Treatment Of Diaphragmatic Hernia Research Articles

Evaluation of the efficacy of freeze-dried bovine pericardium and acellular bovine skin in the treatment of diaphragmatic hernia in dogs

Evaluation of the efficacy of freeze-dried bovine pericardium and acellular bovine skin in the treatment of diaphragmatic hernia in dogs

Laparoscopic proximal sleeve gastrectomy as an alternative for management of giant hiatal hernias

Background and aim: Large anatomic defects of the diaphragmatic hiatus known as giant hiatal hernias could be associated with reflux esophagitis disease (GERD) and other life-threatening complications such as gastric volvulus, ischemia and perforation, thus surgical repair is warranted. Although usually the key steps to surgical repair are reduction of the herniated stomach, complete excision of the sac, hiatus repair, and an antireflux procedure, surgery in these cases is associated with a great rate of anatomic and functional failure, therefore different techniques have been described since the original description of Collis gastroplasty designed to lengthen the short esophagus. Methods: We report here the technique and results performing proximal vertical gastrectomy or proximal sleeve gastrectomy (PSG) as an alternative in cases in which the possibility of recurrence of the hiatal hernia (HH) is high. Results: After years of follow-up after surgery, all the case patients presented here are free of gastroesophageal reflux or dysphagia symptoms, with no necessity for acid suppression medication, and no side effects of the surgery. Conclusion: The treatment of giant HH is a complex and challenging disorder to treat. PSG seems to be a good surgical alternative for the treatment of some special cases of giant HH minimizing the GERD symptoms and possible recurrences.

Evaluation of robot-assisted laparoscopic versus conventional laparoscopic hiatal hernia repair in children.

Laparoscopic approach is the gold standard for repairing hiatal hernia (HH). Robotic technology is now widely accepted, but it is rarely used in children with HH. Our aim was to evaluate the clinical effect of robot-assisted laparoscopic surgery (RALS) and conventional laparoscopic surgery (CLS) in the treatment of HH in children. A retrospective study was carried out in patients undergoing elective robot-assisted laparoscopic or conventional laparoscopic HH repair at a tertiary academic hospital from January 2020 to December 2022, and patients who met the inclusion criteria were included in this study. We compared the characteristics and clinical results of patients to understand the effects of the two surgical methods. Forty-six patients (CLS, group 1, n = 25; RALS, group 2, n = 21) met the inclusion criteria. All operations were performed by one experienced pediatric surgeon. In this study, no significant differences were found in terms of gender, age, weight, size of HH, total operation times, the effective operation time (excluding setup time) and complications between group 1 and group 2. (P = 0.979, P = 0.438, P = 0.265, P = 0.800, P = 0.122, P = 0.427 and P = 0.478, respectively). However, the intraoperative bleeding, the intensive care unit (ICU) admission, postoperative hospital length of stay (LOS) and postoperative fasting time were significantly less for RALS (P = 0.016, P = 0.040, P = 0.035 and P = 0.025, respectively). Meanwhile, the overall charges were significantly higher in group 2 (P < 0.01). Despite higher charges for robotic-assisted HH repair, it is a safe and reliable alternative to CLS and was associated with better outcomes in children.

Evidence mapping on how to perform an optimal surgical repair of large hiatal hernias

BackgroundSymptomatic and large hiatal hernia (HH) is a common disorder requiring surgical management. However, there is a lack of systematic, evidence-based recommendations summarizing recent reviews on surgical treatment of symptomatic HH. Therefore, this systematic review aimed to create evidence mapping on the key technical issues of HH repair based on the highest available evidence.MethodsA systematic review identified studies on eight key issues of large symptomatic HH repair. The literature was screened for the highest level of evidence (LE from level 1 to 5) according to the Oxford Center for evidence-based medicine’s scale. For each topic, only studies of the highest available level of evidence were considered.ResultsOut of the 28.783 studies matching the keyword algorithm, 47 were considered. The following recommendations could be deduced: minimally invasive surgery is the recommended approach (LE 1a); a complete hernia sac dissection should be considered (LE 3b); extensive division of short gastric vessels cannot be recommended; however, limited dissection of the most upper vessels may be helpful for a floppy fundoplication (LE 1a); vagus nerve should be preserved (LE 3b); a dorso-ventral cruroplasty is recommended (LE 1b); routine fundoplication should be considered to prevent postoperative gastroesophageal reflux (LE 2b); posterior partial fundoplication should be favored over other forms of fundoplication (LE 1a); mesh augmentation is indicated in large HH with paraesophageal involvement (LE 1a).ConclusionThe current evidence mapping is a reasonable instrument based on the best evidence available to guide surgeons in determining optimal symptomatic and large HH repair.

