Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.324
Filtrar
1.
Zentralbl Chir ; 146(2): 200-203, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33851382

RESUMO

In the surgical treatment of gastroesophageal reflux disease and of hiatal hernias, the high rate of recurrence of hiatal hernias is a central problem. Against this background, various, primarily alloplastic, meshes are used to augment suture closure on the esophageal hiatus. Very different results have been reported in the past and the use of meshes in hiatus reconstruction is controversial. In addition to the frequency of recurrences, reports about complications of mesh augmentation are in the foreground. On the basis of several prospective randomised double-blinded comparative studies and meta-analyses (class Ia and Ib evidence), the current data do not show any advantages of mesh-augmented hiatoplasty for the prevention of recurrence of hiatal hernia. At the same time, there exist reports of more long-term postoperative complications, especially dysphagia, after use of meshes for augmentation of hiatus reconstruction. Therefore, routine use of mesh augmentation for hiatus reconstruction is currently not recommended.


Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Humanos , Estudos Prospectivos , Recidiva , Telas Cirúrgicas
2.
Wiad Lek ; 74(1): 168-171, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851610

RESUMO

The article presents a case report of patients with multimorbid pathology - hiatal hernia with gastroesophageal reflux disease, cholecystolithiasis and umbilical hernia. Simultaneous surgery was performed in all cases - laparoscopic hiatal hernia with fundoplication, laparoscopic cholecystectomy and umbilical hernia alloplasty (in three cases - by IPOM (intraperitoneal onlay mesh) method and in one - hybrid alloplasty - open access with laparoscopic imaging). After the operation in one case there was an infiltrate of the trocar wound, in one case - hyperthermia, which were eliminated by conservative methods. The follow-up result showed no hernia recurrences and clinical manifestations of gastroesophageal reflux disease.


Assuntos
Colecistectomia Laparoscópica , Hérnia Hiatal , Hérnia Umbilical , Laparoscopia , Colecistectomia Laparoscópica/efeitos adversos , Fundoplicatura , Hérnia Hiatal/cirurgia , Hérnia Umbilical/cirurgia , Humanos , Plásticos , Telas Cirúrgicas
4.
BMC Surg ; 21(1): 158, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752652

RESUMO

BACKGROUND: Laparoscopic paraesophageal hernia repair is associated with higher recurrence rate. Mesh is used to reduce the recurrence rate. This retrospective study is to review our experience of biological mesh fixed with suture and medical glue in hiatal hernias repairs. METHODS: A retrospective chart review was conducted for a consecutive series of patients undergoing laparoscopic hiatal herniorrhaphy between January 2018 and January 2019. After hiatus closure, a piece of biological prosthesis was fixed with medical glue and suture for reinforcement of the crural closure. Clinical outcomes were reviewed, and data were collected regarding operative details, complications, symptoms, and follow-up imaging. Radiological evidence of any size of hiatal hernia was considered to indicate a recurrence. RESULTS: Thirty-six patients underwent surgery uneventfully without any serious complication. There was no mortality. The follow-up was, on average, 18.4 months, and there was no symptomatic recurrence. There was one anatomical recurrence without any related presentation. The method of mesh fixation with medical glue and suture took 12 min on average, and the handling was fairly easy. CONCLUSIONS: Biological mesh fixed with suture and medical glue was safe and effective for repairing large hiatal hernias. Of course, a longer follow-up is still needed for determining long-term outcomes.


Assuntos
Hérnia Hiatal , Herniorrafia , Laparoscopia , Adesivos , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas , Suturas , Resultado do Tratamento
5.
Zentralbl Chir ; 146(2): 194-199, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33556982

RESUMO

Net augmentation in surgical care of hiatus hernias has many advantages, but is still controversial. Optimal surgical treatment of symptomatic hiatus hernia is to provide long-term correction of the malposition of the stomach and other organs that have been displaced in the thorax, as well as reducing the necessity of risky reoperations. In order to assess the role of net augmentation in repair of the hiatus here, the benefit in the form of the avoidance of symptomatic recurrence and reoperations must be balanced against the risk of net-associated complications. In the present review article, we present a detailed evaluation of current evidence on net augmentation. We conclude that net augmentation in large hernias (> 5 cm), with or without paraesophageal involvement, should be routinely employed, as this reduces the risk of recurrence and the need for complex reoperations with a high risk of complications. Net-associated complications are rare and can largely be avoided with the correct implantation technique and proper net materials. The level of evidence could be improved if more validated register and randomised controlled studies were performed.


Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Herniorrafia , Humanos , Recidiva , Estudos Retrospectivos , Telas Cirúrgicas
6.
Zentralbl Chir ; 146(2): 204-209, 2021 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-33567462

RESUMO

BACKGROUND: The hernia recurrence rate after surgical treatment of large hiatal hernias is still very high. The optimal technique to reduce the recurrence rate is still under debate. The aim of this work is to clarify whether pledgeted reinforced sutures or a resorbable mesh can reduce the recurrence rate compared to hiatus closure with only sutures. MATERIALS AND METHODS: An Austria-wide, multi-centre, prospective, randomised study was planned. The study protocol was prepared by the main test centre (University Clinic for General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg). The study includes patients who are scheduled to undergo laparoscopic or robot-assisted surgery for a large symptomatic hiatal hernia. A large hiatal hernia is defined as > 5 cm in manometry or gastroscopy or at least ⅓ of the stomach lying intrathoracically. The primary study endpoint is defined as the hernia recurrence rate, objectively assessed by gastroscopy. After inclusion in the study, patients will be followed up for 6 months, 1 year, 3 years and 5 years after the operation, using standardised questionnaires and gastroscopy. The power calculation showed a requirement of 55 patients per group. Preoperative randomisation and data management are software-based. RESULTS: The study approval by the leading ethics committee is currently pending and the study itself has been registered on ClinicalTrials.gov since October 2020. The Clinical Trials Registration Number is NCT04591860. Five clinics are participating in the study at the moment and all centres are actively enrolling patients. The duration of the study is set until January 2027. CONCLUSION: This study is the world's first prospective randomised study that examines the value of pledgets and resorbable mesh to reduce the recurrence rate after treatment of large hiatal hernias. The results will help to find the optimal technique to close the hiatus of large hiatal hernias.


Assuntos
Hérnia Hiatal , Laparoscopia , Áustria , Hérnia Hiatal/cirurgia , Herniorrafia , Humanos , Estudos Prospectivos , Recidiva , Telas Cirúrgicas , Suturas , Resultado do Tratamento
7.
Obes Surg ; 31(4): 1449-1454, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33405182

RESUMO

INTRODUCTION: One anastomosis gastric bypass (OAGB) offers favourable weight loss outcomes and is associated with reduced morbidity and mortality when compared to other mainstream bariatric procedures. However, a randomised trial reported a conversion rate to roux-en-Y configuration (RYC) of 3.1%, and some surgeons consider the procedure unsuitable for patients with a preoperative hiatus hernia (HH) or symptoms of gastrooesophageal reflux disease (GORD). METHODS: We carried out a retrospective review of patients undergoing OAGB in our institution. Included were all patients on PPI for symptoms of GORD preoperatively, as well as patients with HH or oesophagitis on preoperative endoscopy. We recorded GORD outcomes as well as rates of conversion to RYC in patients. RESULTS: Medium term follow up data at 23-28 months was available for 89 patients. Of these, 63 had HH, 34 had preoperative GORD requiring PPI and 9 had confirmed oesophagitis. The conversion rate to RYC was nil (0/63) in patients with HH. At the same time, 14.7% (5/34) of patients with preop GORD on PPI required conversion to RYC at a median time interval of 16 months. In patients already on PPI preoperatively, 16/34 (47.1%) needed to continue on PPI long term. In patients with HH, 20.6% (13/63) suffered de novo GORD symptoms. CONCLUSION: OAGB can be offered to patients with HH with acceptable GORD outcomes but caution is advised in patients with preoperative GORD symptoms. Larger prospective and randomised studies are required to further assess this subgroup.


Assuntos
Derivação Gástrica , Refluxo Gastroesofágico , Hérnia Hiatal , Obesidade Mórbida , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Humanos , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
8.
Arq Bras Cir Dig ; 33(3): e1543, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470373

