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

作　　者：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 

机构地区：[1]Department of Surgery,Hopital de Antequera,Antequera 29200,Spain [2]DOXA,Microfluidics,Rincon de la Victoria 29730,Spain [3]Department of Surgery,HRU Carlos Haya,Unidad Cirugia Hepatobiliopancreat&Trasplantes,Malaga 29200,Spain

出　　处：《World Journal of Gastrointestinal Surgery》2023年第12期2739-2746,共8页世界胃肠外科杂志（英文版）（电子版）

摘　　要：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.

关 键 词：Hiatal hernia Abdominal surgery LAPAROSCOPY Thoracoscopy surgery 

分 类 号：R571[医药卫生—消化系统]