10 Critical Steps of Hiatal Hernia Repair and Anti-Reflux Surgery: An Expert Consensus and Literature Review

Background: There is significant variability in the treatment of hiatal hernias, which has led to various perspectives regarding the proper manner of dissection, repair, and reconstruction. We sought to evaluate and analyze expert opinions, survey data, and the literature to define the critical steps in hiatal hernia repair. Methods: A focus group ( focus) of expert foregut surgeons defined and agreed upon a sequence of critical steps of a hiatal hernia repair. Using the data from the focus group, an anonymous survey was compiled and distributed to members of the American Foregut Society (AFS). The survey data ( survey) was then compared to the focus for agreement. The compiled focus and survey data was interpreted as expert recommendation ( expert). A literature review ( literature) was then conducted and compared to expert data for agreement and evaluation of discordance. This was used to define the critical steps of hiatal hernia repair. Results: Of the 10 identified critical steps, there was agreement on 9 of 10 steps between focus and survey. The 1 step with discordance was supported by the literature. Conclusions: Ten critical steps have been identified to help produce a succinct and reproducible approach to hiatal hernia repair. It is believed that adherence to these steps will allow the surgeon to achieve a safe and successful hiatal repair.

Causes of failures of known methods of antireflux laparoscopic interventions for hiatal hernias

Background. The objective: to compare the effectiveness and safety of known laparoscopic antireflux interventions in the treatment of hiatal hernia and to detect the causes for their failure in a retrospective study. Materials and methods. In a retrospective comparative study, the long-term results of using the main methods of laparoscopic plastic surgery for hiatal hernias of various types and degrees were analyzed. Seventy-four (56.5%) patients who underwent Nissen fundoplication were included in group 1. Group 2 consisted of 37 (28.2%) people who underwent Toupet fundoplication and group 3 included 20 (15.3%) patients who underwent Dor fundoplication. The study includes patients operated in the clinic of the institute over a 7-year period, with the possibility of clinical evaluation of long-term results and the exclusion of factors affecting the results of plastic surgery. All patients underwent X-ray and endoscopic examinations of the esophagus, stomach, duodenum, as well as manometry. Results. When analyzing the complaints of patients from groups 1–3 in the postoperative period, it can be noted that the most statistically significant indicators were dysphagia, regurgitation, cough, heartburn, bloating, stomach heaviness, pain behind the sternum (p&lt;0.05, exact F test). During endoscopic examination, reflux esophagitis was detected in 16 (21.6%) patients of group 1, in 7 (18.9%) of group 2, and in 2 (10.0%) patients of group 3. Erosions of the lower third of the esophagus were found in 14 (18.9%) patients from group 1, in 6 (16.2%) from group 2, and in 2 (10.0%) patients from group 3. Esophageal stricture was detected in 1 (1.4%) patient from group 1 in the postoperative period during endoscopic examination. Signs of a “second entrance” to the stomach were found in 16 (13.5%) patients of group 1, in 5 (13.5%) of group2, and in 2 (10.0%) of group 3. Dislocation of the fundoplication cuff was noted in 1 (1.3%) patient of group1, resulting in deformation of the esophagogastric junction and pain syndrome. Pylorospasm was found in 8 (8.8%) patients from group 1, in 3 (2.9%) from group 2 and in 1 (5.0%) patient from group 3. During the X-ray examination, recurrent hiatal hernia was detected: in group 1— in 10 (13.5%) cases, in group 2— in 5 (13.5%), in group 3— in 2(10.0%). When assessing the quality of life of patients after surgical interventions, it was found that in group 1, the average score on the Gastroesophageal Reflux Disease— Health-Related Quality of Life (GERD-HRQL) questionnaire was (11.0±5.5 (3–35) points, in group 2— (19.0±8.0 (3–35)), in group 3— (16.0±7.3 (3–35)) points, which was quite high in all groups. The distribution of satisfaction with the condition in group 1 was as follows: satisfied— 34 (45.9%) patients, partially satisfied— 24 (32.4%), unsatisfied— 16 (21.6%). The distribution of satisfaction with the condition in group 2 was as follows: satisfied— 16 (43.2%) patients, partially satisfied— 14 (37.8%), unsatisfied— 7 (19.0%). The distribution of satisfaction with the condition in group 3 was as follows: satisfied— 9 (45.0%) patients, partially satisfied— 8 (40.0%), unsatisfied— 3 (15.0%). In the distant postoperative period, complications (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures) occurred in 40 (54.1%) patients of group 1, in 14 (37.8%) of group 2, and in 6 (30.0%) of group 3. There were no significant differences in the frequency of postoperative complications between groups (54.1 vs. 37.8%, p&gt;0.05, exact F test; 54.1 vs. 30.0%, p&gt;0.05, exact F test; 37.8 vs. 30.0%, p&gt;0.05, exact F test). Conclusions. 1. The number of patients who are unsatisfied with the results of surgery according to GERD-HRQL questionnaire, was 21.6% ((11.0±5.5) points) after Nissen fundoplication, 19.0% ((19.0±8.0) points) after Toupet fundoplication, and 15.0% ((16.0±7.3) points) after Dor fundoplication. 2. Failures of the known methods of antireflux laparoscopic interventions for hiatal hernia are associated with the destruction of the components of the physiological cardia and occurred in 40 (54.1%) patients of group 1 (pylorospasm, dysphagia, dyspeptic disorders, reflux esophagitis, esophageal strictures), in 14 (37.8%) in group 2 and in 6 (30.0%) in the third group. 3. Nissen fundoplication in the postoperative period was significantly more often accompanied by dysphagia and pylorospasm compared to Toupet and Dor fundoplications (p&lt;0.05).

