Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia

Lara, Francisco Javier Pérez; Jiménez, Rogelio Zubizarreta; Donoso, Francisco; González, José María Senciales; Arjona, Tatiana Prieto-Puga; Moreno, Arturo del Rey; Martínez, María Pitarch

doi:10.4240/wjgs.v13.i12.1638

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…In addition, based on CT, a technique for preoperative modeling of camera fields of view and access angles of instruments, depending on the location of the trocar, is presented. This allows predicting visibility and maneuverability for any placement of trocars during laparoscopic access and identifying candidates for thoracoscopic access in case the laparoscopic approach is dangerous [79].…”

Section: Diagnosis Of Paraesophageal Herniasmentioning

confidence: 99%

Paraesophageal hernia: the state of the problem and controversial issues. Review

Tarasov

Markulan²

2022

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The literature review focuses on the controversial issues regarding the treatment of paraesophageal hernia. The limitations of the current classification of hiatal hernias are highlighted. It is irrelevant and does not meet clinical needs. Objective criteria for its improvement are proposed. Data on the prevalence and course of hiatal hernias are given. Their pathogenetic factors and diagnostic methods are underlined. Considerable emphasis is placed on the paraesophageal hernia treatment strategies in patients with an asymptomatic and mildly symptomatic clinical course of the disease. Arguments are presented in favour of both wait‑and‑see tactics and planned hernioplasty. The choice of hernioplasty technique, especially in the case of giant hernias, the feasibility and indications for the use of mesh implants depending on their shape and composition, and the potential complications of allogenioplasty are the main topics for discussion. The problem of selecting a fundoplication method is addressed while weighing the advantages and potential side effects of employing various fundoplication modifications. The effects of correcting a short esophagus and eliminating the axial pressure on the esophageal hiatus are thoroughly evaluated, as these conditions increase the risk of hernia recurrence. The authors concluded that there are many controversial issues in the treatment of paraesophageal hernia. A consensus is needed on the classification of paraesophageal hernias, which would meet the urgent needs of choosing the method of operative delivery, and, in particular, the definition of the concepts of «large hernia» and «giant hernia.» Further research is required on issues such as the indications for operative treatment of paraesophageal hernias, especially in the case of asymptomatic large hernias and incarcerated hernias; the feasibility of using implants for plastic surgery of the esophageal hiatus; the choice of a fundoplication method; the diagnosis and correction of a short esophagus; and methodology for evaluating long‑term treatment outcomes.

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Section: Diagnosis Of Paraesophageal Herniasmentioning

confidence: 99%

Paraesophageal hernia: the state of the problem and controversial issues. Review

Tarasov

Markulan²

2022

ЗХ

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Economic evaluation of robotic and laparoscopic paraesophageal hernia repair

2023

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Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor

Pérez Lara,

Zubizarreta Jimenez,

Prieto-Puga Arjona

et al. 2023

World J Gastrointest Surg

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BACKGROUND Giant hernias present a significant challenge for digestive surgeons. The approach taken (laparoscopic vs thoracoscopic) depends largely on the preferences and skills of each surgeon, although in most cases today the laparoscopic approach is preferred. AIM To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem, in order to assess the need for a thoracoscopic approach. METHODS For the retrospective series of patients treated in our hospital for hiatal hernia (n = 112), we calculated the laparoscopic field of view and the working area accessible to surgical instruments, by means of preoperative imaging tests, to assess the likely outcome for cases inaccessible to laparoscopy. RESULTS Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded. The difference was statistically significant. Moreover, the insertion of mesh did not improve results for the non-accessible group. CONCLUSION For patients with giant hiatal hernias, it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery. When parts of the intrathoracic sac are inaccessible laparoscopically, the thoracoscopic approach should be considered.

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Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia

Cited by 3 publications

References 25 publications

Paraesophageal hernia: the state of the problem and controversial issues. Review

Paraesophageal hernia: the state of the problem and controversial issues. Review

Economic evaluation of robotic and laparoscopic paraesophageal hernia repair

Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor

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