V-11. Standardized Stepwise Approach to Laparoscopic Repair of Type IV Giant Paraesophageal Hernia: Technical Strategies for Long-Term Durability

Clicks: 15
ID: 326022
2026
Free PDF
Article Quality & Performance Metrics
Overall Quality
Not rated
Combines reader engagement with the AI quality analysis. This article has not been analysed, so there is no overall score — reader engagement is measured and shown alongside.
AI Quality Assessment
Not analyzed
Readership in this journal
Steady

Ranked #434 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

Most read Least read

Bar heights use a square-root scale. Only the 120 most-read articles are drawn; the journal has 453 in total.

Mint this article as an NFT
Not yet minted

Create a permanent, verifiable on-chain record of this article on the Scimatic Network. The NFT is held in your Journament account, and you can withdraw it to your own wallet at any time.

5 SUSD one-off · no wallet required
Sign in to mint
Abstract
Abstract Topic Benign Disease: Gastro-Esophageal Reflux and Hiatal Hernia Background Laparoscopic repair of Type IV Giant Paraesophageal Hernia (GHH) remains technically demanding, especially in elderly patients, with historical recurrence rates reaching 20%. Challenges include distorted anatomy and the necessity for significant mediastinal mobilization to ensure anatomical durability. We present a standardized 6-step surgical protocol designed to enhance safety and reduce recurrence. This approach emphasizes the "Critical View" and strategic dissection maneuvers tailored to complex cases, providing a reproducible framework for surgeons to achieve superior clinical and anatomical outcomes in challenging hiatal repairs. Methods A 79-year-old female presented with acute epigastric pain and gastric outlet obstruction, which improved after endoscopic decompression. Preoperative imaging confirmed a Type IV GHH, which improved after endoscopic decompression. The operation followed a 6-step standardized protocol: Results The patient’s postoperative course was unremarkable. She tolerated a liquid diet early on, transitioning to a soft diet for two weeks, and was successfully discharged on postoperative day 3. No perioperative complications were observed. Follow-up at 16 months confirmed the patient remained completely asymptomatic with no radiologic evidence of recurrence. These results demonstrate that a systematic approach, combined with strategic anatomical preservation and tailored anti-reflux maneuvers, ensures high-quality surgical outcomes and long-term durability in complex Type IV giant paraesophageal hernia repairs. Conclusion A standardized stepwise approach is essential for managing complex Type IV GHH in elderly patients. Prioritizing the preservation of the accessory left hepatic artery and consistently achieving the "Critical View" provide a safe and reproducible framework for surgeons. By ensuring a tension-free intra-abdominal esophagus and selecting appropriate fundoplication, this protocol significantly mitigates recurrence risks and postoperative complications. This case illustrates that even in acute presentations of giant hernia, systematic laparoscopic intervention leads to excellent long-term anatomical durability and functional success. Video Description This video demonstrates a Standardized Stepwise Approach for the laparoscopic repair of a complex Type IV Giant Paraesophageal Hernia (GHH) in a 79-year-old patient. The presentation covers the entire clinical spectrum, from the acute management of gastric outlet obstruction via endoscopic decompression to a definitive 6-step surgical repair. Why is this video unique and important for the Congress? 1.Clinical Significance: It highlights a successful outcome in a high-risk elderly patient, achieving discharge on postoperative day 3 and maintaining zero recurrence at 16 months. 2. Educational Value: By standardizing complex anatomy into a reproducible framework, this video offers surgeons practical strategies to enhance anatomical durability and safety in challenging hiatal hernia cases.
Reference Key
openalex_W7203985809 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Thawatchai Tullavardhana
Are you one of these authors? Claim your profile
Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.411
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.411/70760943/doag077.411.pdf
Keywords Keywords not found

Citations

No citations found. To add a citation, contact the admin at info@scimatic.org

Comments

No comments yet. Be the first to comment on this article.