterology, Shanxi Datong University Affiliated Cancer Hospital, Datong, Shanxi 037000, P.R. China
| | - Xing Chen
- Department of Gastroenterology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
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Ribolsi M, Savarino E. Towards a better diagnosis of gastro esophageal reflux disease. Expert Rev Gastroenterol Hepatol 2023; 17:999-1010. [PMID: 37800858 DOI: 10.1080/17474124.2023.2267435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION GERD is a common disorder and is characterized by the presence of typical or atypical symptoms. In GERD patients, the presence of mucosal alterations in endoscopy is detected in up to 30% of individuals. The clinical presentation of GERD patients may be complex and their management is challenging, due to the heterogeneous clinical presentation. The present review has been performed searching all relevant articles in this field, over the past years, using PubMed database. AREAS COVERED The diagnosis and management of GERD have been significantly improved in the last years due to the increasing availability of reflux monitoring techniques and the implementation of new procedures in the therapeutic armamentarium. Beside traditional impedance-pH variables, new metrics have been developed, increasing the diagnostic yield of reflux monitoring and better predicting the treatment response. Traditional pharmacological treatments include acid-suppressive-therapy and/or anti-acid. On the other hand, surgical treatment and, more recently, endoscopic procedures represent a promising field in the therapeutic approach. EXPERT OPINION Diagnosis and treatment of GERD still represent a challenging area. However, we believe that an accurate upfront evaluation is, nowadays, necessary in addressing patients with GERD to a more accurate diagnosis as well as to the best treatment options.
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Affiliation(s)
- Mentore Ribolsi
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, Rome, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
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5
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Redwan B, Kirstein R, Kösek V, Thiel B, Zirngibl H, Schmitz B. An unusual case of a tension pneumothorax. J Surg Case Rep 2022; 2022:rjac496. [PMID: 36405680 PMCID: PMC9667875 DOI: 10.1093/jscr/rjac496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
A total intra-thoracic stomach describes the case of a complete herniation of the stomach into the thoracic cavity. Symptoms may vary from mild to an acute life-threatening situation in case of perforation or bleeding, requiring emergency surgery. Here we describe the case of a gastric perforation leading to a tension pneumothorax and concomitant pleural empyema due to a giant hiatal recurrence after previous surgery. Multidisciplinary management involving thoracic surgeons helped in achieving the best clinical outcome for the patient.
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Affiliation(s)
- Bassam Redwan
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen , Lünen , Germany
| | - Robert Kirstein
- Department of General Surgery, Klinik am Park, Klinikum Westfalen , Lünen , Germany
| | - Volkan Kösek
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen , Lünen , Germany
| | - Burkhard Thiel
- Department of Thoracic Surgery, Klinik am Park, Klinikum Westfalen , Lünen , Germany
| | - Hubert Zirngibl
- Depertment of Surgery , Helios University Hospital Wuppertal, , Wuppertal , Germany
- University of Witten/Herdecke , Helios University Hospital Wuppertal, , Wuppertal , Germany
| | - Björn Schmitz
- Department of General Surgery, Klinik am Park, Klinikum Westfalen , Lünen , Germany
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Yoo IH, Yang HR. Pelvic radiography as a non-invasive screening tool for hiatal hernia in children with cerebral palsy. Medicine (Baltimore) 2022; 101:e29522. [PMID: 35984193 PMCID: PMC9387974 DOI: 10.1097/md.0000000000029522] [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: 01/05/2023] Open
Abstract
The diagnosis of hiatal hernia (HH), causing severe gastroesophageal reflux disease and complications in children with cerebral palsy (CP) is cumbersome because invasive investigations are required for diagnosis. Hip displacement, one of the most common complications in children with CP, can be diagnosed with a simple pelvic radiograph. This study aimed to evaluate the association between the severity of hip displacement and HH and the diagnostic accuracy of Reimers' hip migration percentage (MP) on pelvic radiography in assessing the presence of HH. A total of 52 children with CP (27 boys, 25 girls; mean age, 6.3 years; range, 0.6-17.4 years) who underwent esophagogastroduodenoscopy, upper gastrointestinal series and pelvic radiography between March 2013 and February 2020 were recruited. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were evaluated and statistically analyzed. HH was defined as ≥ 2 cm proximal displacement of the gastroesophageal junction identified in esophagogastroduodenoscopy or upper gastrointestinal series, and MP was calculated by evaluating the pelvic radiograph. Of the 52 children enrolled in this study, HH was diagnosed in 18 children (34.6%). When the patients were classified and analyzed according to the MP result, HH was observed in 10%, 26.7%, and 70.6% in MP <33%, MP 33%-39%, and MP > 40% groups, respectively (P < .001). The optimal MP cutoff of 36.5% distinguished pediatric CP patients with HH from those without HH with a sensitivity of 78%, specificity of 68%, a positive predictive value of 56.0%, and a negative predictive value of 85.2%, respectively. The application of MP and the severity of hip displacement, which can be easily measured by simple radiography, may be useful and reliable in screening for detecting HH in children with CP. Retrospectively registered. This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-2007-627-106).
