N 4 (195) 2025. P. 41–45

ADVANCES IN SURGICAL TECHNIQUES FOR THE TREATMENT OF GIANT HIATAL HERNIA

V. V. Grubnyk, D. V. Korchevyi, Viktor V. Grubnyk, R. S. Parfentiev,
Z. D. Bugrydze

Odesa National Medical University, Odesa, Ukraine

DOI 10.32782/2226-2008-2025-4-6

Background. Laparoscopic surgery for large and giant hiatal hernias is associated with significant technical difficulties. This study compared outcomes of two surgical approaches: the use of mesh implants and relaxing incisions of the diaphragmatic crura.

Materials and Methods. Between 2015 and 2024, 78 patients (66.7% women; mean age 64.5 ± 1.1 years; BMI 29.4 ± 3.2 kg/m²) underwent laparoscopic surgery for giant hiatal hernia. Patients were randomized into two groups: Group I (n = 46) received mesh implants (Ultra Pro, PTFE-coated), while Group II (n = 32) underwent relaxing incisions of the diaphragmatic crura with defect coverage using a self-fixing ProGrip mesh. Follow-up lasted 12 months and included assessment of complications, recurrences, and quality of life (QoL) using the SF-36, GIQLI, and Visick scales.

Results. All procedures were performed laparoscopically. In Group I, there was one fatal case and 15 complications, compared with no deaths and three complications in Group II. Recurrence rates were 21.7% vs. 9.4%, respectively. Dysphagia (34.8% vs. 12.5%) and heartburn (37.0% vs. 15.6%) were significantly more common in Group I. Reoperations were required in 26.1% vs. 6.3% of cases (p = 0.02). Long-term QoL was higher in Group II, with significantly lower somatic discomfort and improved SF-36 scores (p < 0.05).

Conclusions. Laparoscopic surgery of giant hiatal hernias using relaxing incisions of the diaphragmatic crura is a safe and effective alternative to mesh implantation. This technique reduces recurrence rates (21.7% to 9.4%) and re-operations (26.1% to 6.3%; χ² = 5.04, p = 0.02), while improving patient quality of life.

Keywords: hiatal hernia, mesh implant, fundoplication, minimally invasive surgery, quality of life.

