Page 37 - WALS Journal

World Journal of Laparoscopic Surgery, May-August 2008;1(2):40-43
Sajal Kumar
Role of Laparoscopy in the Management

of Giant Hiatal Hernia

Sajal Kumar
Senior Resident, Bhagwan Mahavir Hospital, New Delhi

Abstract: Giant hiatal hernia is defined as greater than one third of the 4. Complication
1
stomach in the thoracic cavity and representing 5 to 10 % of all hiatal 5. Hospital stay
8
hernia. The hiatal opening in a patient with a large hernia is wide, with 6. Functional index
the right and left crura very thin and often separated by 5 cm or more. 8 7. Quality of life analysis
The aim of this review is to analyze the role of laparoscopy in the
management of giant hiatal hernia.
OPERATIVE PROCEDURE
Introduction: Traditionally repair of giant paraesophageal hernia has The surgical technique employed include:
been performed through open laparotomy or thoracotomy, with the
advent of laparoscopy, nowadays giant hiatal hernia are performed • Standerd five cannula technique
with laparoscopy. • Devide the lesser omantom to expose the right hilar piller
within the lesser sac
Saveral recent reports have shown that laparoscopic repair of • Reduction of hernia by means of atraumatic grasper in a
paraesophageal hiatal hernia is feasibadle and effective, obtaining hand over hand fashion
comparative result to open surgery. 2
• Complete excision of sac
Material and method: A review of article was done through the internet • Primary closure of hiatal hernia defect with either suture
using search engine Google, high wire press springerlink pubmed approximation of crura or by different type of mesh
through the internet facility available in laparoscopy hospital in application (for tension-free repair)
Delhi.—using • After closing the hiatus a fundoplication (Nissen or toupet)

About 3500 articles available on the net, only selected article were with or without collies gastroplasty will complete the
screened for further reference. Operative procedure selected only from operation depending upon the finding of intraoperative
the center, where the study was done, are specialized in laparoscopic gastrointestinal endoscopic assessment of short esophagus
surgery. and esophageal manometry.
Keywords: Giant hiatal hernia, Laparoscopy management, complication,
recurrence. Review of Citation
8
M. Morino et al 2006, Performed laparoscopic repair of giant
SURGICAL PROCEDURE
hiatal hernia on 65 patients Oct 1991- April 2003.
Preoperation work-up including carefull history regarding patient • Primary (suture) closure of the hiatal defect was done in 14
symptom: I. Barium swallow X-ray, II. Upper gastrointestinal cases
endoscopy, III. Esophageal manometry, IV. pH monitoring, • Tension-free repair using a mesh was performed in 37 cases
should be done. • 14 patients underwent Collies – Nissen gastroplasty.
• There was no intraoperative complication and no conversion
Aim and Objective to open technique
• Mesh operation time was 130 min
The aim of the study was to evaluate the effectiveness and • No motility
safety of laparoscopy in the treatment of giant hiatal hernia. • One major complication (1.5%)
The following parameter were evaluated;
• An esophageal perforation
1. Operative time • Postoperative complication – 12 patients have transient sub-
2. Operative technique cutaneous emphysema in the neck that resolve
3. Postoperative pain spontaneously.

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