RESUMO

BACKGROUND: Endoscopic aspect of fundoplication anatomy: Normal aspect of Nissen fundoplication. Upper digestive endoscopy is important for the evaluation of patients submitted to fundoplication, especially to elucidate postoperative symptoms. However, endoscopic assessment of fundoplication anatomy and its complications is poorly standardized among endoscopists, which leads to inadequate agreement. AIM: To assess the frequency of postoperative abnormalities of fundoplication anatomy using a modified endoscopic classification and to correlate endoscopic findings with clinical symptoms. METHOD: This is a prospective observational study, conducted at a single center. Patients were submitted to a questionnaire for data collection. Endoscopic assessment of fundoplication was performed according to the classification in study, which considered four anatomical parameters including the gastroesophageal junction position in frontal view (above or at the level of the pressure zone); valve position at retroflex view (intra-abdominal or migrated); valve conformation (total, partial, disrupted or twisted) and paraesophageal hernia (present or absent). RESULTS: One hundred patients submitted to fundoplication were evaluated, 51% male (mean age: 55.6 years). Forty-three percent reported postoperative symptoms. Endoscopic abnormalities of fundoplication anatomy were reported in 46% of patients. Gastroesophageal junction above the pressure zone (slipped fundoplication), and migrated fundoplication, were significantly correlated with the occurrence of postoperative symptoms. There was no correlation between symptoms and conformation of the fundoplication (total, partial or twisted). CONCLUSION: This modified endoscopic classification proposal of fundoplication anatomy is reproducible and seems to correlate with symptomatology. The most frequent abnormalities observed were slipped and migrated fundoplication, and both correlated with the presence of symptoms.


Assuntos
Endoscopia do Sistema Digestório/métodos , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Laparoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Resultado do Tratamento
9.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334749

RESUMO

Gastrointestinal pathology can cause cardiac symptoms and disorders. We present a case of a patient who had worsening of her palpitations with food intake. She was found to have a high burden of premature ventricular contractions in the setting of hiatal hernia and gastro-oesophageal reflux disease. After extensive investigations and ruling out cardiac causes, her arrhythmia resolved with the surgical correction of hiatal hernia.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Hérnia Hiatal/diagnóstico , Obesidade/complicações , Complexos Ventriculares Prematuros/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Diagnóstico Diferencial , Eletrocardiografia , Endoscopia do Sistema Digestório , Feminino , Fundoplicatura , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Hérnia Hiatal/cirurgia , Humanos , Pessoa de Meia-Idade , Síndrome , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/tratamento farmacológico
12.
Am Surg ; 86(9): 1083-1087, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32809844

RESUMO

INTRODUCTION: Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. METHODS: A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher's exact test. Continuous variables were analyzed with Student's t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. RESULTS: Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). DISCUSSION: Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Robótica/métodos , Seguimentos , Humanos , Tempo de Internação/tendências , Duração da Cirurgia , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
Ann R Coll Surg Engl ; 102(8): 611-615, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32735121

RESUMO

INTRODUCTION: Laparoscopic anti-reflux surgery is the standard surgical treatment for gastro-oesophageal reflux disease in patients for who long-term pharmacotherapy is intolerable or ineffective. Advances in anaesthesia and minimally invasive surgery have led to day case treatment being adopted by some centres. The objective of this study is to describe our day case pathway and peri- and postoperative outcomes. MATERIALS AND METHODS: This is a single centre, retrospective case series review of a prospectively collected database from October 2014 to August 2019 performed in a tertiary centre for upper gastrointestinal surgery. Data collected included demographics, comorbidities, indications, complications, length of stay and readmission. RESULTS: A total of 362 patients underwent laparoscopic anti-reflux surgery with or without hiatus hernia repair of up to 10cm, with day case rates of 59%. Unplanned admission following day surgery was 5.1% (13/225) and 30-day readmission was 2.2% (8/362); 90.6% of patients remained in hospital for less than 24 hours. There was one intraoperative complication and one patient required revisional surgery within 30 days. The rate of all postoperative complications was 1.38% (5/362) with one postoperative mortality. DISCUSSION: The inclusion of larger hernias is unusual, as most studies limit size to 5cm or less. Our results show the safety and feasibility of the procedure even when applied to hiatus hernias up to 10cm. Success was multifactorial and based on standardisation of procedures and support from dedicated specialist nursing staff. CONCLUSION: Laparoscopic anti-reflux surgery can be performed safely as a day case procedure even in larger hiatus hernias, with a dedicated care pathway and specialist nurse practitioners to support it.


