Department of Morphology, Experimental Medicine and Surgery, Section of Chirurgia 1, Sant'Anna Hospital, University of Ferrara, Ferrara, Italy.
J Laparoendosc Adv Surg Tech A. 2023 Apr;33(4):381-388. doi: 10.1089/lap.2023.0019. Epub 2023 Mar 16.
The current gold standard of treatment for giant hiatal hernias (GHHs) is laparoscopic surgery. Laparoscopic surgery was performed as a less invasive procedure for paraesophageal hernias more than 25 years ago. Its viability and safety have almost all been shown. A review of recent and current studies' literature was done. Prospective randomized trials, systematic reviews, clinical reviews, and original articles were all investigated. The data were gathered in the form of a narrative evaluation. We examine the state of laparoscopic GHH repair today and outline the GHH management strategy. In this review, we clear up misunderstandings of GHH and address bad habits that may have contributed to poor results, and we have consequently performed a methodical evaluation of GHH. First, we address subcategorizing GHH and provide criteria to define them. The preoperative workup strategies are then discussed, with a focus on any pertinent and frequent atypical symptoms, indications for surgery, timing of surgery, and the importance of surgery. The approach to the techniques and the logic behind surgery are then presented along with some important dissection techniques. Finally, we debate the role of mesh reinforcement and evaluate the data in terms of recurrence, reoperation rate, complications, and delayed stomach emptying. Finally, we suggest a justification for common postoperative investigations. Surgery is the only effective treatment for GHH at the moment. If the right operational therapy principles are applied, this is generally successful. There is a growing interest in laparoscopic paraesophageal hiatal hernia repair as a result of the introduction of laparoscopic antireflux surgery. Today's less invasive procedures provide a better therapeutic choice with a lower risk.
目前，治疗巨大食管裂孔疝（GHH）的金标准是腹腔镜手术。25 多年前，腹腔镜手术作为一种针对食管裂孔疝的微创方法开始应用。其可行性和安全性已得到充分证实。对近期和当前研究文献进行了综述。调查了前瞻性随机试验、系统评价、临床评价和原始文章。以叙述性评估的形式收集数据。我们检查了当今腹腔镜 GHH 修复的现状，并概述了 GHH 管理策略。在这篇综述中，我们澄清了对 GHH 的误解，并解决了可能导致不良结果的不良习惯，因此我们对 GHH 进行了系统的评估。首先，我们解决了 GHH 的分类问题，并提供了定义它们的标准。然后讨论了术前检查策略，重点讨论了任何相关的、常见的非典型症状、手术指征、手术时机以及手术的重要性。然后介绍了手术技术的方法和手术背后的逻辑，以及一些重要的解剖技术。最后，我们讨论了网片加固的作用，并根据复发率、再次手术率、并发症和胃排空延迟等方面的数据进行评估。最后，我们对常见的术后检查提出了合理化建议。目前，手术是 GHH 的唯一有效治疗方法。如果应用正确的手术治疗原则，一般可以取得成功。随着腹腔镜抗反流手术的引入，腹腔镜食管裂孔疝修补术越来越受到关注。如今，微创技术提供了更好的治疗选择，风险更低。
