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1.
Summary The authors report their experience of laparoscopic repair of large paraoesophageal hernias (POH). From February 1994 to January
1997, nine patients with a large POH containing at least 50% of the stomach have been treated laparoscopically. The surgical
procedure included reduction of the herniated stomach, closure of the hiatal orifice, and construction of a circular fundoplication.
There was no conversion into open surgery. One case of postoperative atelectasis was seen (morbidity: 12.5%). Postoperative
X-Ray demonstrated the restoration of a normal anatomical arrangements as well as an effective anti-reflux fundoplication.
Laparoscopy makes it possible to safely and efficiently repair large POHs with an acceptable morbidity. However, this type
of operation requires a good training in laparoscopic surgery. 相似文献
2.
Giuseppe Zambito Robert Roether Brittany Kern Ryan Conway David Scheeres Amy Banks-Venegoni 《American journal of surgery》2021,221(3):575-577
BackgroundThe aim of the study is to determine if barium esophagram (BE) alone is sufficient to diagnose esophageal dysmotility when compared to the gold standard, high-resolution manometry (HRM).MethodsThis is a retrospective review of patients that underwent laparoscopic fundoplication by two surgeons at a single institution from 10/1/2015-6/29/2019. Patients with large paraesophageal hernias and patients without both BE and HRM were excluded.ResultsForty-six patients met the inclusion criteria. BE was found to be concordant with HRM for esophageal motility in only 21 patients (46%). Setting HRM as the gold standard, BE had a sensitivity of 14% (95% CI: 5%–35%), specificity of 72% (95% CI: 52%–86%), PPV of 30% (95% CI: 11%–60%), and NPV of 50% (95% CI: 35%–66%). The accuracy was 46%, while a McNemar test showed p = 0.028.ConclusionTraditional BE should not be used in place of HRM for assessing pre-operative motility in patients undergoing anti-reflux surgery. 相似文献
3.
Kristina H. Lewis Katherine Callaway Stephanie Argetsinger Jamie Wallace David E. Arterburn Fang Zhang Adolfo Fernandez Dennis Ross-Degnan Justin B. Dimick J. Frank Wharam 《Surgery for obesity and related diseases》2021,17(1):72-80
BackgroundHiatal hernias are often repaired concurrently with bariatric surgery to reduce risk of gastroesophageal reflux disease–related complications.ObjectivesTo examine the association between concurrent hiatal hernia repair (HHR) and bariatric outcomes.SettingA 2010–2017 U.S. commercial insurance claims data set.MethodsWe conducted a retrospective cohort study. We identified adults who underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) alone or had bariatric surgery concurrently with HHR. We matched patients with and without HHR and followed patients up to 3 years for incident abdominal operative interventions, bariatric revisions/conversions, and endoscopy. Time to first event for each outcome was compared using multivariable Cox proportional hazards modeling.ResultsWe matched 1546 SG patients with HHR to 3170 SG patients without HHR, and we matched 457 RYGB patients with HHR to 1156 RYGB patients without HHR. A total of 73% had a full year of postoperative enrollment. Patients who underwent concurrent SG and HHR were more likely to have additional abdominal operations (adjusted hazard ratio [aHR], 2.1; 95% CI, 1.5–3.1) and endoscopies (aHR, 1.5; 95% CI, 1.2–1.8) but not bariatric revisions/conversions (aHR, 1.7; 95% CI, .6–4.6) by 1 year after surgery, a pattern maintained at 3 years of follow-up. Among RYGB patients, concurrent HHR was associated only with an increased risk of endoscopy (aHR, 1.4; 95% CI, 1.1–1.8)) at 1 year of follow-up, persisting at 3 years.ConclusionsConcurrent SG/HHR was associated with increased risk of some subsequent operative and nonoperative interventions, a pattern that was not consistently observed for RYGB. Additional studies could examine whether changes to concurrent HHR technique could reduce risk. 相似文献
4.
IntroductionGastric volvulus are rare. Complications can be life threatening, including necrosis and perforation. Assessment of mucosal viability is essential, and urgent surgical intervention is mandatory in case of vascular compromise.Presentation of caseAn 72-year-old female known for a paraesophageal hiatal hernia was admitted at our emergency department with acute abdominal pain. Blood count demonstrated leukocytosis and increased C-reactive protein. Abdominal computed tomography showed a mesenteroaxial gastric volvulus. Urgent upper endoscopy revealed mucosal ischemia, which prompted immediate laparotomy with partial gastrectomy, cruroplasty, and Dor fundoplication. Postoperative course was uneventful.DiscussionGastric volvulus is initially treated with nasogastric tube decompression, but definitive treatment is achieved surgically. When there is an associated hernia, closing the anatomical defect and fundoplication should be performed. Complication such as necrosis is associated with a high mortality, and requires urgent surgical repair.ConclusionGastric volvulus can be life-threatening. Urgent endoscopic or surgical assessment should be conducted to assess mucosal viability. 相似文献
5.
