General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Via Massimo Arcamone 1, 06034, Foligno, Italy.
Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Polyclinic of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
World J Emerg Surg. 2020 Jun 1;15(1):37. doi: 10.1186/s13017-020-00316-1.
Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature.
During 10 years (December 2009-December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review.
The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences.
Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations.
巨大食管裂孔疝（GHH）是一种胃的三分之一迁移到胸腔的疾病。如今，腹腔镜治疗可获得极佳的术后效果。绞窄性食管裂孔疝较为罕见，其紧急修复与较高的发病率和死亡率相关。我们报告了五例经微创腹腔镜和机器人辅助方法治疗的绞窄性食管裂孔疝病例，并对文献进行了系统回顾。
在 10 年期间（2009 年 12 月至 2019 年 12 月），31 例 GHH 患者接受了机器人辅助或常规腹腔镜手术治疗。其中，五例在紧急情况下接受治疗。我们对微创紧急治疗 GHH 进行了 PubMed MEDLINE 搜索，选择了 18 篇文章进行综述。
五例患者均为男性，平均年龄 70 ± 18 岁。所有患者因严重的腹痛、胸痛、恶心和呕吐就诊于急诊。CT 扫描和内镜检查是主要的诊断工具。所有患者血流动力学均稳定，可进行微创尝试。其中 3 例（60%）采用机器人辅助手术，2 例（40%）采用腹腔镜手术。患者无并发症或复发。
回顾现有文献，对于绞窄性食管裂孔疝的紧急治疗尚无一般建议。急性机械性出口梗阻、胃壁缺血或穿孔以及严重出血是紧急手术指征的原因。在稳定的情况下，微创方法通常是可行的。此外，在具有挑战性的情况下，机器人辅助方法可提供稳定的 3D 视图并使用铰接器械，是一种合理的选择。
