Skip to main content

Advertisement

SpringerLink
Log in

Treatment of giant paraesophageal hernia: pro laparoscopic approach

  • Invited Review
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Giant paraesophageal hernias (GPEH) are relatively uncommon and account for less than 5% of all primary hiatal hernias. Giant Secondary GPEH can be observed after surgery involving hiatal orifice opening, such as esophagectomy, antireflux surgery, and hiatal hernia repair. Surgical treatment is challenging, and there are still residual controversies regarding the laparoscopic approach, even though a reduced morbidity and mortality, as well as a shorter hospital stay have been demonstrated.

Methods

A Pubmed electronic search of the literature including articles published between 1992 and 2016 was conducted using the following key words: hiatal hernia, paraesophageal hernias, mesh, laparoscopy, intrathoracic stomach, gastric volvulus, diaphragmatic hernia.

Results

Given the risks of non-operative management, GPEH surgical repair is indicated in symptomatic patients. Technical steps for primary hernia repair include hernia reduction and sac excision, correct repositioning of the gastroesophageal junction, crural repair, and fundoplication. For secondary hernias, the surgical technique varies according to hernia type and components and according to the approach used during the first surgery. There is an ongoing debate regarding the best and safest method to close the hiatal orifice. The laparoscopic approach has demonstrated a lower postoperative morbidity and mortality, and a shorter hospital stay as compared to the open approach. A high recurrence rate has been reported for primary GPEH repair. However, recent studies suggest that recurrence does not reduce symptomatic outcomes.

Conclusions

The laparoscopic treatment of primary and secondary GPEH is safe and feasible in elective and emergency settings, especially in high-volume centers. The procedure is still challenging. The main steps are well defined. However, there is still room for improvement to lower the recurrence rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kahrilas PJ, Kim HC, Pandolfino JE (2008) Approaches to the diagnosis and grading of hiatal hernia. Best Pract Res Clin Gastroenterol 22(4):601–616. 10.1016/j.bpg.2007.12.007

    Article  PubMed  PubMed Central  Google Scholar 

  2. Mitiek MO, Andrade RS (2010) Giant hiatal hernia. Ann Thorac Surg 89(6):S2168–S2173. 10.1016/j.athoracsur.2010.03.022

    Article  PubMed  Google Scholar 

  3. Heitmiller RF, Gillinov AM, Jones B (1997) Transhiatal herniation of colon after esophagectomy and gastric pull-up. Ann Thorac Surg 63(2):554–556

    Article  CAS  Google Scholar 

  4. Watson DI, Jamieson GG, Devitt PG, Mitchell PC, Game PA (1995) Paraoesophageal hiatus hernia: an important complication of laparoscopic Nissen fundoplication. Br J Surg 82(4):521–523

    Article  CAS  Google Scholar 

  5. Maziak DE, Todd TR, Pearson FG (1998) Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg 115(1):53–60 (discussion 61–52)

    Article  CAS  Google Scholar 

  6. Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatus hernia. Long-term results with 1,030 patients. J Thorac Cardiovasc Surg 53(1):33–54

    CAS  PubMed  Google Scholar 

  7. Sihvo EI, Salo JA, Rasanen JV, Rantanen TK (2009) Fatal complications of adult paraesophageal hernia: a population-based study. J Thorac Cardiovasc Surg 137(2):419–424. 10.1016/j.jtcvs.2008.05.042

    Article  PubMed  Google Scholar 

  8. Stylopoulos N, Rattner DW (2003) Paraesophageal hernia: when to operate? Adv Surg 37:213–229

    PubMed  Google Scholar 

  9. Draaisma WA, Gooszen HG, Tournoij E, Broeders IA (2005) Controversies in paraesophageal hernia repair: a review of literature. Surg Endosc 19(10):1300–1308. 10.1007/s00464-004-2275-3

    Article  CAS  PubMed  Google Scholar 

  10. Allen MS, Trastek VF, Deschamps C, Pairolero PC (1993) Intrathoracic stomach. Presentation and results of operation. J Thorac Cardiovasc Surg 105(2):253–258 (discussion 258–259

    CAS  PubMed  Google Scholar 

  11. Aly A, Munt J, Jamieson GG, Ludemann R, Devitt PG, Watson DI (2005) Laparoscopic repair of large hiatal hernias. Br J Surg 92(5):648–653. 10.1002/bjs.4916

