Surgical Treatment Of Hiatal Hernia Research Articles

Complications of surgical treatment of hiatal hernia and tactics of its elimination: An observational non-randomized study

Complications of surgical treatment of hiatal hernia and tactics of its elimination: An observational non-randomized study

Analysis of reconstructive interventions in case of failures in hiatal hernia surgery

INTRODUCTION. The method of laparoscopic fundoplication for hiatal hernia is today the most common surgical intervention for this pathology. However, there are a significant number of complications, one of the most severe is relapse of the disease. Today, according to the world literature, there is not enough information about the causes of relapse, methods of prevention and long-term postoperative results of reconstructive operations.The OBJECTIVE was to analyze of reconstructive surgeries in patients who underwent surgery for gastroesophageal reflux disease associated with hiatal hernia.METHODS AND MATERIALS. The work was performed on the basis of data from two clinics – Oncology Department ¹ 2 of the RCOD of the Ministry of Health of the Republic of Tatarstan and Thoracic Department ¹ 2 of the RCB of the Ministry of Health of the Republic of Tatarstan. 1,661 laparoscopic interventions were performed in patients with hiatal hernia. The basis of the work is the analysis of reconstructive operations in 99 patients.RESULTS. The most common reasons for reconstructive operations were relapses of diseases in gastroesophageal reflux disease associated with a hiatal hernia: destruction and (or) migration of the fundoplication cuff – 77 (77 %) cases, recurrence of paraesophageal hiatal hernia – 10 (11 %). Reconstructive surgery in patients with relapse of hiatal hernia remains the method of choice and leads to positive results in 83 % of cases.CONCLUSION. Surgical treatment of hiatal hernia should be carried out in a specialized hospital and experienced surgeons who own both laparoscopic and open methods of treating this pathology.

To the question of surgical correction of evacuatory disturbances of upper part of the gastrointestinal tract

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results.Materials and methods: 52 patients who underwent laparoscopic correction of hiatal hernia were examined.Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Laparoscopic Surgical Treatment of Hiatal Hernia with Gastric Volvulus: Report of a Case

Paraesophageal hernias represent 5 to 10% of all hiatal hernias. Mainly because of the ageing of the population, their incidence is increasing: the etiopathogenesis is defined in fact by weakening of the diaphragmatic esophageal ligament, dilatation of the esophageal hiatus due to vertebral body fracture, gibbus deformity, obesity, and an increase in abdominal pressure [2]. They are classified into four types [1]:

Robot-assisted laparoscopic repair in hiatal hernia with kyphosis: A case report with meta-analysis

Abstract BACKGROUND: Hiatal hernia is a high incidence disease, of which, partial patients requiring surgery have gastroesophageal reflux or dysphagia. Although minimally invasive surgery has been widely utilized in recent years, the optimal surgical therapy still remains controversial. In this study, we reported a kyphosis patient undergoing robot-assisted laparoscopic hiatal hernia repair and launched a meta-analysis aiming to evaluate the advantages of this surgery strategy. MATERIALS AND METHODS: Six databases (Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, EMBASE, ClincialTrials.gov database and Web of Science) were searched from inception to September 20, 2022. All studies describing the patients undergoing robotic hiatal hernia or laparoscopic hiatal hernia were included. And the meta-analysis was performed using R package meta (v6.0.0). RESULTS: We reported a 75-year-old female patient of short stature and with severe kyphosis was diagnosed with hiatal hernia and underwent a robotic surgery. For meta-analysis, 1,128 articles were identified in the initial database search, and among them, 6 articles were included in the final analysis. The results showed that robotic surgery had no advantage in operation time and intraoperative complications rate compared with traditional laparoscopic surgery (both P < 0.01). Regardless of the statistical significance, robotic surgery tended to have a lower conversion and postoperative complication rate, as well as the length of hospital stay. CONCLUSIONS: Robotics have some advantages in the surgical treatment of hiatal hernia compared with the conventional laparoscopic surgery, the use of which can facilitate the treatment for some challenging cases.