Assuntos
Hérnia Hiatal/epidemiologia , Hérnia Hiatal/cirurgia , Herniorrafia , Adulto , Idoso , Idoso de 80 Anos ou mais , Redução de Custos/estatística & dados numéricos , Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Herniorrafia/efeitos adversos , Herniorrafia/economia , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido , Adulto Jovem
14.
Am Surg ; 86(7): 796-798, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32683923

RESUMO

Laparoendoscopic hiatal hernia repair (LEHHR) involves laparoscopic repair of hiatal hernia with concomitant transoral incisionless fundoplication (TIF). The objective of this case presentation is to highlight the benefits of LEHHR in a patient with long term follow up. This patient is a 56-year-old woman with symptoms of gastroesophageal reflux disease for 40 years. Esophagogastroduodenoscopy (EGD) showed a 2 cm hiatal hernia. DeMeester score was 21.3. She underwent LEHHR 33 months ago. The patient underwent laparoscopic cholecystectomy for symptomatic biliary dyskinesia. This provided the opportunity to examine the operative anatomy. There were minimal adhesions to the liver. The partial fundoplication was intact. The angle of His was preserved. The fundus was spared from any adhesions as TIF utilizes the cardia rather than the fundus to create the wrap. The plane behind the stomach was undisturbed. LEHHR has 10 main benefits. Anatomical benefits result from the preservation of the angle of His. Functional benefits relate to a partial fundoplication which normalizes pH values. LEHHR avoids bleeding from short gastric vessels and the creation of a wrap when anatomical obstacles present. Strategic benefits are directed toward any subsequent revisional reflux surgery. The lack of adhesions, easy access to the base of left crus, and sparing the fundus render revisional surgery straightforward.


Assuntos
Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Feminino , Hérnia Hiatal/complicações , Hérnia Hiatal/diagnóstico , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes
15.
Ann Surg ; 272(2): 241-247, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675536

RESUMO

OBJECTIVE: To determine whether absorbable or nonabsorbable mesh repair of large hiatus hernias is followed by less recurrences at late follow-up compared to sutured repair. SUMMARY OF BACKGROUND DATA: Radiological recurrences have been reported in up to 30% of patients after repair of large hiatus hernias, and mesh repair has been proposed as a solution. Earlier trials have revealed mixed outcomes and early outcomes from a trial reported previously revealed no short-term advantages for mesh repair. METHODS: Multicentre prospective double-blind randomized controlled trial of 3 methods of hiatus hernia repair; sutures versus absorbable mesh versus nonabsorbable mesh. Primary outcome - hernia recurrence assessed by barium meal X-ray and endoscopy at 3-4 years. Secondary outcomes - clinical symptom scores at 2, 3, and 5 years. RESULTS: 126 patients were enrolled - 43 sutures, 41 absorbable mesh, and 42 nonabsorbable mesh. Clinical outcomes were obtained at 5 years in 89.9%, and objective follow-up was obtained in 72.3%. A recurrent hernia (any size) was identified in 39.3% after suture repair, 56.7% - absorbable mesh, and 42.9% - nonabsorbable mesh (P = 0.371). Clinical outcomes were similar at 5 years, except chest pain, diarrhea, and bloat symptoms which were more common after repair with absorbable mesh. CONCLUSIONS: No advantages were demonstrated for mesh repair at up to 5 years follow-up, and symptom outcomes were worse after repair with absorbable mesh. The longer-term results from this trial do not support mesh repair for large hiatus hernias.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Telas Cirúrgicas/efeitos adversos , Técnicas de Sutura , Implantes Absorvíveis , Adulto , Análise de Variância , Austrália , Distribuição de Qui-Quadrado , Método Duplo-Cego , Feminino , Seguimentos , Hérnia Hiatal/diagnóstico por imagem , Herniorrafia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recidiva , Reoperação/métodos , Medição de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento , Cicatrização/fisiologia
16.
Khirurgiia (Mosk) ; (5): 76-80, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500693

RESUMO

In this article is described a rare postoperative complication: epiphrenal diverticulum of the esophagus of the lower third of the esophagus in patient after antireflux surgery. Brief description of the main stages of surgical treatment. 96 patients with cardiofundal, subtotal or total hiatal hernias underwent operation. There were complications of I-II degree according to Clavien-Dindo in the early postoperative period in 11 patients (11.4%). Complications of IIIb degree were revealed in 2 patients (2.1%) in the early postoperative period and in 1 patient (1.0%) in the late postoperative period (2 months after hospitalization) - epiphrenal diverticulum of the esophagus. Laparotomy, the sagittal diafragmalnaya, diverticulectomy, valisesta pyloroplasty were performed. Postoperative period without complications. The patient's nutrition through the mouth is restored on the 5-th day. No dysphagia and reflux esophagitis were detected radiologically and endoscopically.


