Removal of the sac during surgery for the repair of “giant” paraesophageal hernias

doi:10.4240/wjgs.v17.i7.106365

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Jul 27, 2025 (publication date) through Jul 26, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Jul 27, 2025; 17(7): 106365
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.106365

Table 1 Patient demographic and preoperative characteristics, n (%)

	Hiatal hernia repair without removal of the hernia sac (n = 36, 54.5%)	Hiatal hernia repair with removal of the hernia sac (n = 30, 45.5%)	P value
Age, years, median (range)	54.8 (29-81)	54.6 (28-72)
Sex, female	23 (63.9)	21 (70)
BMI, kg/m², median (range)	29.6 (24.6-35.1)	29.7 (24.6-36.8)
ASA
II	23 (63.9)	22 (73.3)
III	13 (36.1)	8 (26.7)
Esophagitis	14 (38.9)	12 (40)
Grade A	8 (22.2)	7 (23.3)
Grade B	4 (11.1)	2 (6.7)
Grade C	1 (2.78)	2 (6.7)
Grade D	1 (2.78)	1 (3.3)
Preoperative PPI use	24 (66.7)	21 (70)

BMI: Body mass index; ASA: American Society of Anesthesiologists; PPI: Proton pump inhibitor.

Table 2 Operative and postoperative outcomes, n (%)

	Hiatal hernia repair without removal of the hernia sac (n = 36)	Hiatal hernia repair with removal of the hernia sac (n = 30)	P value
Method of operation
Laparoscopy	28 (77.8)	24 (80)
Open	6 (16.7)	4 (13.3)
Conversion	2 (5.5)	2 (6.7)
Type of PHH
Type II	17 (47.2)	14 (46.7)
Type III	12 (33.3)	10 (33.3)
Type IV	7 (19.5)	6 (20)
Intrathoracic stomach	11 (30.6)	8 (26.7)
Operation time, minute, median (range)			< 0.001
Laparoscopy	114 (100-135)	144 (125-170)
Open + conversion	169 (140-185)	190 (180-200)
Postoperative length of stay, days, median (range)			< 0.001
Laparoscopy	2.4 (2-4)	2.55 (2-4)
Open + conversion	5.75 (4-7)	6.17 (5-7)
Postoperative complications	9 (25)	11 (36.7)
Pneumonia	2 (5.6)	3 (10)
Pleural effusion	3 (8.3)	4 (13.4)
Dysphagia	4 (11.1)	3 (10)
Intraabdominal hematoma	0 (0)	1 (3.3)
Radiologic recurrence	7 (19.4)	5 (16.7)
Asymptomatic	4 (11.1)	3 (10)
Symptomatic	3 (8.3)	2 (6.7)
Reoperation	3 (8.3)	2 (6.7)
Postoperative PPI use	3 (8.3)	3 (10)

PHH: Paraesophageal hiatal hernias; PPI: Proton pump inhibitor.

Table 3 Results of the postoperative follow-up assessment

	Hiatal hernia repair without removal of the hernia sac (n = 29)	Hiatal hernia repair with removal of the hernia sac (n = 26)	P value
Visik I	16	12
Visik II	7	9
Visik III	3	3
Visik IV	3	2

Citation: Hakobyan VM, Petrosyan AA, Yeghiazaryan HH, Aleksanyan AY, Safaryan HH, Shmavonyan HH, Papazyan KT, Ayvazyan KH, Davtyan LG, Khachatryan AA, Sargsyan GS, Stepanyan SA. Removal of the sac during surgery for the repair of “giant” paraesophageal hernias. World J Gastrointest Surg 2025; 17(7): 106365
URL: https://www.wjgnet.com/1948-9366/full/v17/i7/106365.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i7.106365