Surgical treatment of hiatal hernia complicated by short esophagus: a prospective study

To analyze immediate and long-term postoperative results in patients with hiatal hernia complicated by short esophagus. We prospectively analyzed postoperative outcomes in 113 patients with hiatal hernia who underwent surgery between 2013 and 2021. The main group consisted of 54 patients with length of intra-abdominal segment of esophagus <4 cm who underwent Collis procedure or esophagus >4 cm and indications for Nissen fundoplication cuff. The control group consisted of 59 patients and indications for esophageal lengthening procedure only if length of intra-abdominal segment of esophagus was less than 2 cm. This surgery was started with anterolateral vagotomy, and Collis procedure was performed in case of ineffective vagotomy. Nissen fundoplication was performed for abdominal segment of esophagus >2 cm. In the main group, 17 (31.5%) patients with intra-abdominal segment of esophagus <4 cm required Collis procedure. In the control group, length of intra-abdominal segment of esophagus <2 cm was observed in 6 (10.2%) patients. In all cases, anterolateral vagotomy was performed. Surgery time was 189 (80-290) and 136 (90-320) min, respectively (p=0.001). Postoperative complications in the main group occurred in 8 (14.8%) patients, in the control group - 4 (6.8%) patients (p=0.281). One (1.7%) patient died in the control group. The follow-up period was 38 (12-66) months. In long-term period, recurrence developed in 2 (3.7%) and 11 (20%) patients, respectively (p=0.026). High satisfaction with postoperative outcomes was observed in 51 (94.4%) and 46 (79.3%) patients, respectively (p=0.038). Uncorrected shortening of the esophagus can be one of the main risk factors of recurrence in long-term period. Expanding the indications for Collis gastroplasty can reduce the incidence of poor outcomes without affecting the incidence of postoperative complications.

To the question of surgical correction of evacuatory disturbances of the upper departments of the gastrointestinal tract

Aim. To study the possibilities of using video endoscopic technologies in the surgical treatment of hiatal hernia and evaluate long-term results. Materials and methods. 52 patients who underwent laparoscopic correction of hiatal hernia were examined. Results. Excellent and good results were obtained in 31 patients (73,8%), a group with satisfactory treatment results were 2 (4,8%) patients, and an unsatisfactory result was observed in 9 (21,4%) patients.

Досвід хірургічного лікування гриж стравохідного отвору діафрагми лапароскопічним доступом

Актуальність. Діагностика та лікування хворих із грижею стравохідного отвору діафрагми (ГСОД) є однією з найбільш актуальних проблем сучасної медицини. Мета роботи — надати досвід хірургічного лікування гриж стравохідного отвору діафрагми лапароскопічним доступом. Матеріали та методи. У відділенні хірургії органів травлення ДУ «Інститут гастроентерології НАМН України» за період з 2013 по 2017 р. лапароскопічні втручання з приводу ГСОД і ГЕРБ були виконані у 67 пацієнтів. Результати. Серед оперованих пацієнтів у 64 (95,6 %) була аксіальна ГСОД (тип I), у 2 (2,9 %) — параезофагеальна ГСОД (тип II), у 1 (1,5%) — змішана ГСОД з укороченим стравоходом. Крурорафія виконана у 100 % пацієнтів: задня — у 60 (89,6 %), передня — у 2 (2,9 %), поєднана — у 5 (7,5 %) і алопластика — у 6 (8,9 %) пацієнтів. Виконано лапароскопічні фундоплікації: за Ніссеном — у 46 (68,7 %), за Дор — у 7 (10,4 %), за Тупе — в 14 (20,9 %) пацієнтів. Фундодіафрагмопексія виконана у 61 (91,0 %) пацієнта. Симультанні оперативні втручання виконані у 5 (7,4 %) пацієнтів, конверсії — в 1 (1,4 %). Летальних випадків після оперативних втручань не було. Висновки. Результати дослідження свідчать про високу ефективність лапароскопічного доступу в хірургічному лікуванні пацієнтів із ГСОД.

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Factors associated with hiatal hernia in neurologically impaired children

AbstractBackgroundHiatal 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.MethodsWe 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.ResultsOf 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.ConclusionsTimely 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.

Collis gastroplasty in surgical treatment of hiatal hernia

To analyze the early and long-term postoperative outcomes after Collis gastroplasty in the treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease and shortening of the esophagus. Postoperative outcomes after Collis gastroplasty were analyzed in 22 patients with hiatal hernia and shortening of the esophagus. The control group consisted of 166 patients after simple repair of hiatal hernia without Collis procedure. In case of Collis gastroplasty, surgery time was 185 (160-250) min. Intraoperative complications were observed in 3 (13.6%) patients, incidence of postoperative complications - 18.2%. There were no lethal outcomes in this group of patients. Mild functional dysphagia was observed in 2 (9.1%) patients. Length of hospital stay was 7.8±2.4 days. Mean follow-up was 34 (6-52) months. There were no anatomical recurrences. A relapse of gastroesophageal reflux was noted in 1 (4.6%) case. GERD-HRQL score was 4.8±2.2 points. Additional Collis gastroplasty did not affect the immediate and long-term results of surgical treatment in comparison with simple cruroraphy and fundoplication. Unreduced shortening of the esophagus may be followed by high incidence of recurrent hiatal hernia and GERD in long-term period. In case of shortening of the esophagus, surgery should include Collis gastroplasty. This effective and safe procedure does not impair treatment outcomes. Indications and optimal technique of Collis gastroplasty require clarification and further research.

