Hiatal Hernias Revisited-A Systematic Review of Definitions, Classifications, and Applications.

IF 3.2 3区生物学 Q1 BIOLOGY Life-Basel Pub Date : 2024-09-11 DOI:10.3390/life14091145

Karl Hermann Fuchs, Ioannis Kafetzis, Alexander Hann, Alexander Meining

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Abstract

Introduction: A hiatal hernia (HH) can be defined as a condition in which elements from the abdominal cavity herniate through the oesophageal hiatus in the mediastinum and, in the majority of cases, parts of the proximal stomach. Today, the role of HHs within the complex entity of gastroesophageal reflux disease (GERD) is very important with regard to its pathophysiology, severity, and therapeutic and prognostic options. Despite this, the application and stringent use of the worldwide accepted classification (Skinner and Belsey: Types I-IV) are lacking. The aim of this study was to carry out a systematic review of the clinical applications of HH classifications and scientific documentation over time, considering their value in diagnosis and treatment.

Methods: Following the PRISMA concept, all abstracts published on pubmed.gov until 12/2023 (hiatal hernia) were reviewed, and those with a focus and clear description of the application of the current HH classification in the full-text version were analysed to determine the level of classification and its use within the therapeutic context.

Results: In total, 9342 abstracts were screened. In 9199 of the abstracts, the reports had a different focus than HH, or the HH classification was not used or was incompletely applied. After further investigation, 60 papers were used for a detailed analysis, which included more than 12,000 patient datapoints. Among the 8904 patients, 83% had a Type I HH; 4% had Type II; 11% had Type III; and 1% had Type IV. Further subgroup analyses were performed. Overall, the precise application of the HH classification has been insufficient, considering that only 1% of all papers and only 54% of those with a special focus on HH have documented its use.

Conclusions: The application and documentation of a precise HH classification in clinical practice and scientific reports are decreasing, which should be rectified for the purpose of scientific comparability.

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重新审视疝气--对定义、分类和应用的系统回顾。

导言食管裂孔疝（HH）可定义为腹腔脏器通过纵隔的食管裂孔疝出，在大多数情况下还会疝出部分近端胃。如今，HHs 在胃食管反流病（GERD）这一复杂实体中的作用对其病理生理学、严重程度、治疗和预后选择都非常重要。尽管如此，世界公认的分类法（斯金纳和贝尔西：I-IV 型）仍缺乏应用和严格使用。本研究的目的是对 HH 分类的临床应用和长期以来的科学文献进行系统回顾，考虑其在诊断和治疗中的价值：按照 PRISMA 概念，对截至 2023 年 12 月 12 日在 pubmed.gov 上发表的所有摘要（食管裂孔疝）进行了审查，并对全文版本中重点明确描述了当前 HH 分类应用的摘要进行了分析，以确定分类水平及其在治疗中的应用：结果：共筛选出 9342 篇摘要。结果：共筛选出 9342 篇摘要，其中 9199 篇摘要的报告重点与 HH 不同，或未使用 HH 分类法，或使用不完全。经过进一步调查，60 篇论文被用于详细分析，其中包括 12000 多个患者数据点。在 8904 名患者中，83% 属于 I 型 HH；4% 属于 II 型；11% 属于 III 型；1% 属于 IV 型。我们还进行了进一步的分组分析。总体而言，HH分类的精确应用还不够，因为只有1%的论文和54%特别关注HH的论文记录了HH分类的应用：结论：临床实践和科学报告中对 HH 精确分类的应用和记录越来越少，为了实现科学的可比性，应纠正这种情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Life-Basel Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology

CiteScore

4.30

自引率

6.20%

发文量

1798

审稿时长

11 weeks

期刊介绍： Life (ISSN 2075-1729) is an international, peer-reviewed open access journal of scientific studies related to fundamental themes in Life Sciences, especially those concerned with the origins of life and evolution of biosystems. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers.