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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Removal of the sac during surgery for the repair of “giant” paraesophageal hernias
Vahe M Hakobyan, Areg A Petrosyan, Hayk H Yeghiazaryan, Andranik Y Aleksanyan, Hayk H Safaryan, Hakob H Shmavonyan, Karen T Papazyan, Khachik H Ayvazyan, Levon G Davtyan, Aram A Khachatryan, Ghukas S Sargsyan, Suren A Stepanyan
Vahe M Hakobyan, Areg A Petrosyan, Hayk H Yeghiazaryan, Andranik Y Aleksanyan, Hayk H Safaryan, Hakob H Shmavonyan, Karen T Papazyan, Khachik H Ayvazyan, Aram A Khachatryan, Suren A Stepanyan, Department of Surgery 1, Yerevan State Medical University, Yerevan 0025, Armenia
Vahe M Hakobyan, Areg A Petrosyan, Hayk H Yeghiazaryan, Andranik Y Aleksanyan, Hayk H Safaryan, Hakob H Shmavonyan, Karen T Papazyan, Khachik H Ayvazyan, Aram A Khachatryan, Ghukas S Sargsyan, Suren A Stepanyan, Clinic of Surgery, Mikaelyan Institute of Surgery, Yerevan 0052, Armenia
Levon G Davtyan, Department of Radiology, Mikaelyan Institute of Surgery, Yerevan 0052, Armenia
Author contributions: Hakobyan VM, Petrosyan AA, Yeghiazaryan HH, Aleksanyan AY, Safaryan HH, Shmavonyan HH, Papazyan KT, Ayvazyan KH, Davtyan LG, Khachatryan AA, Sargsyan GS and Stepanyan SA performed the research, designed the research study, drafted the article and made critical revisions related to the content of the manuscript; Hakobyan VM, Petrosyan AA and Stepanyan SA analyzed the data and wrote the manuscript; All the authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Mikaelyan Institute of Surgery (approval No. 480225).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
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: Suren A Stepanyan, PhD, Chairperson, Chief, Full Professor, Depart
ment of Surgery 1, Yerevan State Medical University, 2 Koryun St, Yerevan 0025, Armenia.
sastepanyan5@gmail.com
Received: February 24, 2025
Revised: March 30, 2025
Accepted: June 6, 2025
Published online: July 27, 2025
Processing time: 149 Days and 22.2 Hours
BACKGROUND
The presence of a large paraesophageal hernia is a source of concern in foregut surgery. Thus, scholars have focused on ascertaining the optimal surgical approach, methods for reinforcing the esophageal hiatus, and strategies for preventing hernia recurrence and gastroesophageal reflux.
AIM
To investigate the outcomes of surgery for giant paraesophageal hernias without sac removal.
METHODS
Sixty-six consecutive patients who underwent surgery for a giant paraesophageal hernia between May 2010 and December 2024 were included in this retrospective study. The pre- and postoperative examinations included upper gastrointestinal endoscopy, X-ray with barium contrast swallow, contrast-enhanced computed tomography (CT) scans of the chest and abdomen, 24-hour potential hydrogen esophageal monitoring, and esophagomanometry. The study group included 36 patients who underwent surgery without sac removal, and the control group included 30 patients who underwent surgery with sac removal.
RESULTS
Fifty-two patients (28 in the study group and 24 in the control group) underwent laparoscopic procedures, 10 (6 in the study group and 4 in the control group) underwent open procedures, and 4 (2 in each group) underwent conversion procedures. The operative time and postoperative length of stay were significantly longer in the control group than in the study group. In 12 patients in the study group, X-ray examination on postoperative days 3-5 revealed air-fluid levels at the site of the remaining hernia sac; all air-fluid levels disappeared without intervention 2 months later. Postoperative day 60 CT and X-ray examinations revealed no pathological changes related to the hernia sac in the mediastinum.
CONCLUSION
Removal of the hernia sac during surgery for giant paraesophageal hernias is not mandatory. Further large-scale multicentric randomized trials are needed for a more detailed investigation in this field.
Core Tip: This article highlights several technical aspects of surgery for “giant” paraesophageal hiatal hernias. The step involving the evacuation of the hernia contents and mobilization of the sac was emphasized in this study. The findings of this investigation underscore the importance of technical aspects of surgery for giant paraesophageal hiatal hernias, reinforcing the hiatus and assessing the need for antireflux interventions.
