Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor.

Autor:	Pérez Lara FJ; Department of Surgery, Hopital de Antequera, Antequera 29200, Spain. javinewyork@hotmail.com., Zubizarreta Jimenez R; DOXA, Microfluidics, Rincon de la Victoria 29730, Spain., Prieto-Puga Arjona T; Department of Surgery, Hopital de Antequera, Antequera 29200, Spain., Gutierrez Delgado P; Department of Surgery, HRU Carlos Haya, Unidad Cirugia Hepatobiliopancreat & Trasplantes, Malaga 29200, Spain., Hernández Carmona JM; Department of Surgery, Hopital de Antequera, Antequera 29200, Spain., Hernández Gonzalez JM; Department of Surgery, Hopital de Antequera, Antequera 29200, Spain., Pitarch Martinez M; Department of Surgery, Hopital de Antequera, Antequera 29200, Spain.
Jazyk:	angličtina
Zdroj:	World journal of gastrointestinal surgery [World J Gastrointest Surg] 2023 Dec 27; Vol. 15 (12), pp. 2739-2746.
DOI:	10.4240/wjgs.v15.i12.2739
Abstrakt:	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. Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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