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- *Correspondence: Hye Ran Yang, Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Korea (e-mail: , )
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7
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Koo E, Clarke JO, Yang B, Pasricha PJ, Zhang N. Quantitative assessment of multichannel intraluminal impedance pH and its clinical implications. Physiol Rep 2022; 10:e15199. [PMID: 35224878 PMCID: PMC8882696 DOI: 10.14814/phy2.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/10/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022] Open
Abstract
We sought to quantify the characteristics of acid reflux episodes in patients with extraesophageal GERD symptoms (EES), hiatal hernia (HH), and erosive esophagitis (EroE) using multichannel intraluminal impedance pH (MII‐pH) and investigate the correlation between impedance parameters and high resolution esophageal manometry (HREM). This was a retrospective analysis of esophageal manometric and impedance data inpatients with typical GERD symptoms who underwent both HREM and 24 h MII‐pH tests. Within the three patient subgroups, we evaluated impedance metrics such as average height of reflux, total duration of reflux, maximum duration of reflux, average pH, and average area of reflux. We also introduce a novel composite reflux index (CRI) metric, which is a measure of reflux height, duration, and acidity. Patients with EES exhibited a 29.3% increase in average height of reflux, compared to non‐EES patients (p < 0.01); the average height of reflux was found to be an independent predictor of EES (p < 0.01). Patients with HH showed a 190% longer total reflux duration (p < 0.01, vs. non‐HH patients). Total reflux duration was twice as long in EroE patients compared to those without (p = 0.02). Average CRI was significantly different within all three subgroup comparisons (p < 0.01). Impedance metrics shared weak negative correlations with lower esophageal sphincter (LES) rest pressure and distal contractile integral (DCI), and weak positive correlations with % absent peristalsis (p < 0.05 to p < 0.01 for various parameters). Quantitative impedance metrics provide useful insight into the pathophysiology of reflux in patients with EES, HH, and EroE.