Assuntos
Divertículo Esofágico/etiologia , Divertículo Esofágico/cirurgia , Fundoplicatura/efeitos adversos , Hérnia Hiatal/cirurgia , Diafragma/cirurgia , Humanos , Laparotomia , Piloro/cirurgia
17.
Khirurgiia (Mosk) ; (6): 38-43, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573530

RESUMO

OBJECTIVE: To find out significance of the main locking mechanisms of lower esophageal sphincter in the relapse of GERD in patients with axial hiatal hernia after previous antireflux laparoscopic surgery. MATERIAL AND METHODS: There were 103 patients with GERD and axial hiatal hernia who underwent original circular laparoscopic esophagofundoplication with correction of hiatal opening dimensions by crural and hiatal repair. Depending on generalized DeMeester index (within the normal range or its excess), all patients were divided into two groups - without relapse (group 1, n=88) and with recurrent GERD (group 2, n=15). Both groups were comparable by the main characteristics and postoperative follow-up period (mean - 6 years). Antireflux function was investigated by X-ray examination and endoscopy, manometry of the esophageal-gastric passage, intra-esophageal 24-hour pH-monitoring. Processing and graphical presentation of data was carried out using Statistica v.10.0 Rus software (StatSoft, USA) and Microsoft Office Excel 2013 (USA). RESULTS: Abnormal gastroesophageal reflux was detected in 14.56±3.48% of patients after laparoscopic anti-reflux surgery. Recurrent hiatal hernia occurred in 20±10.33% of these patients, malfunction of lower esophageal sphincter - in 80±10.33%. Failure of cardia was caused by shortening of its length by 30.43% and decrease of tone by 6.78% with significantly (61.09%) increased tone of the stomach. Failure of cardia was manifested by increase of generalized DeMeester index in the lower third of the esophagus by 3.2 times, acidic gastroesophageal refluxes, reflux index and index reflux values. Preserved esophageal motility combined with shortening of time of esophageal clearance in patient's lying position was associated with reduced incidence of reflux-esophagitis by 77.26% even in case of recurrent GERD. CONCLUSION: Abnormal reflux after antireflux laparoscopic surgery due to GERD with axial hiatal hernia is caused by recurrent hiatal hernia in every fifth patient while the main reason is failure of LES cuff with increased intragastric pressure.


Assuntos
Esfíncter Esofágico Inferior/fisiopatologia , Fundoplicatura/efeitos adversos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Esfíncter Esofágico Inferior/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/diagnóstico , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/fisiopatologia , Hérnia Hiatal/diagnóstico , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia , Recidiva
18.
BMC Surg ; 20(1): 109, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434571

RESUMO

BACKGROUND: Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life. METHODS: All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life. RESULTS: The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%). CONCLUSIONS: Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.


Assuntos
Hérnia Hiatal/cirurgia , Laparoscopia/métodos , Qualidade de Vida , Idoso , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Recidiva , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
19.
Arq Bras Cir Dig ; 33(1): e1489, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32428134

RESUMO

BACKGROUND: Erosion and migration into the esophagogastric lumen after laparoscopic hiatal hernia repair with mesh placement has been published. AIM: To present surgical maneuvers that seek to diminish the risk of this complication. METHOD: We suggest mobilizing the hernia sac from the mediastinum and taking it down to the abdominal position with its blood supply intact in order to rotate it behind and around the abdominal esophagus. The purpose is to cover the on-lay mesh placed in "U" fashion to reinforce the crus suture. RESULTS: We have performed laparoscopic hiatal hernia repair in 173 patients (total group). Early postoperative complications were observed in 35 patients (27.1%) and one patient died (0.7%) due to a massive lung thromboembolism. One hundred twenty-nine patients were followed-up for a mean of 41+28months. Mesh placement was performed in 79 of these patients. The remnant sac was rotated behind the esophagus in order to cover the mesh surface. In this group, late complications were observed in five patients (2.9%). We have not observed mesh erosion or migration to the esophagogastric lumen. CONCLUSION: The proposed technique should be useful for preventing erosion and migration into the esophagus.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/efeitos adversos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Telas Cirúrgicas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Migração de Corpo Estranho , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/cirurgia , Herniorrafia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação , Técnicas de Sutura , Resultado do Tratamento
20.
J Laparoendosc Adv Surg Tech A ; 30(6): 673-678, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32397807

RESUMO

Although the results of a laparoscopic repair of a paraesophageal hernia are convincing and accepted, controversies still persist regarding indications for elective repair, the need for a concurrent fundoplication, the use of mesh, and the need for a Collis gastroplasty. This article is a description of our surgical approach to the patient with a paraesophageal hernia in need of a repair.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Esofagoplastia/métodos , Fundoplicatura/métodos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Humanos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...