Outcomes of surgical treatment for physiological cardia insufficiency in hiatal hernias andgastroesophageal reflux disease

Background. The purpose was to determine the effectiveness of the developed method of surgical treatment for insufficiency of the physiological cardia in hiatal hernias (HH) and gastroesophageal reflux disease (GERD). Materials and methods. From January 2013 to September 2021, 141 patients were treated laparoscopically for HH and GERD at the clinic of the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine, 44 (31.2%) men and 97 (68.8%) women aged 21–70 (36.5±4.2) years. To evaluate the immediate and long-term results in the follow-up period lasting from 11 months to 3 years, a randomized comparative study was conducted between groupI— 45 patients after classical antireflux operations and group II— 34 patients after surgery to restore the physiological cardia. X-ray examination of the esophagus and stomach was performed to diagnose HH. Endoscopic examination was used to evaluate the condition of the mucous membrane of the esophagogastroduodenal zone. Results. In 141 patients, the following types of laparoscopic surgical interventions were performed: Nissen fundoplication— in 84 (59.6%), Toupet fundoplication— in 12 (8.5%), Dor fundoplication— in 11 (7.8%), restoration of the physiological cardia according to the proposed method, namely, medial cruroplication, anterior cardiogastroplication with gastrodiaphragmopexy,— in 34 (24.1%) cases. Crurorrhaphy was carried out in 100.0% of patients: posterior— in 64 (45.4%), anterior and posterior (combined)— in 27 (20.1%), medial cardiocrurorrhaphy and lateral cardiofundocrurorrhaphy according to the proposed method— in 34 (19.1%). Alloplasty of the esophageal hiatus was performed in 16 (11.3%) cases. By the frequency of intraoperative and early postoperative complications, a significant difference was detected in favor of group II (5 (11.1%) vs. 1 (2.9%), p&lt;0.05, and 14 (31.1%) vs. 2 (5.8%), p&lt;0.05, respectively, Fisher’s exact test). Depending on the frequency of anatomical (5.8 vs. 17.7%, p=0.003, χ2 test), functional (5.8 vs. 13.3%, p=0.045, χ2 test) and a combination of anatomical and functional (11.1 vs. 2.9%, p=0.003, χ2 test) relapses, a significant difference is revealed in favor of group II. In terms of the frequency of pylorospasm and dysphagia, a significant difference was detected in favor of groupII (2.9 vs. 17.7%, p=0.009, and 2.9 vs. 28.9%, p=0.007, respectively, Fisher’s exact test). Conclusions. The analysis of the immediate results of using the proposed method of surgical treatment for the restoration of the physiological cardia has shown that it ensures the elimination of pathological changes in HH, in comparison with classical antireflux methods, reduces the frequency of intraoperative (2.9 vs. 11.1%) and early postoperative (5.8 vs. 31.1%) complications. In the long-term period after surgical treatment of HH with the proposed method, the frequency of HH recurrence is reliably reduced compared to the outcomes when using classical antireflux methods, particularly the frequency of anatomical (5.8 vs. 17.7%, p=0.003, χ2 test) and functional (5.8 vs. 13.3%, p=0.045, χ2 test) relapses.

