Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature

Abstract Purpose Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. Methods Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. Results Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. Conclusion Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.

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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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