    Article  CAS  PubMed  Google Scholar 

  12. Le Page PA, Furtado R, Hayward M, Law S, Tan A, Vivian SJ, Van der Wall H, Falk GL (2015) Durability of giant hiatus hernia repair in 455 patients over 20 years. Ann R Coll Surg Engl 97(3):188–193. 10.1308/003588414X14055925060839

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bhayani NH, Kurian AA, Sharata AM, Reavis KM, Dunst CM, Swanstrom LL (2013) Wait only to resuscitate: early surgery for acutely presenting paraesophageal hernias yields better outcomes. Surg Endosc 27(1):267–271. 10.1007/s00464-012-2436-8

    Article  CAS  PubMed  Google Scholar 

  14. Watson DI, Davies N, Devitt PG, Jamieson GG (1999) Importance of dissection of the hernial sac in laparoscopic surgery for large hiatal hernias. Arch Surg 134(10):1069–1073

    Article  CAS  Google Scholar 

  15. Edye M, Salky B, Posner A, Fierer A (1998) Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia. Surg Endosc 12(10):1259–1263

    Article  CAS  Google Scholar 

  16. Jobe BA, Aye RW, Deveney CW, Domreis JS, Hill LD (2002) Laparoscopic management of giant type III hiatal hernia and short esophagus. Objective follow-up at three years. J Gastrointest Surg 6(2):181–188 (discussion 188)

    Article  Google Scholar 

  17. Jones R, Tadaki C, Oleynikov D (2015) Laparoscopic redo paraesophageal hernia repair with collis gastroplasty for shortened esophagus. Surg Endosc 29(3):736. 10.1007/s00464-014-3728-y

    Article  PubMed  Google Scholar 

  18. Johnson AB, Oddsdottir M, Hunter JG (1998) Laparoscopic Collis gastroplasty and Nissen fundoplication. A new technique for the management of esophageal foreshortening. Surg Endosc 12(8):1055–1060

    Article  CAS  Google Scholar 

  19. Luketich JD, Nason KS, Christie NA, Pennathur A, Jobe BA, Landreneau RJ, Schuchert MJ (2010) Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg 139(2):395–404, 404 e391. 10.1016/j.jtcvs.2009.10.005

    Article  Google Scholar 

  20. Zehetner J, Demeester SR, Ayazi S, Kilday P, Augustin F, Hagen JA, Lipham JC, Sohn HJ, Demeester TR (2011) Laparoscopic versus open repair of paraesophageal hernia: the second decade. J Am Colloid Surg 212(5):813–820. 10.1016/j.jamcollsurg.2011.01.060

    Article  Google Scholar 

  21. Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Colloid Surg 190(5):553–560 (discussion 560–551)

    Article  CAS  Google Scholar 

  22. Dallemagne B, Kohnen L, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Laparoscopic repair of paraesophageal hernia. Long-term follow-up reveals good clinical outcome despite high radiological recurrence rate. Ann Surg 253(2):291–296. 10.1097/SLA.0b013e3181ff44c0

    Article  PubMed  Google Scholar 

  23. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP (2002) A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg 137(6):649–652

    Article  Google Scholar 

  24. Granderath FA, Schweiger UM, Kamolz T, Asche KU, Pointner R (2005) Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg 140(1):40–48. 10.1001/archsurg.140.1.40

    Article  PubMed  Google Scholar 

  25. Oelschlager BK, Pellegrini CA, Hunter J, Soper N, Brunt M, Sheppard B, Jobe B, Polissar N, Mitsumori L, Nelson J, Swanstrom L (2006) Biologic prosthesis reduces recurrence after laparoscopic paraesophageal hernia repair: a multicenter, prospective, randomized trial. Ann Surg 244(4):481–490. 10.1097/01.sla.0000237759.42831.03

    Article  PubMed  PubMed Central  Google Scholar 

  26. Watson DI, Thompson SK, Devitt PG, Smith L, Woods SD, Aly A, Gan S, Game PA, Jamieson GG (2015) Laparoscopic repair of very large hiatus hernia with sutures versus absorbable mesh versus nonabsorbable mesh: a randomized controlled trial. Ann Surg 261(2):282–289. 10.1097/SLA.0000000000000842