REFERENCES

  1. D’Urbano F, Tamburini N, Resta G, Maniscalco P, Marino S, Anania G. A Narrative Review on Treatment of Giant Hiatal Hernia. J Laparoendosc Adv Surg Tech A. 2023 Apr;33(4):381–388. doi: 10.1089/lap.2023.0019. Epub 2023 Mar 16. PMID: 36927045.
  2. Usenko OYu, Tyvonchuk OS, Vynogradov RI, Zhytnik DYu. Laparoscopic Treatment of Morgagni-Larrey Diaphragmatic Hernia with Reposition of the Transverse Colon in Patients with Cardiac Comorbidity. Clinical Observation. Ukrainian Journal of Cardiovascular Surgery. 2023;31(2):68–72. (In Ukrainian). DOI: https://doi.org/10.30702/ujcvs/23.31(02)/ UT015-6872.
  3. Tartaglia E, Cuccurullo D, Guerriero L, et al. The use of biosynthetic mesh in giant hiatal hernia repair: is there a rationale? A 3-year single-center experience. Hernia. 2021 Oct;25(5):1355–1361. doi: 10.1007/s10029-020-02273-9. Epub 2020 Jul 25. PMID: 32712835.
  4. Rajkomar K, Berney CR. Large hiatus hernia: time for a paradigm shift? BMC Surg. 2022 Jul 8;22(1):264. doi: 10.1186/ s12893-022-01705-w. PMID: 35804332; PMCID: PMC9264491.
  5. Tsuboi K, Masuda T, Omura N, et al. Is it meaningful to add mesh reinforcement to laparoscopic fundoplication for esophageal hiatal hernias in patients with a high risk of hiatal hernia recurrence? Esophagus. 2024 Jan;21(1):67–75. doi: 10.1007/s10388-023-01026-8. Epub 2023 Oct 10. PMID: 37817043.
  6. Ilyashenko VV, Grubnyk VV, Grubnik VV. Laparoscopic management of large hiatal hernia: mesh method with the use of ProGrip mesh versus standard crural repair. Surg Endosc. 2018 Aug;32(8):3592–3598. doi: 10.1007/s00464-018-6087-2. Epub 2018 Feb 8. PMID: 29423552.
  7. Guan L, Nie Y, Yuan X, Chen J, Yang H. Laparoscopic repair of giant hiatal hernia for elderly patients. Ann Transl Med. 2021 Apr;9(8):704. doi: 10.21037/atm-21-1495. PMID: 33987402; PMCID: PMC8106099.
  8. Ardu M, Bisogni D, Bruscino A, Tucci R, Falchini M, Valeri A, Prosperi P. Laparoscopic giant hiatal hernia repair with absorbable mesh. J Minim Access Surg. 2022 Apr–Jun;18(2):248–53. doi: 10.4103/jmas.JMAS_26_21. PMID: 35313434; PMCID: PMC8973483.
  9. Grubnik VV, Ilyashenko VV, Grubnik VV, Korchovyi DV, Parfentiev RS. A new approach to the treatment of large and giant hiatal hernia. Ukr J Clin Surg. 2023 Sep-Oct;90(5):16–19. doi: 10.26779/2786-832X.2023.5.16.
  10. McKay SC, DeMeester SR, Sharata A, et al. Diaphragmatic relaxing incisions for complex hiatal reconstruction: longer-term follow-up confirms safety, efficacy, and rare complications. Surg Endosc. 2023 Nov;37(11):8636–43. doi: 10.1007/ s00464-023-10293-6. Epub 2023 Jul 26. PMID: 37495846.
  11. Vigneswaran Y, Hussain M, Varsanik MA, Corvin C, Gottlieb LJ, Alverdy JC. IDEAL Phase 2a Results: Posterior Rectus Sheath Flap for Hiatal Augmentation in Complex Paraesophageal Hernias. Ann Surg. 2024 Jun 1;279(6):1000–1007. oi: 10.1097/SLA.0000000000006247. Epub 2024 Feb 20. PMID: 38375674; PMCID: PMC11086674.
  12. Ward MA, DeMeester SR. Diaphragmatic Relaxing Incisions for Crural Tension During Hiatal Hernia Repair. In: Yeo CJ, editor. Shackelford’s Surgery of the Alimentary Tract, 2 Volume Set. 8th ed. Philadelphia: Elsevier; 2019. p. 301–4. https://doi.org/10.1016/B978-0-323-40232-3.00028-5.
  13. Zadorozhna VI, Vynnyk NP. Issues of bioethics and biosafety in the problem of biotechnology and the use of vaccines for the prevention of human infectious diseases. Biotechnol Acta. 2020;13(2):5–15. (In Ukrainian). doi: 10.31073/vet_ biotech32(1)-62.
  14. Ware JE Jr, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36): I. conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–83. doi: 10.1097/00005650-199206000-00002. PMID: 1593914.
  15. Le Page PA, Furtado R, Hayward M, et al. Durability of giant hiatus hernia repair in 455 patients over 20 years. Ann R Coll Surg Engl. 2015 Apr;97(3):188–93. doi: 10.1308/003588414X14055925060839. PMCID: PMC4474010.
  16. Rijnhart-De Jong HG, Draaisma WA, Smout AJ, Broeders IA, Gooszen HG. The Visick score: a good measure for the overall effect of antireflux surgery? Scand J Gastroenterol. 2008;43(7):787–93. doi: 10.1080/00365520801935467. PMID: 18584516.
  17. Sun Z, Tao Y, Li S, Ferguson KK, Meeker JD, Park SK. Statistical strategies for constructing health risk models with multiple pollutants and their interactions: possible choices and comparison. Environ Health. 2013;12(1):85. doi: 10.1186/1476-069X-12-85.
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