Henriques Catarina D, Rodrigues Egon F, Carvalho Lucia, Pereira Ana Marta, Nora Mário
Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, PRT.
Cureus. 2024 Feb 8;16(2):e53836. doi: 10.7759/cureus.53836. eCollection 2024 Feb.
The management of giant hiatal hernias (HHs) remains challenging and is associated with a high risk of recurrence. Currently, several strategies are used to reduce recurrence, and a newly proposed trend is the administration of adjuvant botulinum toxin type A (BTX), a procedure already performed in complex ventral hernias. Here, we present a case of a 63-year-old man with a giant paraesophageal HH type IV containing the entire stomach and transverse colon with loss of domain, who underwent adjuvant BTX and subsequently laparoscopic hiatoplasty with a biological mesh with partial fundoplication. At six months' follow-up, the patient reported a significant improvement in the quality of life without dysphagia or gastroesophageal reflux and with a good respiratory function. A control computed tomography was performed, which documented a partial recurrence of HH, completely asymptomatic. This clinical case showed the successful treatment of a giant HH using adjuvant BTX injection to increase abdominal wall compliance as had already been described in the treatment of complex ventral hernia. Thus, the use of BTX is a promising strategy for selected cases of giant HHs mainly if there is a loss of domain; however, more case series and controlled trials are needed to show the reproducibility of the benefit of this strategy.
巨大食管裂孔疝（HH）的治疗仍然具有挑战性，且复发风险很高。目前，有几种策略用于降低复发率，一种新提出的趋势是使用辅助性A型肉毒杆菌毒素（BTX），这一方法已在复杂的腹疝治疗中应用。在此，我们报告一例63岁男性患者，患有IV型巨大食管旁HH，包含整个胃和横结肠且存在区域丧失，该患者接受了辅助性BTX治疗，随后进行了腹腔镜食管裂孔成形术，并使用生物补片进行部分胃底折叠术。在六个月的随访中，患者报告生活质量有显著改善，无吞咽困难或胃食管反流，呼吸功能良好。进行了对照计算机断层扫描，结果显示HH有部分复发，但完全无症状。该临床病例表明，使用辅助性BTX注射来提高腹壁顺应性，成功治疗了巨大HH，这与复杂腹疝治疗中已描述的情况相同。因此，对于选定的巨大HH病例，使用BTX是一种有前景的策略，主要适用于存在区域丧失的情况；然而，需要更多的病例系列和对照试验来证明该策略益处的可重复性。
