Romano Angela, D'Amore Davide, Esposito Giuseppe, Petrillo Marianna, Pezzella Modestino, Romano Francesco Maria, Izzo Giuseppe, Cosenza Angelo, Torelli Francesco, Volpicelli Antonio, Di Martino Natale
Department of General Surgery, University of Campania "Luigi Vanvitelli", Italy.
Int J Surg Case Rep. 2018;48:142-144. doi: 10.1016/j.ijscr.2018.04.036. Epub 2018 May 7.
Giant hiatal hernia is characterized by the presence of more than 1/3 of the stomach in the chest, through the diaphragmatic hiatus, with or without other intra-abdominal organs. It is a rare pathology, representing the 5-10% of all hiatal hernias. The advent of laparoscopic surgery led to new surgical techniques, which include the simple reduction with the excision of the hernial sac and the execution of a posterior hiatoplasty, with or without mesh, and the execution of a Collis-Nissen gatroplasty in case of short esophagus.
We followed 24 cases of giant hiatal hernia with more than 1/3 stomach located in the chest, analyzing the results reached by the miniinvasive procedure, and the long-term pathophysiologic results of the disease.
Laparoscopic hiatal hernia repair results in less postoperative pain compared with the open approach. The smaller incisions of minimally-invasive surgery are less likely to be complicated by incisional hernias and wound infection. Postoperative respiratory complications are reduced.
Results from multiple studies are similar, with shorter hospital stay and less morbidity resulting from the minimally invasive approach.
巨大食管裂孔疝的特征是超过三分之一的胃通过膈肌裂孔位于胸腔内，可伴有或不伴有其他腹腔内器官。它是一种罕见的病理情况，占所有食管裂孔疝的5%-10%。腹腔镜手术的出现带来了新的手术技术，包括单纯疝囊切除复位以及进行或不进行补片的后壁裂孔成形术，对于食管短缩的情况则进行科利斯-尼森胃成形术。
我们对24例超过三分之一胃位于胸腔内的巨大食管裂孔疝病例进行了随访，分析了微创手术取得的结果以及该疾病的长期病理生理结果。
与开放手术相比，腹腔镜食管裂孔疝修补术术后疼痛较轻。微创手术较小的切口发生切口疝和伤口感染的可能性较小。术后呼吸并发症减少。
多项研究结果相似，微创方法导致住院时间缩短且发病率降低。
