3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision

Background. The aim of this study is to evaluate if 3-dimensional high-definition (3D) vision in laparoscopy can prompt advantages over conventional 2D high-definition vision in hiatal hernia (HH) repair. Study design. Between September 2012 and September 2015, we randomized 36 patients affected by symptomatic HH to undergo surgery; 17 patients underwent 2D laparoscopic HH repair, whereas 19 patients underwent the same operation in 3D vision. Results. No conversion to open surgery occurred. Overall operative time was significantly reduced in the 3D laparoscopic group compared with the 2D one (69.9 vs 90.1 minutes, P = .006). Operative time to perform laparoscopic crura closure did not differ significantly between the 2 groups. We observed a tendency to a faster crura closure in the 3D group in the subgroup of patients with mesh positioning (7.5 vs 8.9 minutes, P = .09). Nissen fundoplication was faster in the 3D group without mesh positioning ( P = .07). Conclusions. 3D vision in laparoscopic HH repair helps surgeon’s visualization and seems to lead to operative time reduction. Advantages can result from the enhanced spatial perception of narrow spaces. Less operative time and more accurate surgery translate to benefit for patients and cost savings, compensating the high costs of the 3D technology. However, more data from larger series are needed to firmly assess the advantages of 3D over 2D vision in laparoscopic HH repair.

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370 LAPAROSCOPIC HIATAL HERNIA REPAIR: INSIGHTS FROM A HIGH-VOLUME CENTER

Diseases of the Esophagus ◽

10.1093/dote/doaa087.87 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

L Giulini ◽

D Razia ◽

S Mittal

Keyword(s):

Quality Of Life ◽

Hiatal Hernia ◽

Laparoscopic Repair ◽

Operative Time ◽

High Volume ◽

Perioperative Outcomes ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

Abstract When a hiatal hernia (HH) becomes symptomatic, surgical repair is indicated. The surgical procedure can be safely carried out laparoscopically with good results. However, it is unclear whether the size of the hernia affects perioperative outcomes. The aim of this study was to assess whether laparoscopic repair of large hiatal hernias (L-HH) has comparable results to laparoscopic repair of small hernias (S-HH). Methods After approval from the Institutional Review Board, a prospectively maintained database was reviewed for data on patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). HHs were defined as “large” when at least 50% of the stomach was herniated through the hiatus. Data on perioperative results and mid-term follow-up were analyzed. The Clavien-Dindo (CD) classification was used to define complications. Results Of 170 identified patients, 55 had L-HH; 115 had S-HH. Mean ages were 72 ± 10 for L-HH and 61 ± 11.3 years for S-HH (p < 0.001). Median operative time was 95 (IQR, 80–110) and 75 minutes (IQR, 65–90) for L-HH and S-HH, respectively (p < 0.001). L-HH patients had longer hospital stays (median 2 vs 1 days, IQR 1–2 for both; p = 0.001) and more complications (12/55 [21.8%] vs 4/115 [3.5%]; p < 0.001) than S-HH patients. Two L-HH patients had CD grades IIIb and IVa. At follow-up (20.9 ± 8.7 months), gastroesophageal reflux disease quality of life scores were comparable between groups (6.4 ± 11.7 vs 5.2 ± 0; p = 0.9). Conclusion Laparoscopic HH repair is safe and feasible; however, is more technically challenging and is associated with longer operative time, longer hospital stay, and increased morbidity when performed as treatment for L-HH (ie, at least 50% of the stomach herniated through the hiatus). Nonetheless, good quality of life outcomes can be achieved at mid-term follow-up in both patients with S-HH and patients with L-HH who undergo treatment by an experienced surgeon.

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Laparoscopic hiatal hernia repair: why they fail

Hernia ◽

10.1007/bf01201070 ◽

2000 ◽

Vol 4 (4) ◽

pp. 219-222 ◽

Cited By ~ 3

Author(s):

C. J. Filipi

Keyword(s):

Hernia Repair ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

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Iatrogenic cardiac tamponade after laparoscopic hiatal hernia repair requiring emergency sternotomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy433 ◽

2018 ◽

Vol 56 (1) ◽

pp. 215-215 ◽

Cited By ~ 1

Author(s):

Samuel Heuts ◽

Walther N K A van Mook ◽

Eric J Belgers ◽

Roberto Lorusso

Keyword(s):

Hernia Repair ◽

Cardiac Tamponade ◽

Hiatal Hernia ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

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532 OUTCOME OF QUILICI’S HEPATIC SHOULDER PROCEDURE TO AUGMENT LAPAROSCOPIC HIATOPLASTY IN LARGE OR RECURRENT HIATAL HERNIA

Diseases of the Esophagus ◽

10.1093/dote/doab052.532 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Johannes Zacherl ◽

Viktoria Kertesz ◽

Cordula Höfle ◽

Lisa Gensthaler ◽

Bernhard Eltschka ◽

...

Keyword(s):

High Risk ◽

Hernia Repair ◽

Hiatal Hernia ◽

Laparoscopic Hernia Repair ◽

Perioperative Complications ◽

Recurrent Hernia ◽

Hernia Recurrence ◽

Hiatal Hernia Repair ◽

Laparoscopic Hiatal Hernia Repair

Abstract Laparoscopic hiatoplasty and fundoplication is the gold standard of surgical treatment of GERD and hiatal hernia. However, the main drawback of laparoscopic hiatal hernia repair is a substantial recurrence rate. Hence, prosthetic meshs have been used to reduce the risk for recurrence. But meshs may cause major complications. As a consequence we adopted the hepatic shoulder plasty described by Quilici to augment the hiatal hernia repair in patients with a high risk for hernia recurrence. Methods Patients with large (>4 cm) axial hiatal hernia, giant paraesophageal or with recurrent hernia consecutively underwent laparoscopic hernia repair with crural sutures and hepatic shoulder plasty. A Toupet or a floppy Nissen fundoplication was added. In patients with giant paraesophageal hernia the hernia sack was resected. Perioperative complications were recorded. Follow-up comprised endoscopy and/or radiography and QoL-evaluation with the Eypasch score (GIQLI). Results Between 2012 and 2018 51 patients (mean age 71 years, 65% female) underwent Quilici’s procedure. Among them 33,3% had one or more previous hiatal hernia repair. There were no conversions. Postoperative complication rate was 7.8%. At follow-up after 2 years 6 recurrences (12%) were encountered, 4 of them were symptomatic (8%). One patient underwent reoperation due to hernia recurrence. In 84% QoL was significantly improved at follow-up. Conclusion In patients with high risk of recurrence, biological augmentation of the hiatal closure with the left lobe of the liver may be a valuable alternative to prosthetic reinforcement. We observed no complication attributable to liver lobe transposition.

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