6.
《Surgery for obesity and related diseases》2020,16(6):732-737
BackgroundThe main side effect of long-term laparoscopic sleeve gastrectomy is the onset of severe gastroesophageal reflux disease (GERD).ObjectivesThe aim of this study was to evaluate the effectiveness of gastric bypass conversion in controlling postsleeve GERD.SettingUniversity Hospital and Private Hospital, France and Private Hospital, Italy.MethodsThis retrospective multicenter study included patients who underwent laparoscopic sleeve gastrectomy and suffered from postoperative GERD, who did not respond to medical treatment and were converted to laparoscopic Roux-en-Y gastric bypass. The study involved 2 French university hospitals, 4 French private centers, and an Italian public hospital.ResultsA total of 80 patients were reviewed. Treatment of a hiatal hernia was performed during laparoscopic sleeve gastrectomy in 3 patients, while 19 patients were operated for hiatal hernia during conversion to bypass (P = .0004). Six months after surgery, 23 of 80 patients maintained reflux symptomatology with a daily frequency, for which continued proton pump inhibitor treatment was required. The persistence of GERD was significantly more frequent among patients with previous gastric banding (n = 19) compared with patients with no history of gastric banding (n = 4, P = .02). In other words, the likelihood of having poor clinical success from conversion of the sleeve to bypass because of intractable GERD was 3 times higher if the patient had a history of gastric banding (relative risk = 2.89, odds ratio = 3.69).ConclusionThe results of this study show that, despite the conversion, the symptomatology of GERD does not always disappear, especially in patients with previous gastric banding. 相似文献
7.
IntroductionSleeve gastrectomy (SG) is a frequently used surgical procedure for the treatment of morbid obesity. Several complications of SG have been described; however, de novo hiatal hernia of the gastric tube, as a complication of SG, has not been described in the literature.Presentation of caseHere, we report a case of a hiatal hernia 2 years after SG. In the case reported here, the hiatal hernia was associated with weight regain. The mechanisms responsible for the herniation of the pouch are difficult to identify. Conversion from sleeve gastrectomy to Roux-en-Y gastric bypass is an effective treatment for this complication. Its management is safe and effective.DiscussionObesity itself is an independent risk factor for hiatal hernia, found preoperatively in more than half of the morbidly obese patients. This predisposition is explained by higher intra-gastric pressure due to intra-abdominal or visceral fat, reduced inferior oesophageal sphincter pressure, and oesophageal motility problems.ConclusionTo our knowledge, this is the first described case of hiatal hernia of the gastric tube after SG. 相似文献
9.
目的分析比较食管裂孔疝抗反流手术中迷走神经切断与保留对减少术后复发风险的影响。
方法检索Pubmed、Web of Science、Embase、ScienceDirect、ovid、CNKI数据库,检索建库至2019年9月,有关食管裂孔疝术中切断迷走神与保留迷走神经的临床研究,进行文献筛选、资料提取及质量评估,使用Cochrane5.1.0系统评价手册进行Meta分析。根据Cochrane循证医学指南的建议,二分类数据(食管裂孔疝复发与否)表示为比值比(odds ratio,OR)和95%可信区间。合并效应量的统计推断采用Z检验,以P<0.05为差异有统计学意义。纳入研究结果间的异质性统计推断采用Q检验计算I2,如果I2<50%,并且P>0.1,则说明合并不存在异质性,采用固定效应模型进行合并,反之则用随机效应模型进行合并。明显的临床异质性采用亚组分析或敏感性分析等方法进行处理。
结果共纳入11项回顾性对照研究,根据术后食管裂孔疝复发的诊断方式将各研究分为解剖复发组和临床复发组。解剖复发组中,迷走神经切断430例,迷走神经保留383例;迷走神经切断复发风险大于迷走神经保留组(P<0.05),相对危险度为1.96,95%可信区间(CI)=1.45~2.64。临床复发组中,迷走神经切断337例,迷走神经保留420例;迷走神经切断复发风险大于迷走神经保留(P<0.05)。合并组分析显示,迷走神经切断术后复发风险大于迷走神经保留,相对危险度为1.78,95%可信区间(CI)=1.42~2.24,差异具有统计学意义(P<0.05)。
结论抗反流术中保留迷走神经对减少食管裂孔疝术后复发可能具有积极意义,还需进一步临床试验进行验证。 相似文献
10.
Rupa Seetharamaiah Rey Jesús Romero Radomir Kosanovic Michelle Gallas Juan-Carlos Verdeja Jorge Rabaza Anthony Michael Gonzalez 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(4):570-577