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Coss-Adame E, Furuzawa-Carballeda J, Perez-Ortiz AC, López-Ruiz A, Valdovinos MA, Sánchez-Gómez J, Peralta-Figueroa J, Olvera-Prado H, López-Verdugo F, Narváez-Chávez S, Santés-Jasso Ó, Aguilar-León D, Torres-Villalobos G. A Higher Manometric Esophageal Length to Height Ratio in Achalasia Explains the Lower Prevalence of Hiatal Hernia. J Neurogastroenterol Motil 2023; 29:501-512. [PMID: 37612234 PMCID: PMC10577459 DOI: 10.5056/jnm22139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/22/2022] [Accepted: 11/26/2022] [Indexed: 08/25/2023] Open
Abstract
Background/Aims The evidence suggests that a shorter esophageal length (EL) in gastroesophageal reflux disease (GERD) patients is associated with the presence of hiatal hernia (HH). However, there are no reports of this association in patients with achalasia. The aim is to (1) determine the prevalence of hiatal hernia in achalasia patients, (2) compare achalasia EL with GERD patients and healthy volunteers (HV), (3) measure achalasia manometric esophageal length to height (MELH) ratio, and (4) determine if there are differences in symptoms between patients with and without hiatal hernia. Methods This retrospective and cross-sectional study consist of 87 pre-surgical achalasia patients, 22 GERD patients, and 30 HV. High-resolution manometry (HRM), barium swallow, and upper endoscopy were performed to diagnose HH. The EL and MELH ratio were measured by HRM. Symptoms were assessed with Eckardt, Eating Assessment Tool, and GERD-health-related quality of life questionnaires. Results The HH in GERD's prevalence was 73% vs 3% in achalasia patients (P < 0.001). Achalasia patients had a longer esophagus and a higher MELH ratio than HV and GERD patients (P < 0.001). GERD patients had a lower MELH ratio than HV (P < 0.05). EAT-10 (P < 0.0001) and Eckardt (P < 0.05) scores were higher in achalasia without HH vs HH. Conclusions The prevalence of HH in achalasia is significantly lower than in GERD. The longer EL and the higher MELH ratio in achalasia could explain the lower prevalence of HH. Despite the low prevalence of HH in achalasia patients, the surgeon should be encouraged not to rule out HH since the risk of postoperative reflux may increase if this condition is not identified and corrected.
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Affiliation(s)
- Enrique Coss-Adame
- Departments of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Janette Furuzawa-Carballeda
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Ana López-Ruiz
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Miguel A Valdovinos
- Departments of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Josué Sánchez-Gómez
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - José Peralta-Figueroa
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Héctor Olvera-Prado
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Fidel López-Verdugo
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Sofía Narváez-Chávez
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Óscar Santés-Jasso
- Departments of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Diana Aguilar-León
- Departments of Pathology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Gonzalo Torres-Villalobos
- Departments of Experimental Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
- Departments of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
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Radovanovic D, Pavlovic M, Canovic D, Lazic D, Cvetkovic A, Spasic M, Stojanovic B, Milosevic B. The Collis Procedure and the Acquired Short Esophagus. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.1515/sjecr-2016-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
One of the most intriguing problems in modern esophageal surgery is the acquired short esophagus. While some authors recognize this entity, others deny its existence. There is a consensus about types of the short esophagus, its etiology and pathophysiology. Definitive diagnosis can be established only intraoperatively. There are a few surgical procedures for this problem, and most frequently is used Collis gastroplasty with fundoplication. In this review we emphasize recent literature data and further perspectives of the Collis procedure.
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Affiliation(s)
- Dragce Radovanovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Mladen Pavlovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Dragan Canovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Dejan Lazic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Aleksandar Cvetkovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Marko Spasic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Bojan Stojanovic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
| | - Bojan Milosevic
- Clinic for general and thoracic surgery , Clinical center Kragujevac , Kragujevac , Serbia
- University of Kragujevac , Faculty of Medical Sciences , Kragujevac , Serbia
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Li J, Cheng T. Mesh erosion after hiatal hernia repair: the tip of the iceberg? Hernia 2019; 23:1243-1252. [DOI: 10.1007/s10029-019-02011-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
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Canovic D, Milosevic B, Lazic D, Cvetkovic A, Spasic M, Stojanovic B, Mitrovic S, Pavlovic M. Esophageal Mobilization in the Treatment of Short Esophagus. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2018. [DOI: 10.1515/sjecr-2016-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Short esophagus is well known complication of a long term gastroesophageal disease. There are several ways to solve this problem intraoperatively. One of the first steps is extensive esophageal mobilisation. In this review we emphasize different approaches and types of this procedure, with their advantages and disadvantages.