Laparoscopic Nissen fundoplication: a five-year single-center clinical experience and results.

The current surgical approach in the treatment of hiatal hernia with gastroesophageal reflux disease is known as hernioplasty together with antireflux surgical procedures. Among the antireflux surgical treatment procedures, the most applied approach is the laparoscopic Nissen fundoplication. In this study, we aimed to examine the results and effectiveness of laparoscopic Nissen fundoplication and to share our clinical experiences. Patients who underwent laparoscopic Nissen fundoplication operation between January 2017 and January 2022 in the general surgery clinic of a tertiary healthcare center were included in the study. The clinical data, preoperative, operative, and postoperative findings and results of the cases were investigated. The mean age of the patients was 46.2 ± 14.7 years, and the female/male ratio was 1.5/1. According to the Clavien-Dindo classification system, 9.9% of the patients had grade I, and 18.3% grade II complications. The patients were followed up for a mean of 32.6 ± 14.8 months. During the follow-up, reoperation was planned in 5.6% of the patients due to recurrence. Laparoscopic Nissen fundoplication is a well-defined technique. It is a safe and effective surgical method with appropriate patient selection.

Is systematic formal crural repair mandatory at the time of magnetic sphincter augmentation implantation?

Laparoscopic placement of the LINX Magnetic Sphincter Augmentation (MSA) device has become an accepted alternative to fundoplication in appropriate patients. Initial studies of MSA targeted to patients with 'early' disease allowed for the most minimal dissection of the esophagus to place the device, without hiatal dissection or repair (NoHHR), in patients with no or minimal hernia findings at surgery. Subsequent studies have compared systematic formal hiatal dissection and repair (Formal HHR) with the original minimal dissection technique. Review of published literature on MSA includes discussion on treatment of hiatal hernia at the time of implantation, accompanying the review of the physiology of the crural diaphragm. Formal hiatal hernia repair at the time of MSA implantation results in better control of reflux with less dysphagia and risk of postoperative hernia than NoHHR, regardless of the presence or size of hiatal hernia. Systematic crural repair should accompany any MSA implantation regardless of the presence or size of hiatal hernia.

Migrasyon Olan Nissen Fundoplikasyon Meshinin Endoskopik Çıkarılması

Laparoscopic Nissen fundoplication is known to be a safe and feasible method in the treatment of hiatal hernias. However, a recurrence rate of 42% has been reported. Using mesh repair in patients undergoing Nissen fundoplication has shown fewer recurrence rates than the primary suture, even though there have been few complications reported. Some complications that may occur with mesh placement are; severe fibrosis, esophageal strictures, esophageal perforations, mesh migration to the upper gastrointestinal tract, and mesh erosion in the intestinal wall, etc. In this report, the migration of the leathery esophagus developed after about 11 years was presented. In such cases, patients may have several surgical options. Among these options, the mesh was completely removed endoscopically. No further surgery was required. In conclusion, it is recommended to use a very selective mesh in the laparoscopic repair of the hiatal hernias, considering the surgeon's experience, hiatus anatomy, and patient's symptoms.

Roux-en-Y Gastrojejunostomy: is it an effective treatment for complex Hiatal hernias in the morbidly obese?

Primary repair failure rates for hiatal hernias (HH) can reach up to 40%, this is especially high in the morbidly obese patient. There is no clear data on how to manage this patient subset. This paper evaluates the efficacy of Roux-N-Y Gastrojejunostomy (RNY GJ) for treatment of symptomatic HH. A retrospective analysis of all patients who received a Roux-en-Y Gastrojejunostomy (RNY GJ) for HH at our institution between January 2016 and January 2021 was performed. Patient demographics, symptoms, and post-operative outcomes were recorded and univariate analysis was performed between preoperative and postoperative symptoms. Thirty-seven patients with a mean age of 56.9years (SD 11.8) underwent RNY GJ. Patients were mostly female (81.1%) with a mean BMI of 36.8 (SD 8.4). An 78.4% reduction in symptoms of either heartburn, dysphagia, or regurgitation was noted at follow up (p < 0.001). RNY GJ represents a safe procedure for morbidly obese patients with hiatal hernias with no mortalities amongst our patient cohort along with a significant reduction in pre-operative symptoms and no symptomatic recurrences. RNY GJ should be considered as the operation of choice for repair for this patient population.

