Transthoracic Repair of Giant Paraesophageal and Hiatal Hernias: A Systematic Review and Meta-Analysis.

The utilization of transthoracic approaches for the repair of large hiatus hernias remains a topic of clinical debate. This study aims to evaluate the efficacy, safety, and recovery metrics for transthoracic hiatal hernia repair. A literature search was conducted using the key terms "hiatus hernia," "thoracotomy," "thoracic approach," and "Belsey Mark IV." The databases searched included MEDLINE, EMBASE, and Web of Science, covering the period from 2000 to June 2024. Extracted data included patient demographics, study design characteristics, length of stay, complication rate, and mortality rate. A total of five citations were selected, comprising a total of 560 patients, of which 164 were male (29.3%), with an overall mean age of 64.9 (pooled SD = 1.93) and a weighted mean follow-up length of 56.4 months (pooled SD = 39.1 months). The weighted overall mean length of stay was 14.5 days (pooled SD = 7.42). The overall rate of minor complications was 19% (95% confidence interval (CI) (6%, 31%)). The overall rate of major complications was 13% (95% CI (6%, 21%)). There were four reported mortalities in total and an overall leak rate of 1% (95% CI (0%, 2%)). Transthoracic approaches have unique benefits and risks in the context of hiatal hernia surgery. Access via thoracotomy is associated with a higher incidence of complications. However, for large or emergent paraesophageal hernias, the transthoracic approach may represent a viable option in select patients.