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Affiliation(s)
- Dragan Canovic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Bojan Milosevic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Dejan Lazic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Aleksandar Cvetkovic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Marko Spasic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Bojan Stojanovic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Slobodanka Mitrovic
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
- Department for pathologic and anatomic diagnostics, Clinical center Kragujevac , Kragujevac , Serbia
| | - Mladen Pavlovic
- Clinic for General and Thoracic surgery, Clinical center Kragujevac , Kragujevac , Serbia
- Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
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5
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Patients are well served by Collis gastroplasty when indicated. Surgery 2017; 162:568-576. [DOI: 10.1016/j.surg.2017.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/21/2017] [Accepted: 04/05/2017] [Indexed: 01/21/2023]
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Routine versus selective contrast imaging to identify the need for early re-intervention following laparoscopic fundoplication: A retrospective cohort study. Int J Surg 2015; 20:123-7. [PMID: 26118598 DOI: 10.1016/j.ijsu.2015.06.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 06/10/2015] [Accepted: 06/18/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine post-operative contrast studies. The study aimed to examine whether routine contrast studies more effectively recognised early post-operative complications following anti-reflux surgery compared with selective use. METHODS This was a retrospective analysis of 240 adults who had undergone primary anti-reflux surgery. Selective use of water-soluble contrast swallows was employed for 115 patients (Group 1) while 125 patients (Group 2) had routine studies. RESULTS 10 (0.9%) patients from Group 1 underwent contrast studies, four (40%) of which were abnormal. Routine studies in Group 2 identified thirty-two abnormalities (27%) however the inter-group difference was not significant (p = 0.32). Only one case from group 2 required immediate re-intervention. This was not statistically significant (p = 0.78). Multivariate analysis found no significant association between selective or routine imaging and re-intervention rates. One patient from group 2 presented three days following discharge with wrap migration requiring reoperation despite a normal post-operative study. CONCLUSION Routine use of contrast imaging following anti-reflux and hiatus hernia surgery is not necessary. It does not identify a significantly greater number of post-operative complications in comparison to selective use. Additionally, routine use of contrast studies does not ensure the diagnosis of all complications in the post-operative period.
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8
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9
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Abstract
The first laparoscopic Nissen fundoplication was performed 20 years ago. Surgical management of gastroesophageal reflux disease (GERD) should be offered only to appropriately studied and selected patients, with the ultimate aim of improving the well-being of the individual, the "quality of life." The choice of fundoplication should be dictated by the surgeon's preference and experience.
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Affiliation(s)
- Bernard Dallemagne
- Department of Digestive and Endocrine Surgery, and Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), University Hospital of Strasbourg, IRCAD-EITS, 1 Place de l'Hôpital, 67091, Strasbourg, France.