Long-term outcomes and satisfaction of laparoscopic non-absorbable mesh-reinforced hiatal hernia repair

BackgroundInterest in laparoscopic mesh-reinforced hiatal hernia (HH) repair is driven by concern of recurrences following primary suture repair alone. There is need for further evidence on non-absorbable mesh-related complications or the long-term outcomes and patient satisfaction of laparoscopic mesh-reinforced HH repair. MethodsA retrospective analysis of consecutive patients (2005-2016) of a single surgeon. Patients were further surveyed via telephone and mailed questionnaires to assess long-term satisfaction and outcomes using Visick and gastro-oesophageal reflux disease symptoms assessment scale (GSAS) scores. Results174 patients underwent laparoscopic HH repair, either as part of laparoscopic anti-reflux surgery (ARS) or for treatment of para-oesophageal HH in this period and fulfilled the study criteria. Patients with crural defects > 2cm received primary closure and those with larger defects received mesh reinforcement. Primary repair was performed in 28.2% (n=49) and mesh-reinforcement in 71.8% (n=125). HH recurrence (20.4% vs 17.6%, p=0.67) and reoperation rates (16.3% vs 10.4%, p=0.28) were not significantly different between the two groups. GSAS scores (2.1 vs 1.8. p=0.74) and patient satisfaction (p=0.82) were similar. Resolution of symptoms (Visick 1) favoured the mesh-reinforced group (19.4% vs 46.5%, p=0.04). There were no mesh infections or erosions. ConclusionIn our cohort, laparoscopic non-absorbable mesh-reinforced HH repair of large defects had similar long-term results to primary repair of small defects. There were potential long-term improvements in patient symptomatic outcomes as determined by the Visick score.

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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Diaphragmatic hernia following living-donor right hepatectomy: Experience of a high-volume transplant center

Right diaphragmatic hernia (DH) occurs more in recipients or those receiving hepatectomy (for neoplasms, not for transplantation), but very rarely in donor patients. Between November 1994 and December 2020, we experienced DH following living-donor right hepatectomy in 6 of 5,672 adult LDLT. Here, we report successful treatment of DH and evaluate long-term outcomes by reviewing the medical records of the 6 patients. All 6 patients presented with abdominal pain and underwent diaphragmatic repair at a median time interval of 4.95 years (range, 0.24-17.00 years) after hepatectomy. All patients were diagnosed by computerized tomography scan. Except for one patient who underwent an abdominal approach, the rest of the patients had a right thoracotomy with lysis of the adhesions, reduction of the hernia, and primary repair of the diaphragm. At last follow-up, all 6 patients remain normal chest X-ray examination demonstrating no recurrence of diaphragmatic hernia, and normal liver functions tests. Although rare, diaphragmatic hernia should be considered as an important potential late complication in live donor underwent right hepatectomy. The screening protocol for early identification should be applied to prevent the development of complications.

Successful repair of diaphragmatic hernia with simultaneously performed thoracotomy and median laparotomy in a horse

AbstractThis report describes the successful treatment of a chronic diaphragmatic hernia in a 2.5‐year‐old crossbred gelding. The tear remained unidentified until colic signs and dyspnoea appeared. In this case, an unconventional surgical approach was used. Based on the clinical findings, diaphragmatic herniation with non‐strangulating large intestinal involvement was diagnosed. From the ventral midline approach, a diaphragmatic tear with a diameter of 20 cm in the left ventral area was found together with a fractured 10th rib. Repositioning of the large colon was unsuccessful through the ventral midline approach, therefore lateral thoracotomy via rib resection was performed without closing the ventral midline incision. The simultaneous laparotomy with thoracotomy can be a useful approach in the treatment of diaphragmatic hernias when the tear is located ventrally. Advantages of the described surgical technique were easier reposition of the herniated intestine and good access to close the diaphragmatic tear, and disadvantage was the longer surgical time.