    Article  PubMed  Google Scholar 

  27. Tam V, Winger DG, Nason KS (2016) A systematic review and meta-analysis of mesh vs suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg 211(1):226–238. 10.1016/j.amjsurg.2015.07.007

    Article  PubMed  Google Scholar 

  28. Muller-Stich BP, Kenngott HG, Gondan M, Stock C, Linke GR, Fritz F, Nickel F, Diener MK, Gutt CN, Wente M, Buchler MW, Fischer L (2015) Use of mesh in laparoscopic paraesophageal hernia repair: a meta-analysis and risk-benefit analysis. PLoS One 10(10):e0139547. 10.1371/journal.pone.0139547

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Huddy JR, Markar SR, Ni MZ, Morino M, Targarona EM, Zaninotto G, Hanna GB (2016) Laparoscopic repair of hiatus hernia: does mesh type influence outcome? A meta-analysis and European survey study. Surg Endosc 30(12):5209–5221. 10.1007/s00464-016-4900-3

    Article  PubMed  Google Scholar 

  30. Oelschlager BK, Pellegrini CA, Hunter JG, Brunt ML, Soper NJ, Sheppard BC, Polissar NL, Neradilek MB, Mitsumori LM, Rohrmann CA, Swanstrom LL (2011) Biologic prosthesis to prevent recurrence after laparoscopic paraesophageal hernia repair: long-term follow-up from a multicenter, prospective, randomized trial. J Am Coll Surg 213(4):461–468. 10.1016/j.jamcollsurg.2011.05.017

    Article  PubMed  Google Scholar 

  31. Granderath FA, Kamolz T, Schweiger UM, Pointner R (2003) Laparoscopic refundoplication with prosthetic hiatal closure for recurrent hiatal hernia after primary failed antireflux surgery. Arch Surg 138(8):902–907. 10.1001/archsurg.138.8.902

    Article  PubMed  Google Scholar 

  32. Koch OO, Asche KU, Berger J, Weber E, Granderath FA, Pointner R (2011) Influence of the size of the hiatus on the rate of reherniation after laparoscopic fundoplication and refundopilication with mesh hiatoplasty. Surg Endosc 25(4):1024–1030. 10.1007/s00464-010-1308-3

    Article  PubMed  Google Scholar 

  33. Nandipati K, Bye M, Yamamoto SR, Pallati P, Lee T, Mittal SK (2013) Reoperative intervention in patients with mesh at the hiatus is associated with high incidence of esophageal resection—a single-center experience. J Gastrointest Surg 17(12):2039–2044. 10.1007/s11605-013-2361-8

    Article  PubMed  Google Scholar 

  34. Gouvas N, Tsiaoussis J, Athanasakis E, Zervakis N, Pechlivanides G, Xynos E (2011) Simple suture or prosthesis hiatal closure in laparoscopic repair of paraesophageal hernia: a retrospective cohort study. Dis Esophagus 24(2):69–78. 10.1111/j.1442-2050.2010.01094.x

    Article  CAS  PubMed  Google Scholar 

  35. Zaninotto G, Portale G, Costantini M, Fiamingo P, Rampado S, Guirroli E, Nicoletti L, Ancona E (2007) Objective follow-up after laparoscopic repair of large type III hiatal hernia. Assessment of safety and durability. World J Surg 31(11):2177–2183. 10.1007/s00268-007-9212-2

    Article  PubMed  Google Scholar 

  36. Targarona EM, Grisales S, Uyanik O, Balague C, Pernas JC, Trias M (2013) Long-term outcome and quality of life after laparoscopic treatment of large paraesophageal hernia. World J Surg 37(8):1878–1882. 10.1007/s00268-013-2047-0

    Article  PubMed  Google Scholar 

  37. Huntington TR (1997) Laparoscopic mesh repair of the esophageal hiatus. J Am Coll Surg 184(4):399–400

    CAS  PubMed  Google Scholar 

  38. Alicuben ET, Worrell SG, DeMeester SR (2014) Impact of crural relaxing incisions, Collis gastroplasty, and non-cross-linked human dermal mesh crural reinforcement on early hiatal hernia recurrence rates. J Am Coll Surg 219(5):988–992. 10.1016/j.jamcollsurg.2014.07.937

