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World Journal of Emergency Surgery
Published in: World Journal of Emergency Surgery 1/2020

01-12-2020 | Laparoscopy | Review

Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review

Authors: Graziano Ceccarelli, Alessandro Pasculli, Walter Bugiantella, Michele De Rosa, Fausto Catena, Fabio Rondelli, Gianluca Costa, Aldo Rocca, Mattia Longaroni, Mario Testini

Published in: World Journal of Emergency Surgery | Issue 1/2020

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Abstract

Background

Giant hiatal hernia (GHH) is a condition where one-third of the stomach migrates into the thorax. Nowadays, laparoscopic treatment gives excellent postoperative outcomes. Strangulated GHH is rare, and its emergent repair is associated with significant morbidity and mortality rates. We report a series of five cases of strangulated GHH treated by a minimally invasive laparoscopic and robot-assisted approach, together with a systematic review of the literature.

Methods

During 10 years (December 2009–December 2019), 31 patients affected by GHH were treated by robot-assisted or conventional laparoscopic surgical approach. Among them, five cases were treated in an emergency setting. We performed a PubMed MEDLINE search about the minimally invasive emergent treatment of GHH, selecting 18 articles for review.

Results

The five cases were male patients with a mean age of 70 ± 18 years. All patients referred to the emergency service complaining of severe abdominal and thoracic pain, nausea and vomiting. CT scan and endoscopy were the main diagnostic tools. All patients showed stable hemodynamic conditions so that they could undergo a minimally invasive attempt. The surgical approach was robotic-assisted in three patients (60%) and laparoscopic in two (40%). Patients reported no complications or recurrences.

Conclusion

Reviewing current literature, no general recommendations are available about the emergent treatment of strangulated hiatal hernia. Acute mechanical outlet obstruction, ischemia of gastric wall or perforation and severe bleeding are the reasons for an emergent surgical indication. In stable conditions, a minimally invasive approach is often feasible. Moreover, the robot-assisted approach, allowing a stable 3D view and using articulated instruments, represents a reasonable option in challenging situations.
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Metadata
Title
Minimally invasive laparoscopic and robot-assisted emergency treatment of strangulated giant hiatal hernias: report of five cases and literature review
Authors
Graziano Ceccarelli
Alessandro Pasculli
Walter Bugiantella
Michele De Rosa
Fausto Catena
Fabio Rondelli
Gianluca Costa
Aldo Rocca
Mattia Longaroni
Mario Testini
Publication date
01-12-2020
Publisher
BioMed Central
Published in
World Journal of Emergency Surgery / Issue 1/2020
Electronic ISSN: 1749-7922
DOI
https://doi.org/10.1186/s13017-020-00316-1

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