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Affiliation(s)
- Eden Koo
- Division of Gastroenterology and Hepatology Michigan Medicine Ann Arbor Michigan USA
- John A. Burns School of Medicine University of Hawaii Honolulu Hawaii USA
| | - John O. Clarke
- Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine Baltimore Maryland USA
- Division of Gastroenterology and Hepatology Stanford University School of Medicine Stanford California USA
| | - Boli Yang
- Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Pankaj J. Pasricha
- Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Nina Zhang
- Division of Gastroenterology and Hepatology Johns Hopkins University School of Medicine Baltimore Maryland USA
- Department of Gastroenterology the Affiliated Drum Tower Hospital of Nanjing University Medical School Nanjing Jiangsu Province China
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Yoo IH, Joo JY, Yang HR. Factors associated with hiatal hernia in neurologically impaired children. Neurogastroenterol Motil 2022; 34:e14158. [PMID: 33837998 DOI: 10.1111/nmo.14158] [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] [Revised: 03/15/2021] [Accepted: 03/23/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hiatal hernia is clinically important because it impairs the protective mechanism that prevents gastroesophageal reflux-induced injury. Diagnosing hiatal hernia is more important in neurologically impaired children because hiatal hernia-induced gastroesophageal reflux often causes severe complications such as aspiration pneumonia or malnutrition. We aimed to evaluate the patient characteristics and early predictors of hiatal hernia in neurologically impaired children. METHODS We retrospectively investigated 97 neurologically impaired children who underwent esophagogastroduodenoscopy and upper gastrointestinal series between March 2004 and June 2019. Demographic and clinical characteristics, as well as endoscopic and radiological findings, were statistically analyzed. RESULTS Of the 97 children recruited, 22 (22.7%) had hiatal hernia. When comparing the non-hiatal hernia group with the hiatal hernia group, neurological disease longer than 6 months (odds ratio 10.9, 95% confidence interval 1.2-96.5), wasting (odds ratio 4.6, 95% confidence interval 1.3-16.3), enteral tube feeding (odds ratio 9.2, 95% confidence interval 1.6-53.0), and history of aspiration pneumonia (odds ratio 6.5, 95% confidence interval 1.2-34.5) were identified as early predictors of hiatal hernia. CONCLUSIONS Timely identification of predictors of developing hiatal hernia in neurologically impaired children is important for early diagnostic confirmation to initiate optimal medical or surgical treatment of hiatal hernia to avoid serious complications such as aspiration pneumonia and malnutrition.
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Affiliation(s)
- In Hyuk Yoo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Yeon Joo
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Ran Yang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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9
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Mrzljak A, Kosuta I, Budimir-Bekan I, Franusic L, Popic J. Hiatal Hernia Mistaken for Oesophageal Perforation after Upper Endoscopy. Chonnam Med J 2020; 56:79-80. [PMID: 32021848 PMCID: PMC6976773 DOI: 10.4068/cmj.2020.56.1.79] [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: 08/25/2019] [Revised: 09/20/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Kosuta
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | - Jelena Popic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zagreb, Croatia
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10
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Sfara A, Dumitrascu DL. The management of hiatal hernia: an update on diagnosis and treatment. Med Pharm Rep 2019; 92:321-325. [PMID: 31750430 PMCID: PMC6853045 DOI: 10.15386/mpr-1323] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/13/2019] [Indexed: 12/15/2022] Open
Abstract
Background and aim Hiatal hernia (HH) occurs quite frequently in the general population and is characterized by a wide range of non-specific symptoms, most of them related to gastroesophageal reflux disease. Treatment can be challenging at times, depending on the existence of complications. The most recent guideline regarding the management of hiatal hernia was released by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. This review aims to present the most recent updates on the diagnosis and management of hiatal hernia for clinical practitioners. Methods The PubMed database was screened for publications using the terms: “hiatal hernia”, “paraesophageal hernia”, “management”, “treatment”, “hiatal repair”. A literature review of contemporary and latest studies was completed. The studies that we looked into include prospective, randomized trials, systematic reviews, clinical reviews and original articles. The information was compiled in narrative review format. Results This narrative review presents new data on the diagnosis and management of hiatal hernia. While the diagnostic pathway has remained virtually unchanged, new data have come to light regarding the surgical treatment of hiatal hernia. We present the imaging methods used for its diagnosis, as well as the medical and surgical treatment currently available. Conclusion In the last five years, there has been vast research in the field of hiatal hernia management, especially regarding the surgical treatment. However, unanswered questions still remain and solid updates on the guidelines have yet to be formulated. To address this, more randomized studies need to be done on subsets of patients, stratified by age, gender, symptoms and comorbidities.
