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Treatment of giant paraesophageal hernia: pro laparoscopic approach.
Hernia. 2018 12; 22(6):909-919.H

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.

Authors+Show Affiliations

IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. bernard.dallemagne@ircad.fr. Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. bernard.dallemagne@ircad.fr.Institute of Image Guided Surgery/IHU Strasbourg, 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.Institute of Image Guided Surgery/IHU Strasbourg, 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.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.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29177588

Citation

Dallemagne, B, et al. "Treatment of Giant Paraesophageal Hernia: Pro Laparoscopic Approach." Hernia : the Journal of Hernias and Abdominal Wall Surgery, vol. 22, no. 6, 2018, pp. 909-919.
Dallemagne B, Quero G, Lapergola A, et al. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia. 2018;22(6):909-919.
Dallemagne, B., Quero, G., Lapergola, A., Guerriero, L., Fiorillo, C., & Perretta, S. (2018). Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia : the Journal of Hernias and Abdominal Wall Surgery, 22(6), 909-919. https://doi.org/10.1007/s10029-017-1706-8
Dallemagne B, et al. Treatment of Giant Paraesophageal Hernia: Pro Laparoscopic Approach. Hernia. 2018;22(6):909-919. PubMed PMID: 29177588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of giant paraesophageal hernia: pro laparoscopic approach. AU - Dallemagne,B, AU - Quero,G, AU - Lapergola,A, AU - Guerriero,L, AU - Fiorillo,C, AU - Perretta,S, Y1 - 2017/11/25/ PY - 2017/04/24/received PY - 2017/11/18/accepted PY - 2017/11/28/pubmed PY - 2019/5/10/medline PY - 2017/11/28/entrez KW - Diaphragmatic hernia KW - Giant paraesophageal hernia KW - Hiatal hernia KW - Laparoscopy KW - Mesh SP - 909 EP - 919 JF - Hernia : the journal of hernias and abdominal wall surgery JO - Hernia VL - 22 IS - 6 N2 - 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. SN - 1248-9204 UR - https://www.unboundmedicine.com/medline/citation/29177588/Treatment_of_giant_paraesophageal_hernia:_pro_laparoscopic_approach_ L2 - https://dx.doi.org/10.1007/s10029-017-1706-8 DB - PRIME DP - Unbound Medicine ER -