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10
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Short esophagus: selection of patients for surgery and long-term results. Surg Endosc 2011; 26:704-13. [DOI: 10.1007/s00464-011-1940-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/31/2011] [Indexed: 12/13/2022]
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Houghton SG, Deschamps C, Cassivi SD, Nichols FC, Allen MS, Pairolero PC. The influence of transabdominal gastroplasty: early outcomes of hiatal hernia repair. J Gastrointest Surg 2007; 11:101-6. [PMID: 17390195 DOI: 10.1007/s11605-006-0059-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of our study was to review our experience with transabdominal gastroplasty to determine the safety and short-term efficacy of the procedure. METHODS Retrospective review of all patients that underwent transabdominal hiatal hernia repair with concurrent gastroplasty for shortened esophagus between October 1999 and May 2004. RESULTS There were 63 patients, 27 men and 36 women. Median age was 68 years. The hiatal hernia was classified as type-I in 6 patients, type-II in 10, type-III in 43, and type-IV in 4. The operative approach was laparoscopic in 44 patients and laparotomy in 19. A Nissen fundoplication was performed in 62 patients and a Toupet fundoplication in 1. Wedge gastroplasty was performed in 47 patients and modified Collis gastroplasty in 16. Median hospitalization was 3 days (range, 2-10). Intraoperative complications occurred in 11 patients (17%). One laparoscopic approach (2%) was converted to laparotomy. Postoperative complications occurred in 12 patients (19%), there were no operative deaths. Median follow-up was 12 months (range, 0 to 64). One patient (2%) was found to have a recurrent hiatal hernia diagnosed 14 months, postoperatively. Functional results were excellent in 41 (68%), good in 6 (10%), fair in 12 (20%), and poor in 1 (2%). CONCLUSION Transabdominal gastroplasty can be performed safely, with good functional results and a low incidence of recurrent herniation during the short-term follow-up period.
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Affiliation(s)
- Scott G Houghton
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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12
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Abstract
Laparoscopic fundoplication has emerged as an effective treatment for gastro-oesophageal reflux disease. The majority of patients who have undergone antireflux surgery report an improvement in reflux symptoms and in quality of life. However, some patients are dissatisfied with the outcome of antireflux surgery, and attempts have been made by surgeons to improve the results of this surgery. Careful case selection based on objective evidence of acid reflux, refinement of the surgical technique and 'tailoring' the wrap to suit the patient by selective use of a partial fundoplication may help to optimize the outcome from laparoscopic antireflux surgery.
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Affiliation(s)
- Jeremyd Hayden
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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13
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Ducrotté P, Leblanc-Louvry I. [Sequelae of sub-mesocolic surgery]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:839-45. [PMID: 16294154 DOI: 10.1016/s0399-8320(05)86356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Philippe Ducrotté
- Hépato-Gastroentérologie et Nutrition, Polyclinique, 76031 Rouen Cedex
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14
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Abstract
Gastroesophageal reflux disease (GERD) is a common health problem affecting more than 50% of the population. For those who experience more than occasional symptoms, GERD has a profound effect on their quality of life. With the advent of laparoscopic surgery, fundoplication has been used to treat GERD. Fundoplication also is used in the surgical management of paraesophageal hernias. Technical controversies are addressed in this article, including open versus laparoscopic approaches, the choice of complete (360 degres) or partial fundoplication, whether or not a gastroplasty is required, and the use of prosthetic materials in crural repair.
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Affiliation(s)
- Gail Darling
- University of Toronto, Toronto General Hospital, 10EN-228, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
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15
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Abstract
Short esophagus and peptic esophageal stricture are complications of chronic severe GERD. Short esophagus is properly diagnosed by an objective,intraoperative assessment after appropriate dissection of the GEJ. A laparoscopic Collis gastroplasty combined with an antireflux procedure comprises effective therapy. Peptic stricture should be addressed with an initial course of dilator therapy and optimization of antiacid medication. Consideration is given to an antireflux procedure if conservative therapy fails. Laparoscopic techniques have proven to be safe and effective in treating short esophagus and peptic stricture.
