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

Table 1 Case series

N	Age (y), sex	Symptoms^a, examination^b, history	Comorbidities	BMI kg/m²	CT findings	Endoscopic findings	Waiting time from admission to surgery (days)	Approach of hiatoplasty	Fundoplication	Mesh	Gastropexy/gastrostomy	Operative time (min)	Complications	Hospital stay (days)	Follow-up (minimum 6 months)
1	70, M	Symptomatic GHH	None	25.3	GHH with air-fluid level	Gastric obstruction	0	Robotic assisted	Nissen	No	None	190	None	4	Uneventful
2^c	47, M	Weight loss, asymptomatic GHH	Depression, obesity	37.5	GHH with air-fluid level	Gastric obstruction. Diffuse ischemia of gastric mucosa^d	0	Robotic assisted^e	No	No	Foley 18 in the gastric antrum	230	antrum stenosis	21	Mild reflux, Foley removed on PD 35, endoscopic balloon dilatation
3	86, M	Weight loss, GERD, symptomatic GHH	Hypertension, dyslipidemia	27.4	Gastric volvulus	Gastric obstruction	2^f	Laparoscopic	Toupet	No	Gastrostomy tube	180	None	9	Gastrostomy tube removed on PD 25
4	88, M	Asthenia, GERD, asymptomatic GHH	Atrial fibrillation in OAT, hypertension, COPD	24.4	GHH with upside-down stomach	Gastric obstruction	3 (stop of OAT)	Robotic assisted	Toupet	BIO-A®^g	Gastrostomy tube	190	None	7	Gastrostomy tube removed on PD 20
5	59, M	Coffee ground vomiting, GERD, symptomatic GHH	Obesity	32.6	GHH with air-fluid level and signs of gastric wall vascular insufficiency	Not performed	0	3D laparoscopic	Nissen	BIO-A®^g	Gastropexy	170	None	5	Uneventful

CT computed tomography, GHH giant hiatal hernia, MOF multi organ failure, ICU intensive care unit, GERD gastroesophageal reflux disease, PD postoperative day, OAT oral anticoagulant therapy, COPD chronic obstructive pulmonary disease, BMI body mass index
^aAbdominal and thoracic pain, nausea and vomiting were always present. All patients were stable at admission
^bIn all cases, there was no/incomplete nasogastric tube progression
^cIn this case, elevated white blood cells count and lactate lead to the need of ruling out ischemic heart disease
^d5 postoperative days in ICU
^eIntraoperative gastroscopy to check the mucosa of the distal stomach
^fAttempt of conservative approach
^gGore & Associates Inc, Newark, DE, USA

ISSN: 1749-7922