Pérez Lara FJ, Zubizarreta Jimenez R, Prieto-Puga Arjona T, Gutierrez Delgado P, Hernández Carmona JM, Hernández Gonzalez JM, Pitarch Martinez M. Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor. World J Gastrointest Surg 2023; 15(12): 2739-2746 [PMID: 38222019 DOI: 10.4240/wjgs.v15.i12.2739]
Corresponding Author of This Article
Francisco Javier Pérez Lara, PhD, Chief Physician, Doctor, Surgeon, Department of Surgery, Hopital de Antequera, Avda. Poeta Muñoz Rojas, Antequera 29200, Spain. javinewyork@hotmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Dec 27, 2023; 15(12): 2739-2746 Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2739
Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor
Francisco Javier Pérez Lara, Rogelio Zubizarreta Jimenez, Tatiana Prieto-Puga Arjona, Pilar Gutierrez Delgado, Juan Manuel Hernández Carmona, Jose Manuel Hernández Gonzalez, Maria Pitarch Martinez
Francisco Javier Pérez Lara, Tatiana Prieto-Puga Arjona, Juan Manuel Hernández Carmona, Jose Manuel Hernández Gonzalez, Maria Pitarch Martinez, Department of Surgery, Hopital de Antequera, Antequera 29200, Spain
Rogelio Zubizarreta Jimenez, DOXA, Microfluidics, Rincon de la Victoria 29730, Spain
Pilar Gutierrez Delgado, Department of Surgery, HRU Carlos Haya, Unidad Cirugia Hepatobiliopancreat & Trasplantes, Malaga 29200, Spain
Author contributions: Pérez Lara FJ made a substantial contribution to the concept and design; Pérez Lara FJ and Zubizarreta Jimenez R drafted the article or revised it critically for important intellectual content; and all authors approved the version to be published.
Institutional review board statement: The study was followed our hospital’s ethical committee for human studies.
Informed consent statement: All patients signed the informed consent statement.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: We consent sharing the full data sets underlying the results in our article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francisco Javier Pérez Lara, PhD, Chief Physician, Doctor, Surgeon, Department of Surgery, Hopital de Antequera, Avda. Poeta Muñoz Rojas, Antequera 29200, Spain. javinewyork@hotmail.com
Received: September 28, 2023 Peer-review started: September 28, 2023 First decision: November 1, 2023 Revised: November 9, 2023 Accepted: December 6, 2023 Article in press: December 6, 2023 Published online: December 27, 2023
Abstract
BACKGROUND
Giant hernias present a significant challenge for digestive surgeons. The approach taken (laparoscopic vs thoracoscopic) depends largely on the preferences and skills of each surgeon, although in most cases today the laparoscopic approach is preferred.
AIM
To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem, in order to assess the need for a thoracoscopic approach.
METHODS
For the retrospective series of patients treated in our hospital for hiatal hernia (n = 112), we calculated the laparoscopic field of view and the working area accessible to surgical instruments, by means of preoperative imaging tests, to assess the likely outcome for cases inaccessible to laparoscopy.
RESULTS
Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded. The difference was statistically significant. Moreover, the insertion of mesh did not improve results for the non-accessible group.
CONCLUSION
For patients with giant hiatal hernias, it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery. When parts of the intrathoracic sac are inaccessible laparoscopically, the thoracoscopic approach should be considered.
Core Tip: In a previous study, we presented a series of mathematical formulas that can be used to assess the accessibility of large hiatal hernias to a laparoscopic approach, concluding that for some patients this technique was not viable. In the present retrospective study, we examine whether outcomes are poorer among patients whose hiatal hernias are deemed inaccessible to laparoscopy (according to the mathematical formulation applied to the preoperative imaging results).
