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
ARTICLE HIGHLIGHTS
Research background
The laparoscopic approach to giant hiatal hernias is often a challenge for surgeons. We propose a study to determine in which cases it would be advisable to use this method and in which circumstances thoracoscopy is to be preferred.
Research motivation
We consider whether it is really the case that when the hernial sac area is inaccessible during treatment of a giant hiatal hernia, the post-operatory status is always poorer.
Research objectives
The object of this study is 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.
Research methods
Accordingly, a retrospective study was conducted of the images of patients who underwent surgery for giant hiatal hernia, assessing the accessibility in each case and the treatment results obtained. On this basis, we compared the treatment outcomes according to accessibility.
Research results
The results were worse for patients with less accessible hiatal hernias. In these cases, it might be preferable to use thoracoscopy or to adopt a combined laparoscopic/thoracoscopic approach.
Research conclusions
Patients whose hiatal hernias were less accessible had poorer postoperative results, a greater number of recurrences and were more likely to suffer complications.
Research perspectives
In view of the study results obtained, we suggest a preoperative assessment should be made of all patients with a giant hiatal hernia. When the hernia is inaccessible, a thoracoscopic or combined approach should be adopted, within a prospective study.
