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Reflections on surgery for hiatal hernia.

Alberto Aiolfi1, Davide Bona1, Quan Wang2,3

  • 1Department of Biomedical Sciences for Health, Division of General Surgery, I.R.C.C.S. Ospedale Galeazzi - Sant'Ambrogio, University of Milan, Milan, Italy.

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Summary
This summary is machine-generated.

Gastroesophageal reflux disease (GERD) and hiatal hernias impair the antireflux barrier. Surgical and device-based treatments aim to restore this barrier, with emerging AI tools enhancing surgical outcomes.

Keywords:
Antireflux barrierFundoplicationGastroesophageal reflux diseaseHiatal herniaHiatoplastyLower esophageal sphincter

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Area of Science:

  • Gastroenterology and Surgical Innovation
  • Medical Device Technology
  • Artificial Intelligence in Surgery

Background:

  • Gastroesophageal reflux disease (GERD) and hiatal hernias are prevalent, chronic conditions significantly impacting quality of life.
  • Impaired antireflux barrier function is the primary cause of GERD symptoms and complications.
  • Accurate diagnosis requires a multidisciplinary approach to assess anatomical defects, motility, and reflux severity.

Purpose of the Study:

  • To review current diagnostic and therapeutic strategies for GERD and hiatal hernias.
  • To evaluate the efficacy and safety of surgical and device-based interventions.
  • To explore the emerging role of artificial intelligence in managing these conditions.

Main Methods:

  • Comprehensive multidisciplinary assessment including endoscopy, manometry, and pH monitoring.
  • Laparoscopic surgical management (crural repair, fundoplication) for refractory or complicated cases.
  • Evaluation of novel devices (LINX, RefluxStop) and surgical techniques (robotic-assisted).

Main Results:

  • Laparoscopic fundoplication effectively controls reflux but may cause dysphagia or gas-bloat.
  • Partial fundoplication offers comparable control with fewer side effects in specific patients.
  • Novel devices show promise for lower esophageal sphincter augmentation.
  • The role of mesh in hiatal repair is debated; robotic surgery offers precision but higher costs.
  • AI shows potential for improving surgical planning and outcomes.

Conclusions:

  • Surgical and device-based interventions can restore the antireflux barrier in selected patients.
  • Treatment choice should consider patient-specific factors like esophageal motility.
  • AI is poised to enhance the standardization and efficacy of GERD and hiatal hernia management.