An unexpected case of giant hiatal hernia and review of the literature

Abstract

INTRODUCTION: The management of giant hiatal hernia remains one of the most complicated surgical challenge and several operative approaches have been proposed during the years. Currently, the most practiced is the laparoscopic approach, which adds functional outcomes overlapping those of the conventional open surgery to the own advantages of the technique. The main problem of this operation is the high rate of recurrence, occurring independently by the specific technique adopted.

PRESENTATION OF CASE: An unexpected case of giant hiatal hernia, incidentally discovered in a patient candidate to cholecystectomy for gallstones, is presented. We describe the surgical procedure performed and our cornerstones for a correct and long-lasting hiatal hernia repair, comparing us with the current standards of care.

DISCUSSION: Laparoscopy has facilitated the execution of some surgical steps, such as the hiatal visualization and the intra-thoracic esophagus mobilization, fundamental for the success of the operation. Inheriting the concept of tension free repair, the use of mesh reinforcing the hiatal defect is being encouraged, especially biologic meshes, although some authors warn their employment may introduce potential catastrophic complications for patient.

CONCLUSION: Laparoscopy should be the approach of choice, whenever possible, to treat this condition, while the use of supportive prosthetic devices depends on the single patient’s hernia characteristics and on the surgeon’s personal experience and preferences. Anyways, many factors determine the final outcomes of the surgical intervention, some of which patientdependent, others operator-dependent but, independently from the approach adopted, this operation is often burdened by a high risk of recurrence.