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Affiliation(s)
- Chuong D Hoang
- Section of General Thoracic Surgery, Division of Cardiovascular and Thoracic Surgery, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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16
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Seely AJE, Sundaresan RS, Finley RJ. Principles of laparoscopic surgery of the gastroesophageal junction. J Am Coll Surg 2005; 200:77-87. [PMID: 15631923 DOI: 10.1016/j.jamcollsurg.2004.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 06/21/2004] [Accepted: 08/18/2004] [Indexed: 11/30/2022]
Affiliation(s)
- Andrew J E Seely
- Department of Thoracic Surgery, the University of Ottawa, Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
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Patel HJ, Tan BB, Yee J, Orringer MB, Iannettoni MD. A 25-year experience with open primary transthoracic repair of paraesophageal hiatal hernia. J Thorac Cardiovasc Surg 2004; 127:843-9. [PMID: 15001915 DOI: 10.1016/j.jtcvs.2003.10.054] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The optimal surgical treatment of paraesophageal hiatal hernia is in debate. Our experience with a traditional transthoracic approach was reviewed to provide "benchmark" data against which newer surgical techniques can be measured. METHODS Between 1977 and 2001, 240 patients had primary transthoracic repair of paraesophageal hiatal hernia. Presenting complaints included reflux (69%), pain (67%), dysphagia (36%), and bleeding or anemia (33%). Preoperative esophageal function testing showed abnormal reflux in 86%. Hernia types were combined (type III) in 92% and type IV in 8%. All patients had reduction of the hernia and a concomitant antireflux procedure. An esophageal lengthening Collis gastroplasty was performed in 96%. RESULTS There were 3 perioperative deaths (1.7%). The median length of hospital stay was 7 days. Early complications requiring reoperation occurred in 12 patients (5%) and included recurrent hernia in 4, leak in 3, and a tight hiatal closure in 3. Mean follow-up in 226 patients was 42 months (median 27.8 months). Satisfactory results were obtained in 86% of patients. Follow-up complaints (moderate or persistent symptoms) included dysphagia (4), reflux (1), dumping (3), and post-thoracotomy pain (1). Routine postoperative barium radiographs showed intact repair in 71% (108/153). Of 19 patients with an anatomic recurrence, 4 (2%) had more than a partial asymptomatic migration of the fundoplication and required reoperation. Postoperative esophageal function testing, obtained in 28% of the patients, showed abnormal gastroesophageal reflux in 2. CONCLUSION Open transthoracic repair of paraesophageal hiatal hernia provides good to excellent long-term control of both the hernia and gastroesophageal reflux with relatively low early morbidity.
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Affiliation(s)
- Himanshu J Patel
- Section of Thoracic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA
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Mattioli S, Lugaresi ML, Pierluigi M, Di Simone MP, D'Ovidio F. Review article: indications for anti-reflux surgery in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2003; 17 Suppl 2:60-7. [PMID: 12786615 DOI: 10.1046/j.1365-2036.17.s2.4.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Gastro-oesophageal reflux disease (GERD) is a complex multifactorial disorder whose treatment is based on knowledge of its pathophysiology, natural history and evolution. Recently the relationship between the severest degrees of cardial incontinence and hiatus hernia has been emphasized, which causes the impairment of the mechanical properties of the gastro-oesophageal barrier and of oesophageal acid clearing. Among different types of hiatus hernia, those characterized by the permanent axial orad migration of the oesophago-gastric (EG) junction (nonreducible hiatus hernia) are correlated with severe GERD. Barium swallow may adequately differentiate hiatal insufficiency, concentric hiatus hernia and short oesophagus which are the steps of migration across or above the diaphragm. When associated with panmural oesophagitis and fibrosis of the oesophageal wall, these conditions may be the cause of recurrence of hiatus hernia and reflux after laparoscopic standard anti-reflux surgical procedures; in the presence of nonreducibility of the EG junction below the diaphragm without tension, dedicated surgical procedures are necessary. It is currently agreed that surgical therapy is indicated for patients affected by severe GERD who are not compliant with long-term medical therapy, require high dosages of drugs and are too young for lifetime medical treatment. While the existence of severe GERD correlated with an irreversible anatomical disorder represents an elective indication for surgery, warrants further investigation. Accurate identification of the functional and anatomical abnormalities underlying GERD is mandatory in order to decide whether medical or surgical therapy should be implemented, and to tailor the surgical technique, laparoscopic or open, to each patient.
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Affiliation(s)
- S Mattioli
- Department of Surgery, Center for the Study & Therapy of Diseases of the Oesophagus (Surgical Section), University of Bologna, Bologna, Italy.
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Abstract
There are controversies regarding existence and incidence of short esophagus. The authors reviewed the literature incidence of short esophagus among operated patients due to gastroesophageal reflux disease in the last 3 years. The overall incidence of short esophagus was 1.53%. The proposed risk factors (paraesophageal hernia, Barrett's esophagus, reoperation, esophageal strictures and access route) do have a higher incidence of short esophagus, with the exception of the Barrett's esophagus. Although several biases can be associated with the review, the authors identified the short esophagus incidence in the literature.