Current issues of surgical treatment of large and giant hiatal hernias

This work analyzes Russian and international literature sources that discuss the surgical intervention results for large and giant hiatal hernias. To date, there is no uniform classification of hiatal hernias by the size of the hernial defect. The classifications and algorithms for choosing the plastic method proposed by various authors provide no convincing evidence base. Although there are many methods for surgically correcting hiatal hernia, clear indications for their implementation have not been developed. The postoperative complications and relapses of the disease after surgery represent an unresolved issue. The laparoscopic approach for large and giant hiatal hernias is preferable to open surgery. However, it can lead to serious intra- and postoperative complications, especially in emergency cases. Alloplasty provides clinical improvement and an increase in the quality of life of patients, but has a relatively high risk of recurrence. To date, the treatment of hiatal hernias involves using various prosthetic materials, and their advantages and disadvantages are described in this article. Thus, the search for optimal surgical techniques to treat large and giant hiatal hernias continues.

Modern aspects of treatment of hiatal hernia and its main complications

The aim. To evaluate the features and results of minimally invasive surgical treatment of patients with hiatal hernia (HH) and its main complications using modern endoscopic and laparoscopic technologies. Materials and methods. The treatment results of 244 patients with HH and its main complications are given. 28 (11.5 %) patients had a combination of HH with Barrett’s esophagus, and 34 (13.9 %) patients had a combination of HH with esophageal stricture. In 62 patients with complications of HH, two-stage treatment tactics was used. Complete laparoscopic fundoplication was performed in 185 (75.8 %) patients, posterior partial Toupet fundoplication – in 59 (24.2 %) patients. Laparoscopic posterior crurography was performed in 198 (81.1 %) patients. In 7 (2.9 %) posterior crurography was supplemented by anterior. Teflon gaskets were used in 25 (10.3 %) patients during posterior crurography. Synthetic mesh prostheses were implanted in 14 (5.7 %) patients. Results. In patients with esophageal stricture, the effect was observed after the second session of bougienage or hydro-dilation in 70.6 % of cases, after the third session - in the remaining cases. In Barrett's esophagus, a single session of argon plasma coagulation was radical in 100 % of patients with a lesion size less than 1 cm and in 85 % of patients with lesions of 1 cm to 2 cm in size. Recurrence of type III HH occurred more often than type I. The surgery required sufficient mediastinal dissection and mobilization for an adequate esophagus pull-through. In the surgical treatment of type IV HH, the use of composite diaphragmatic meshes was considered. The effectiveness of antireflux surgical intervention, as well as prevention of specific complications was depended on the technical features of the fundoplication cuff formation. Conclusions. In the treatment of Barrett’s esophagus or esophageal stricture in combination with HH, the two-stage tactics is optimal: stage I – ablation or dilatation, and stage II – laparoscopic antireflux surgery. Laparoscopic fundoplication is an effective and safe method for treatment of patients with HH.

Surgical methods of treatment of hiatal hernias

Surgical methods of treatment of hiatal hernias

Hiatal Hernia with Acute Obstructive Symptoms After Minimally Invasive Oesophagectomy

BackgroundTo evaluate the incidence, treatment and postoperative outcomes of an acute hiatal hernia (HH) after totally minimally invasive esophagectomy (tMIE) for oesophageal cancer. MethodsThe incidence and treatment of acute HH were analysed from our prospective database including all patients that were surgically treated for oesophageal cancer in the period between January 2011 and December 2018. ResultsWithin the study period, the database contained 307 patients that underwent minimally invasive oesophagectomy. Patients’ characteristics were in line with the literature of Western data. The incidence of acute HH was 2.6% (N = 8). All patients presented with gastro-intestinal obstruction symptoms, that required acute operation, repositioning of the intrathoracic organs in combination with a crural repair. Mesh reinforcement was used in 38% (N = 3). In two patients, the intestines were partially resected due to ischemia. Postoperative complications, as atrial fibrillation, respiratory failure and anastomotic leakage, were seen in 63% (N = 5). Recurrence-rate was 38% (N = 3). ConclusionsThis present study demonstrates that an acute HH after tMIE is a serious complication with an incidence of 2.6%. When symptomatic and acute, HH requires surgical intervention and has high postoperative morbidity and recurrence-rate. Therefore, this requires treatment in a centre specialised in oesophageal surgery.