Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2739
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
Processing time: 89 Days and 17 Hours
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.
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.
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.
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.
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.
Core Tip: In a previous study, we presented a series of mathematical formulas that can be used to assess the accessibility of large hiatal hernias to a laparoscopic approach, concluding that for some patients this technique was not viable. In the present retrospective study, we examine whether outcomes are poorer among patients whose hiatal hernias are deemed inaccessible to laparoscopy (according to the mathematical formulation applied to the preoperative imaging results).