    Article  PubMed  Google Scholar 

  39. Zehetner J, Lipham JC, Ayazi S, Oezcelik A, Abate E, Chen W, Demeester SR, Sohn HJ, Banki F, Hagen JA, Dickey M, Demeester TR (2010) A simplified technique for intrathoracic stomach repair: laparoscopic fundoplication with Vicryl mesh and BioGlue crural reinforcement. Surg Endosc 24(3):675–679. 10.1007/s00464-009-0662-5

    Article  PubMed  Google Scholar 

  40. Furnee EJ, Draaisma WA, Gooszen HG, Hazebroek EJ, Smout AJ, Broeders IA (2011) Tailored or routine addition of an antireflux fundoplication in laparoscopic large hiatal hernia repair: a comparative cohort study. World J Surg 35(1):78–84. 10.1007/s00268-010-0814-8

    Article  PubMed  Google Scholar 

  41. Muller-Stich BP, Achtstatter V, Diener MK, Gondan M, Warschkow R, Marra F, Zerz A, Gutt CN, Buchler MW, Linke GR (2015) Repair of paraesophageal hiatal hernias-is a fundoplication needed? A randomized controlled pilot trial. J Am Coll Surg 221(2):602–610. 10.1016/j.jamcollsurg.2015.03.003

    Article  PubMed  Google Scholar 

  42. Ponsky J, Rosen M, Fanning A, Malm J (2003) Anterior gastropexy may reduce the recurrence rate after laparoscopic paraesophageal hernia repair. Surg Endosc 17(7):1036–1041. 10.1007/s00464-002-8765-2

    Article  CAS  PubMed  Google Scholar 

  43. Diaz S, Brunt LM, Klingensmith ME, Frisella PM, Soper NJ (2003) Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients. J Gastrointest Surg 7(1):59–66 (discussion 66–57)

    Article  Google Scholar 

  44. Peters JH (2013) SAGES guidelines for the management of hiatal hernia. Surg Endosc 27(12):4407–4408. 10.1007/s00464-013-3212-0

    Article  PubMed  Google Scholar 

  45. Klinginsmith M, Jolley J, Lomelin D, Krause C, Heiden J, Oleynikov D (2016) Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard? Surg Endosc 30(5):1790–1795. 10.1007/s00464-015-4447-8

    Article  PubMed  Google Scholar 

  46. Polomsky M, Hu R, Sepesi B, O’Connor M, Qui X, Raymond DP, Litle VR, Jones CE, Watson TJ, Peters JH (2010) A population-based analysis of emergent vs. elective hospital admissions for an intrathoracic stomach. Surg Endosc 24(6):1250–1255. 10.1007/s00464-009-0755-1

    Article  PubMed  Google Scholar 

  47. Nguyen NT, Christie C, Masoomi H, Matin T, Laugenour K, Hohmann S (2011) Utilization and outcomes of laparoscopic versus open paraesophageal hernia repair. Am Surg 77(10):1353–1357

    PubMed  Google Scholar 

  48. McLaren PJ, Hart KD, Hunter JG, Dolan JP (2017) Paraesophageal hernia repair outcomes using minimally invasive approaches. JAMA Surg. 10.1001/jamasurg.2017.2868

    Article  PubMed  PubMed Central  Google Scholar 

  49. Duranceau A (2016) Massive hiatal hernia: a review. Dis Esophagus 29(4):350–366. 10.1111/dote.12328

    Article  CAS  PubMed  Google Scholar 

  50. Ferri LE, Feldman LS, Stanbridge D, Mayrand S, Stein L, Fried GM (2005) Should laparoscopic paraesophageal hernia repair be abandoned in favor of the open approach? Surg Endosc 19(1):4–8. 10.1007/s00464-004-8903-0

    Article  CAS  PubMed  Google Scholar 

  51. Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD (2004) A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia. J Thorac Cardiovasc Surg 127(3):843–849. 10.1016/j.jtcvs.2003.10.054

    Article  PubMed  Google Scholar 

  52. Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IHM, Gooszen HG, Janssen LWM, Simmermacher RKJ, Broeders IAMJ (2005) Robot-assisted endoscopic surgery: a four-year single-center experience. Diges Surg 22(5):313–320

    Article  Google Scholar 

  53. Braumann C, Jacobi CA, Menenakos C, Ismail M, Rueckert JC, Mueller JM (2008) Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: a 4-year experience in a single institution. Surg Laparosc Endosc Percutan Technol 18(3):260–266. 10.1097/SLE.0b013e31816f85e5

    Article  Google Scholar 

  54. Brenkman HJ, Parry K, van Hillegersberg R, Ruurda JP (2016) Robot-assisted laparoscopic hiatal hernia repair: promising anatomical and functional results. J Laparoendosc Adv Surg Technol A 26(6):465–469. 10.1089/lap.2016.0065

    Article  Google Scholar 

  55. Gehrig T, Mehrabi A, Fischer L, Kenngott H, Hinz U, Gutt CN, Muller-Stich BP (2013) Robotic-assisted paraesophageal hernia repair–a case–control study. Langenbecks Arch Surg 398(5):691–696. 10.1007/s00423-012-0982-0

    Article  PubMed  Google Scholar 

  56. Seetharamaiah R, Romero RJ, Kosanovic R, Gallas M, Verdeja JC, Rabaza J, Gonzalez AM (2013) Robotic repair of giant paraesophageal hernias. JSLS 17(4):570–577. 10.4293/108680813X13654754534594

    Article  PubMed  PubMed Central  Google Scholar 

  57. Draaisma WA, Gooszen HG, Consten EC, Broeders IA (2008) Mid-term results of robot-assisted laparoscopic repair of large hiatal hernia: a symptomatic and radiological prospective cohort study. Surg Technol Int 17:165–170

    PubMed  Google Scholar 

  58. Wu JS, Dunnegan DL, Luttmann DR, Soper NJ (1996) The influence of surgical technique on clinical outcome of laparoscopic Nissen fundoplication. Surg Endosc 10(12):1164–1169 (discussion 1169–1170)

    Article  CAS  Google Scholar 

  59. Dallemagne B, Arenas Sanchez M, Francart D, Perretta S, Weerts J, Markiewicz S, Jehaes C (2011) Long-term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg 98(11):1581–1587. 10.1002/bjs.7590

    Article  CAS  PubMed  Google Scholar 

  60. Suppiah A, Sirimanna P, Vivian SJ, O’Donnell H, Lee G, Falk GL (2017) Temporal patterns of hiatus hernia recurrence and hiatal failure: quality of life and recurrence after revision surgery. Dis Esophagus 30(4):1–8. 10.1093/dote/dow035

    Article  CAS  PubMed  Google Scholar 

  61. Terry M, Smith CD, Branum GD, Galloway K, Waring JP, Hunter JG (2001) Outcomes of laparoscopic fundoplication for gastroesophageal reflux disease and paraesophageal hernia. Surg Endosc 15(7):691–699. 10.1007/s004640080144

    Article  CAS  PubMed  Google Scholar 

  62. Oor JE, Wiezer MJ, Hazebroek EJ (2016) Hiatal hernia after open versus minimally invasive esophagectomy: a systematic review and meta-analysis. Ann Surg Oncol 23(8):2690–2698. 10.1245/s10434-016-5155-x

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. IRCAD, 1 Place de l’Hôpital, 67091, Strasbourg Cedex, France

    B. Dallemagne & S. Perretta

  2. Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l’Hôpital, 67091, Strasbourg Cedex, France

    B. Dallemagne, G. Quero, A. Lapergola, L. Guerriero, C. Fiorillo & S. Perretta

Authors
  1. B. Dallemagne
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Quero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Lapergola
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Guerriero
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Fiorillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Perretta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Dallemagne.

Ethics declarations

Conflict of interest

BD, GQ, AL, LG, CF and SP declare no conflict of interest.

Ethical approval

For this retrospective review of the litterature, ethical approval is not required.

Human and animal rights

This review article does not contain any study performed on animal by any of the authors.

Informed consent

For this review study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dallemagne, B., Quero, G., Lapergola, A. et al. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia 22, 909–919 (2018). https://doi.org/10.1007/s10029-017-1706-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-017-1706-8

Keywords

Search

Navigation