A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach

Abstract

Introduction Although the traditional bilateral surgical approach to treat hiatal hernia (HH) with gastroesophageal reflux disease (GERD) can provide local protection of the vagus nerve, the integrity of the entire vagus nerve cannot be evaluated. Therefore, we developed and described the total left-side surgical approach (TLSA), which theoretically reduces injury to the vagus nerve, and described the detailed surgical procedure. Methods Initially, we performed a cadaver study to explore the characteristics of the vagus nerve. Then, we prospectively evaluated the TLSA in 5 patients with HH and GERD between June 2020 and September 2020. Demographic characteristics, surgical parameters, perioperative outcomes, and follow-up findings were analyzed. Results The TLSA was successfully used in five patients (40–64 years old), and no major complications were noted. The median total operative time was 114 min, median blood loss was 50 mL, and median postoperative hospital stay was 3.8 days. Gastrointestinal function recovered within 4 days of surgery in all the patients. The 6-month follow-up gastroscopy examination showed well-established gastroesophageal flap valves. Compared with the baseline results, the 6-month follow-up results showed lower values for the total GerdQ score (12.4 vs. 6.2) and the total esophageal acid exposure time (3.48% vs. 0.38%). Based on the European Organization for Research and Treatment of Cancer quality of life questionnaire-stomach module 52 results, the incidence of dysphagia and flatulence decreased over time after the TLSA. Conclusions The TLSA provides a clear and broad surgical field, less trauma, and rapid recovery; moreover, it is technically simple. Although our results suggest that the TLSA provides safety and short-term efficacy and is feasible for patients with HH and GERD, long-term results from a larger clinical trial are needed to validate these findings. Trial registration ChiCTR2000034028, registration date is June 21, 2020. The study was registered prospectively

Functional Food in Relation to Gastroesophageal Reflux Disease (GERD)

“…Moreover, the study noted that patients with large hiatal hernias experienced more severe esophagitis. Another study by Ott et al revealed that 94% of patients with reflux esophagitis had hiatal hernias, highlighting the strong association between the two conditions [ 32 , 33 ].…”

Achalasia and Hiatal Hernia: A Rare Association and a Therapeutic Challenge

“…It is considered a major cause of gastroesophageal reflux disease (GERD), due to the decreased lower esophageal sphincter (LES) pressure associated with the intrathoracic position of the LES. 1 , 2 The estimated prevalence of hiatal hernia in Western patients could reach 50%, 3 and up to 90% in patients with erosive reflux-esophagitis. 4 …”

Assessment of hiatus defect size in hiatal hernia patients using computed tomography

“…Type 3 involves both the GEJ and the stomach fundus shifting into the mediastinum. This type is generally observed in elderly adults and more commonly in women [1,2].…”

“…iatal hernia (HH) occurs through the herniation of abdominal contents into the mediastinum via an enlarged esophageal hiatus [1]. In the Western hemisphere, it is most associated with Gastroesophageal reflux disease (GERD) [2].…”

“…HH is classified as 3 subtypes. Type 1 is a sliding type HH, where the gastroesophageal junction (GEJ) moves over the hiatus due to the laxity of the phrenoesophageal ligament [1,2]. Type 1 is the most associated with GERD.…”