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Affiliation(s)
- F A M Herbella
- Surgical Gastroenterology Department, Federal University of São Paulo, São Paulo, Brazil.
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20
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Meyer C, Buffler A, Rohr S, Lima MC. [Laparoscopic treatment of large hiatal hernias using a prosthesis. Report of ten cases]. ANNALES DE CHIRURGIE 2002; 127:257-61. [PMID: 11980297 DOI: 10.1016/s0003-3944(02)00716-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate prospectively the laparoscopic surgery for giant hiatal hernias treated by fundoplication and hiatal prosthesis. PATIENTS AND METHODS Ten patients were included in this study. Surgical technic included the dissection of oesophageal hiatus, the sac excision and the dissection of the abdominal oesophagus to obtain a physiological length. The decision criterion for a prosthesis was the hiatus oesophagus diameter of 5 cm or more. The crura were closed and the hiatus was reinforce by a prosthesis of 15 x 15 cm. All patients underwent a fundoplication whether partial or complete. RESULTS Eight patients had a type III hernia, and 2 had a type II. The mean size for the hiatus was 6.5 cm (5.5-8). Eight patients underwent a total fundoplicature and 2 a partial one. The prosthesis was made of polypropylene in 5 cases. Average operating time was 182 min (78-240). One patient had postoperative morbidity, with gastroplagia which resolved. There was no mortality. Mean hospitalisation duration was 7.7 days (5-12). No one case of recurrence have been noticed after a mean follow-up of 24 months (8-40). CONCLUSION It appears that the large size hiatal hernia (more than 5 cm) can be treated with good results by using a prosthesis during laparoscopic fundoplication.
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Affiliation(s)
- C Meyer
- Service de chirurgie générale et digestive, centre de chirurgie viscérale et de transplantation, hôpital universitaire de Strasbourg-Hautepierre, 67098 Strasbourg, France.
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Dahlberg PS, Deschamps C, Miller DL, Allen MS, Nichols FC, Pairolero PC. Laparoscopic repair of large paraesophageal hiatal hernia. Ann Thorac Surg 2001; 72:1125-9. [PMID: 11603423 DOI: 10.1016/s0003-4975(01)02972-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this study was to analyze our initial results after laparoscopic repair of large paraesophageal hiatal hernias. METHODS Between October 1997 and May 2000, 37 patients (23 women, 14 men) underwent laparoscopic repair of a large type II (pure paraesophageal) or type III (combined sliding and paraesophageal) hiatal hernia with more than 50% of the stomach herniated into the chest. Median age was 72 years (range 52 to 92 years). Data related to patient demographics, esophageal function, operative techniques, postoperative symptomatology, and complications were analyzed. RESULTS Laparoscopic hernia repair and Nissen fundoplication was possible in 35 of 37 patients (95.0%). Median hospitalization was 4 days (range 2 to 20 days). Intraoperative complications occurred in 6 patients (16.2%) and included pneumothorax in 3 patients, splenic injury in 2, and crural tear in 1. Early postoperative complications occurred in 5 patients (13.5%) and included esophageal leak in 2, severe bloating in 2, and a small bowel obstruction in 1. Two patients died within 30 days (5.4%), 1 from delayed splenic bleeding and 1 from adult respiratory distress syndrome secondary to a recurrent strangulated hiatal hernia. Follow-up was complete in 31 patients (94.0%) and ranged from 3 to 34 months (median 15 months). Twenty-seven patients (87.1%) were improved. Four patients (12.9%) required early postoperative dilatation. Recurrent paraesophageal hiatal hernia occurred in 4 patients (12.9%). Functional results were classified as excellent in 17 patients (54.9%), good in 9 (29.0%), fair in 1 (3.2%), and poor in 4 (12.9%). CONCLUSIONS Laparoscopic repair of large paraesophageal hiatal hernias is a challenging operation associated with significant morbidity and mortality. More experience, longer follow-up, and further refinement of the operative technique is indicated before it can be recommended as the standard approach.
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Affiliation(s)
- P S Dahlberg
- Division of General Thoracic Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA
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