THE EFFECTIVENESS OF MESH REINFORCEMENT DURING LAPAROSCOPIC HIATAL HERNIA REPAIR

Purpose . To analyze short-term and long-term results of surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease. Materials and methods . A retrospective analysis of short-term and long-term results of treatment of 98 patients for the period 2009–2016, who underwented surgical treatment of hiatal hernia with a hernia defect size 5 or more cm was performed. The first group included 69 patients underwent suture repair of hernia defect. The second group underwent mesh repair - 29 patients. Results . Intraoperative complications - 7 (10.1%) versus 2 (6.9%), postoperative complications - 6 (8.7%) versus 3 (10.4%), the duration of surgery - 141 ± 21.1 min versus 179 ± 28.4, duration of hospital stay - 6.7 ± 1.6 days versus 6.9 ± 1.8, postoperative dysphagia - 11 (15.9%) versus 6 (20.7%) were not noted. In 5 years after surgery, reccurence in the suture group were noted in 14 (20.3%) patients, in the mesh group - in 4 (13.8%) patients. The total GERD–HRQL questionnaire score was 6.4 ± 1.8 points in the suture repair group and 5.9 ± 2.1 points in the mesh group. 9 (13%) patients in the suture repair group and 5 (17.2%) in the mesh group evaluated their condition as unsatisfactorily. Conclusion . The analysis of long-term results in 5 years after the surgery showed the absence of benefit after using mesh reinforcement during laparoscopic repair of large hiatal hernias compared to usual suture cruroraphy both in recurrence rate and in assessing the quality of life.

Causes of unsuccessful surgical treatment of hiatal hernia

Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years in 60%. Four types of hiatal hernias (IIV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 1015 4060%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

Laparoscopic Surgery for Recurrent Hiatal Hernia.

Surgical treatment of hiatal hernia (HH) is well standardized. However, recurrence is observed in 15%-60% of cases, and is challenging to manage. The aim of this study was to analyze the causes of surgical failure and provide some guidelines for treatment. The symptoms of recurrent HH vary widely, and include persistent reflux, dysphagia, and permanent discomfort, leading to a marked change in the quality of life. Morphological and functional pretherapeutic evaluation is necessary to determine whether the symptoms are due to recurrent HH, and to understand the cause of failure. Redo surgery is technically difficult and challenging, and should only be used in symptomatic patients whose symptoms are definitively those of recurrent HH.

Hiatal hernia repair with Toupet fundoplication in surgical treatment of hiatal hernia, complicated by gastroesophageal reflux disease

Introduction. Hiatal hernia occupies a third place in the structure of the gastrointestinal tract pathology. The association of hiatal hernia with gastroesophageal reflux disease can lead to severe complications and requires a surgical treatment.&#x0D; Objective. To analyze short-term and long-term results of a surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease (GERD).&#x0D; Methods. A retrospective analysis of the short-term and long-term treatment results of 62 patients suffering from hiatal hernia complicated by gastroesophageal reflux disease was performed. All the patients underwent a laparoscopic hiatal hernia repair supplemented by Toupet fundoplication.&#x0D; Results. The hospital stay duration was 7.21.6 days. The postoperative complication rate was 6.5%. Mild functional dysphagia was noted in 8(12.9%). Persistent long-term dysphagia in the late postoperative period was observed in 2(3.2%) patients. The recurrences of hiatal hernia or GERD were noted in 15(24.2%) patients in 5 years after the surgery. The total GERD-HRQL questionnaire score 5 years after the surgery was 5.73.9.&#x0D; Сonclusion. Laparoscopic interventions are safe, less traumatic, provide the possibility of early rehabilitation of patients, can achieve positive functional results in 85% of patients and should be used in the treatment of patients suffering from hiatal hernia complicated by GERD.

The management of hiatal hernia: an update on diagnosis and treatment.

Background and aimHiatal 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.MethodsThe 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.ResultsThis 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.ConclusionIn 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.