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Affiliation(s)
- Alice Sfara
- Gastroenterology Department, "Prof. Dr. Octavian Fodor" Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Dan L Dumitrascu
- 2 Medical Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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11
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Zanotti D, Fiorani C, Botha A. Beyond Belsey: complex laparoscopic hiatus and diaphragmatic hernia repair. Ann R Coll Surg Engl 2019; 101:162-167. [PMID: 30322286 PMCID: PMC6400907 DOI: 10.1308/rcsann.2018.0183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diaphragmatic and hiatus hernias can cause mild chronic symptoms or have an acute presentation with gastric volvulus and obstruction. Elective or emergency surgery is indicated in symptomatic patients and nowadays is generally performed laparoscopically. METHODS We report four different types of hernias: a giant hiatus hernia following a gastric pull-up for recurrent congenital diaphragmatic hernia; a Bochdalek hernia in a pregnant young woman; concomitant hiatus and Morgagni hernias; and a giant hiatus hernia occupying the right chest. All were approached laparoscopically, either electively or as an emergency. RESULTS Surgery led to a resolution of symptoms in all the cases. We had no any intraoperative complications. Two patients developed minor postoperative complications (chest infection). No recurrences were found during a mean follow-up of 18 months. CONCLUSIONS Transabdominal laparoscopic approach is a safe and feasible approach to all cases of symptomatic hiatus and diaphragmatic hernia.
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Affiliation(s)
- D Zanotti
- Upper Gastrointestinal Surgical Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, London, UK
| | - C Fiorani
- Upper Gastrointestinal Surgical Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, London, UK
| | - A Botha
- Upper Gastrointestinal Surgical Unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, London, UK
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12
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Dallemagne B, Quero G, Lapergola A, Guerriero L, Fiorillo C, Perretta S. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia 2017; 22:909-919. [PMID: 29177588 DOI: 10.1007/s10029-017-1706-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Giant paraesophageal hernias (GPEH) are relatively uncommon and account for less than 5% of all primary hiatal hernias. Giant Secondary GPEH can be observed after surgery involving hiatal orifice opening, such as esophagectomy, antireflux surgery, and hiatal hernia repair. Surgical treatment is challenging, and there are still residual controversies regarding the laparoscopic approach, even though a reduced morbidity and mortality, as well as a shorter hospital stay have been demonstrated. METHODS A Pubmed electronic search of the literature including articles published between 1992 and 2016 was conducted using the following key words: hiatal hernia, paraesophageal hernias, mesh, laparoscopy, intrathoracic stomach, gastric volvulus, diaphragmatic hernia. RESULTS Given the risks of non-operative management, GPEH surgical repair is indicated in symptomatic patients. Technical steps for primary hernia repair include hernia reduction and sac excision, correct repositioning of the gastroesophageal junction, crural repair, and fundoplication. For secondary hernias, the surgical technique varies according to hernia type and components and according to the approach used during the first surgery. There is an ongoing debate regarding the best and safest method to close the hiatal orifice. The laparoscopic approach has demonstrated a lower postoperative morbidity and mortality, and a shorter hospital stay as compared to the open approach. A high recurrence rate has been reported for primary GPEH repair. However, recent studies suggest that recurrence does not reduce symptomatic outcomes. CONCLUSIONS The laparoscopic treatment of primary and secondary GPEH is safe and feasible in elective and emergency settings, especially in high-volume centers. The procedure is still challenging. The main steps are well defined. However, there is still room for improvement to lower the recurrence rate.
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Affiliation(s)
- B Dallemagne
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. .,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - G Quero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - A Lapergola
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - L Guerriero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - C Fiorillo
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - S Perretta
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
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Mozer AB, Speicher JE, Anciano CJ. Thoracic Surgery Considerations in the Mentally Ill or Handicapped Patient. Thorac Surg Clin 2017; 28:59-68. [PMID: 29150038 DOI: 10.1016/j.thorsurg.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Increasing prevalence of mentally ill and handicapped populations requiring surgical thoracic interventions has brought to light their worse associated morbidity and mortality. Baseline functional status, caretaker environment, and mental limitations in day to day life have an impact in the short and long term from these interventions. Aggressive perioperative care, multispecialty approach, technical aspects, palliative procedures, and ethical considerations all play a part in improving outcomes. In this article real cases are presented illustrating points of care and situations for discussion.
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Affiliation(s)
- Anthony B Mozer
- General Surgery Resident, Department of Surgery, East Carolina University, 600 Moye Boulevard, Greenville, NC 27834, USA
| | - James E Speicher
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA
| | - Carlos J Anciano
- Thoracic and Foregut Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA; Minimally Invasive Thoracic Surgery, Department of Cardiovascular Sciences, East Carolina University, 115 Heart Drive, Greenville, NC 27834, USA.
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