High-tech surgery for hiatal hernia repair: Current state, new treatment options and future prospects

Rob Tolboom

    Research output: ThesisPhD Thesis - Research UT, graduation UT

    76 Downloads (Pure)


    The presence of a hiatal hernia and gastroesophageal reflux disease often presents with severe, disabling symptoms and is known to result into a poor quality-of-life for many patients. Nevertheless, it’s often seen by patients and physicians alike as an ailment to be treated by antacids, not as serious disease warranting surgery.

    While most hiatal hernia are straightforward, in some rare cases the pancreas herniates along with the other organs into the thoracic cavity. Little is known about how to proceed surgically. Furthermore, some patients are hindered in their daily life by symptoms of delayed gastric emptying. Antireflux surgery is known to enhance gastric emptying speeds in most cases. Some patients, however, see their gastric emptying worsened. The mechanism behind this phenomenon remains mostly unclear.

    When a hiatal hernia recurs or symptoms persist following primary antireflux surgery, a whole battery of diagnostic tests are done to find the mechanism of failure and therefore also the optimal mode of treatment. We hypothesize that computed tomography (CT) scanning of the gastroesphageal junction offers sufficient information to classify the underlying mechanism of failure.

    Current treatment of hiatal hernia is largely standardized in the Netherlands. Most centers perform partial laparoscopic fundoplications. Some centers, however, see benefits in using robotic assistance.

    And finally, the question remains on how best to treat those patients with severe symptoms and poor quality-of-life following (multiple) previous failed antireflux surgeries and are currently left without any treatment options.

    The aims of this thesis are to find out why the number of referrals for surgery remain lacking in the Netherlands, to describe our experience with intrathoracic herniation of the pancreas, to find the incidence of delayed gastric emptying in patients with large and small hiatal hernia, to describe the effects of surgery on gastric motility, to look at the value of CT-scanning in patients with recurrent disease, to look at the benefits of robotic assistance in primary and redo antireflux surgery, and to describe the development of a novel robot assisted transthoracic minimal-invasive approach for redo-antireflux surgery.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Twente
    • Broeders, Ivo Adriaan Maria Johannes, Supervisor
    • Draaisma, Werner A., Co-Supervisor, External person
    Award date25 Nov 2022
    Place of PublicationEnschede
    Print ISBNs978-90-365-5150-2
    Publication statusPublished - 25 Nov 2022

    Cite this