Хирургическое лечение грыж пищеводного отверстия диафрагмы традиционным и лапароскопическим методами

Хирургическое лечение грыж пищеводного отверстия диафрагмы традиционным и лапароскопическим методами

Esophagogastric Junction Outflow Obstruction: Features, Etiology, and Outcome in a Single-Center Experience - Time for Standardization?

Introduction: Esophagogastric junction outflow obstruction (EGJOO) is defined by the Chicago classification as an elevated integrated relaxation pressure of >15 mm of Hg with preserved peristalsis. This esophageal motility disorder is increasingly recognized and while suggesting obstructive physiology, it does not describe a specific diagnosis. Variant/incompletely expressed achalasia, mechanical obstruction and artifact have all been described as causes. Methods: Aim: To describe the clinical characteristics and outcomes in a cohort of patients with EGJOO. Study design: Consecutive adult patients undergoing high resolution manometry (HRM) between 1/2/17 and 12/31/17 with a diagnosis of EGJOO were identified. Records were reviewed to determine: 1. causes of EGJOO 2.treatment and outcome. Results: Of 839 HRM studies performed, 68 (8.1%) met criteria for EGJOO. Mean age of this patient cohort was 57.6 years. 38 (55.9%) had dysphagia, 12 (17.6%) regurgitation, 6 (8%) heartburn and remainder with miscellaneous symptoms (cough, chest pain). 9 patients had prior gastric/esophageal surgery. 41 patients were evaluated with barium esophagram (BS) - of these 68.3% were abnormal. 36 patients were evaluated by upper endoscopy - 61.1 % showed abnormalities including hiatal hernia, esophagitis, or evidence of prior surgery. Esophageal biopsies in 21 patients excluded eosinophilic esophagitis. 11 had surgical interventions (Refer to figure 1). All had clinical improvement on follow up. Conclusion: EGJOO is frequently found (8%) and comprises a heterogeneous group with obstructive physiology presenting most commonly with dysphagia (56%). Benign anatomic abnormalities such as hiatal hernia are the most common associated anatomic findings as detected by BS (68.3%) or endoscopy (63.2%). Surgical treatment of hiatal hernia associated EGJOO does not subsequently result in dysphagia. Treatment of EGJOO as presumed early or variant expression achalasia is uncommon (5.8%); treatment results in improved symptoms. 402 Figure 1. Evaluation and management of a cohort of patients diagnosed with EGJOO in 2017.

Surgical treatment of hiatal hernia: A ten-year experience

Background/Aim. Today, hiatal hernia and the accompanying gastroesophageal reflux disease (GERD) are the most common benign disorders of the upper gastrointestinal tract. The aim of this study was to present the results of the hiatal hernia and GERD laparoscopic surgery in finding out for best type of fundoplication in each individual case. Methods. The study included 132 patients with the diagnosis of hiatal hernia and GERD, operated in the period from May 2004 to December 2014 at the Clinic for Abdominal, Endocrine and Transplantation Surgery of the Clinical Center Vojvodina, Serbia. The patients were selected for surgery on the basis of the findings of esophago-gastroscopy, barium contrast upper gastrointestinal series, 24-hour pH monitoring and esophageal manometric studies. Results. All the patients in this series underwent a posterior hiatoplasty with direct sutures. An additional mesh reinforcement was performed in 21 (16%) patients with a large hiatal hernia. There were 68 Nissen, 59 Toupet, and 5 Door fundoplications. Recently, the short-floppy Nissen fundoplication has predominantly been performed due to good postoperative outcomes. Intraoperative complications were: the parietal pleura lesion (3 patients), the spleen capsule laceration (4 patients), a minor injury of the adventitia of the distal esophagus (1 patient) and a thermal injury of the gastric fundus (1 patient). The postoperative complications were as folows: one fistula of the gastric fundus, transitory subcutaneous emphysema in the neck (5 patients), minor left-sided pleural effusions (6 patients), a transitory dysphagia (23 patients). The overall recurrence rate was 18.2% (24 patients). There was one fatal outcome. Conclusion. Laparoscopic surgery is considered a safe and effective surgical procedure for the treatment of hiatal hernia. The hiatal repair with a mesh reinforcement is recommended in selected cases. Today all consider the ?short floppy? Nissen fundoplication as procedure of choice for the adequate hiatal repair.

Laparoscopic hernioplasty of hiatal hernia.

Laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its mini-invasive nature and intraperitoneal view and operating angle. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia.