Transthoracic induction of a hiatal hernia in domestic swine.

Background: With the common performance of laparoscopic Nissen fundoplication for gastroesophageal reflux disease, there is renewed interest in the pathophysiology and potential histologic consequences of hiatal hernias. However, in vivo model exists that both reliably reproduces the hiatal hernia and is amenable to subsequent laparoscopic repair.

Methods: A transthoracic approach was used to induce a hiatal hernia surgically in female James pig (50-160 kg; n = 5).

Results: Hiatal hernias were successfully induced in all pigs and verified with barium swallow, endoscopy, and/or laparoscopy. Laparoscopic reduction and Nissen fundoplication were subsequently completed on each animal on postoperative day 30. One postoperative death occurred on postoperative day 4 after thoracotomy.

Conclusions: We describe the induction of a hiatal hernia via a transthoracic approach in domestic swine. The hiatal hernia is amenable to subsequent laparoscopic repair, enabling surgeons to acquire the technical skills required to correct this defect in the laboratory. To our knowledge, this is the first report of a reproducible model of a transthoracically induced hiatal hernia that allows subsequent laparoscopic repair. We suggest that in addition to refinement of surgical skills, our model may provide new information to researchers regarding the potential indications for antireflux procedures, as well as the natural history and appropriate management of hiatal hernias.