Satoshi Inose, Tatsushi Suwa, Tomoko Hukushima, Kazuhiro Karikomi, Eishi Totsuka, Motoi Koyama, Keigo Okada, Kenta Kitamura, Tomonori Matsumura, Hiroyuki Suzuki, Naokazu Nakamura, Shigeru Masamura. Kashiwa Kousei General Hospital
Background: Large hiatal hernia is a rare condition in which more than one-third of the stomach migrated in the thoracic cavity. It may result serious complications such as obstruction, perforation, lung and heart compression. Therefore surgical treatment should be considered by the patient’s overall medical status. We present our experience in managing large hiatal hernia with the surgical procedure.
Methods: Clinical records of all patients who underwent surgical repair of large hiatal hernia in our hospital from April 2011 to March 2016 were reviewed. Our surgical procedure for large hiatal hernia includes transection of the hernia sac at the level of the crus and leaving distal sac as it is. This means that complete resection of the hernia sac from the thoracic cavity is avoided to decrease the risk of complications. Mesh should be carefully replaced not to touch the esophagus directly to avoid esophageal injury. Fundoplication is considered as an optional technique for elderly patients.
Results: Total number of patients were 12, 1 male and 11 females, who underwent laparoscopic repair at least 6 months prior to this study. The median age was 79.5. The median operating time was 138 min and the median intraoperative blood loss was 15 mL. None of the patients had serious complication or symptomatic recurrence.
Conclusion: The hernia sac should not be completely removed from the thoracic cavity in order to decrease the risk of serious complications especially for elderly patients. Our procedure with transection of the hernia sac at the level of the crus and leaving distal sac seems to be reasonable as well as the procedure for the inguinal hernia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79955
Program Number: P661
Presentation Session: Poster (Non CME)
Presentation Type: Poster
