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[Laparoscopic approach in large hiatal hernia--particular considerations]
R Munteanu1, C Copăescu, R Iosifescu
1Clinica de Chirurgie Generală, Spitalul Clinic, Sf. Ioan, Bucureşti. rubinmunteanu@hotmail.com
Chirurgia (Bucharest, Romania : 1990)
|March 5, 2004
Summary
Laparoscopic surgery for large hiatal hernias is feasible and effective, even with complications. This minimally invasive technique offers good outcomes but demands surgical expertise.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Large hiatal hernias involve significant stomach protrusion (>1/3) into the chest, often causing complications.
- While laparoscopic surgery is standard for small hernias, its application in large hernias remains debated.
- This study evaluates the laparoscopic approach for large hiatal hernias, addressing associated controversies.
Observation:
- Twenty-three patients (mean age 65.8) with large hiatal hernias underwent laparoscopic repair between 1995 and 2002.
- Most patients presented with complications such as dysphagia, esophagitis, anemia, and cardiorespiratory failure.
- Hernia types included sliding (16), paraesophageal (2), and mixed (5), with some requiring mesh repair and others concurrent procedures like cholecystectomy or Heller myotomy.
Findings:
- The laparoscopic approach demonstrated feasibility and effectiveness in managing large hiatal hernias.
- Complications during surgery included pneumothorax, and postoperatively, dysphagia and one mortality due to cardiorespiratory failure.
- Good postoperative results were achieved, with 20 patients undergoing a Nissen fundoplication and three receiving mesh repair.
Implications:
- Laparoscopic surgery is a viable option for large hiatal hernias, offering good outcomes.
- The procedure requires advanced minimally invasive surgical skills.
- Further research may explore optimizing techniques and patient selection for improved safety and efficacy.