Gastric Pull-up: A Back-up Surgical Solution in the Treatment of Large Hiatal Hernias.

The laparoscopic treatment of the hiatal hernias is nowadays the standard procedure. However, due to the volume and the age of the affliction, there are some situations in which the classical approach is indicated. The latter is associated with specific risks. The appearance of some intra-operatory incidents or accidents could lead to changes in the tactics and the techniques, moreover the abandon of the classical procedure and the use of alternative solutions. These procedures are meant to solve the case with minimum negative effects on the patient. This article presents the case of a 62 year-old female patient, diagnosed with a large type II hiatal hernia on which the surgical team had to intervene through a median xypho-umbilical laparotomy. During the attempt to perform the Nissen procedure, the irreversible lesion of the abdominal esophagus occurred, the esophageal wall having already suffered because of the esophagitis. This led to the restoring of the gastric continuity using the gastric pull-up technique and a cervical anastomosis. The remaining esophagus was removed during the second procedure, 3 moths later. The immediate and the late evolution of the patient was excellent.

[Multi-level digestive stenosis: of the lower esophagus and postbulbar duodenum--a surgical solution. Case report]. / Stenoze digestive etajate: esofagiana inferioara si postbulbara solutie chirurgicala.

Barrett esophagus is a rare medical entity. We present the case of a 56 years female patient admitted in our clinic for surgical treatment of a complication of a rigid stenosis of the lower esophagus. The situation is particular by the presence of two digestive strictures due to the same cause: gastric acid aggression. The steps of therapy of Barrett esophagus are reviewed, as well as the surgical options for choosing the best digestive segment able to replace the resected esophagus. The excellent immediate and long-term postoperative evolution allow us to believe that the surgical solution we used was the most appropriate and that the resected stomach can be successfully employed as a substitute for the esophagus after the resection of its lower half.