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1.
Khirurgiia (Mosk) ; (7): 29-35, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31355811

RESUMO

OBJECTIVE: To study changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features. MATERIAL AND METHODS: We studied changes of diaphragm and esophageal-diaphragmatic junction depending on age and constitutional features by using of 40 cadaveric specimens (people aged 19-75 years). RESULTS: Esophageal-aortic ligament is observed rarer with age. This ligament is poorly developed in brachiomorphic body type while diaphragmatic-cardiac ligament is generally absent as a rule. This is a predisposing factor for weakening this area. It was revealed that reduced strength and elasticity (especially esophageal-aortic and esophageal-diaphragmatic ligaments) is one of the key factors in the development of hiatal hernia. It is especially relevant for brachiomorphic body type, the 2nd mature and elderly age. The 2nd mature period is associated with reduced diameter and kinking of great arteries, that leads to 1.5-2 times decrease of arterial capacity of the diaphragm. Therefore, hiatal hernia repair using own tissues may be insufficient and accompanied by recurrence in persons with brachiomorphic body type in the 2nd mature period. CONCLUSION: Analysis of biomechanical data and anatomical features of the diaphragm may be useful to predict recurrent hiatal hernia.


Assuntos
Diafragma/patologia , Diafragma/fisiopatologia , Junção Esofagogástrica/patologia , Junção Esofagogástrica/fisiopatologia , Hérnia Hiatal/patologia , Hérnia Hiatal/fisiopatologia , Adulto , Fatores Etários , Idoso , Antropometria , Cadáver , Hérnia Hiatal/etiologia , Humanos , Pessoa de Meia-Idade , Recidiva , Adulto Jovem
2.
Am Surg ; 84(6): 978-982, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29981634

RESUMO

A hiatal hernia (HH) is a frequent finding in patients with gastroesophageal reflux disease (GERD). We examined a consecutive series of patients with GERD diagnosed by a 24-hour pH monitoring. Based on the presence and size of HH on barium swallow, patients were divided into the following groups: no HH, HH <3 cm, HH 3-5 cm and HH >5 cm. A total of 175 patients were included: 43 with no HH, 86 with HH <3 cm, 34 with HH 3-5 cm, and 12 with HH >5 cm. Patients with larger HH had more frequent episodes of coughing and wheezing associated with episodes of reflux. High-resolution manometry showed that the increasing size of the HH was associated with decreasing pressure of the lower esophageal sphincter and weaker peristalsis. Ambulatory pH monitoring revealed that patients with larger HH had more acid reflux, in both the distal and proximal esophagus. Endoscopy showed that patients with larger HH had more severe esophagitis. Fifty per cent of patients with HH >5.0 cm had Barrett's esophagus. These findings should guide gastroenterologists and surgeons in choosing the appropriate therapy in patients with GERD and large HH.


Assuntos
Refluxo Gastroesofágico/etiologia , Hérnia Hiatal/complicações , Esfíncter Esofágico Inferior/fisiopatologia , Monitoramento do pH Esofágico , Feminino , Refluxo Gastroesofágico/patologia , Refluxo Gastroesofágico/fisiopatologia , Hérnia Hiatal/patologia , Hérnia Hiatal/fisiopatologia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Membrana Mucosa/patologia , Estudos Retrospectivos , Fatores de Risco
3.
Am Surg ; 84(3): 387-391, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29559053

RESUMO

Magnetic sphincter augmentation is a novel surgical procedure for gastroesophageal reflux disease. Limited dissection at the hiatus is one of the benefits of the procedure, but makes precise and accurate preoperative assessment of even small hiatal hernia critical. Retrospective cohort study of 136 patients having undergone both endoscopy (EGD) and videoesophagography followed by operative assessment for hiatal hernia during magnetic sphincter augmentation. The objective of the study is to determine which preoperative modality more accurately predicts operative hiatal hernia size. Videoesophagography underestimated operative measurement by 0.37 ± 1.41 cm (P = 0.003) and was less accurate in predicting intraoperative hiatal hernia size than EGD on linear regression analysis (ß -0.729, SE 0.057, P < 0.001). EGD was less accurate at predicting hiatal hernia size as patient age increased (ß -0.018, SE 0.007, P = 0.014) and with larger hernias (ß -0.615, standard error (SE) 0.067, P < 0.001); however, endoscopic measurements did not differ significantly from intraoperative measurements (0.93 ± 1.23 cm vs 1.12 ± 1.43 cm, P = 0.12). EGD better predicts the size of small hiatal hernia measured during subsequent laparoscopic surgery.


Assuntos
Esfíncter Esofágico Inferior/cirurgia , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/diagnóstico , Laparoscopia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Feminino , Hérnia Hiatal/patologia , Hérnia Hiatal/cirurgia , Humanos , Terapia de Campo Magnético , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Regressão , Estudos Retrospectivos
4.
Ann Thorac Surg ; 104(6): 1865-1871, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29054304

RESUMO

BACKGROUND: Thoracic endometriosis syndrome refers to a broad spectrum of clinical manifestations related to the presence of ectopic intrathoracic endometrial tissue. Few studies have reported on manifestations other than pneumothorax. METHODS: Clinical, surgical, and pathology records of all consecutive women of reproductive age referred to our institution from September 2001 to August 2016 for clinically suspected thoracic endometriosis syndrome were retrospectively reviewed. After excluding women with pneumothorax, we enrolled 31 patients, divided into three subgroups: catamenial chest pain (n = 20), endometriosis-related diaphragmatic hernia (n = 6), and endometriosis-related pleural effusion (n = 5). RESULTS: Surgery was performed in 11 patients with catamenial thoracic pain (median age, 30 years; range, 23 to 42). Median pain intensity assessed on the 0 to 10 Visual Analogue Scale was 8 (range, 8 to 9) before surgery. At surgery, 8 patients had diaphragmatic endometriosis implants, which were resected with direct suture of diaphragm. At follow-up, median pain score was 3 (range, 0 to 8). In the group presenting with diaphragmatic hernia (median age, 36 years; range, 29 to 50), diaphragm was repaired by direct suture or placement of prosthesis in 4 and 2 cases, respectively. At follow-up, no sign of recurrent hernia was observed. Finally, among women with endometriosis-related pleural effusion (median age, 30 years; range, 25 to 42), surgical treatment was represented by evacuation of the pleural effusion and biopsy (n = 4) or removal (n = 1) of visible endometrial foci. CONCLUSIONS: Thoracic endometriosis syndrome is a poorly recognized entity responsible for various manifestations other than pneumothorax. In case of catamenial thoracic pain, diaphragmatic hernia and catamenial pleural effusion surgery should be advised in a multidisciplinary setting.


Assuntos
Dor no Peito/patologia , Endometriose/patologia , Hérnia Hiatal/patologia , Derrame Pleural/patologia , Adulto , Dor no Peito/etiologia , Endometriose/diagnóstico por imagem , Endometriose/terapia , Feminino , Hérnia Hiatal/etiologia , Humanos , Derrame Pleural/etiologia , Estudos Retrospectivos , Síndrome , Adulto Jovem
5.
Surg Obes Relat Dis ; 13(12): 1959-1964, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28709560

RESUMO

BACKGROUND: Esophagogastroduodenoscopy (EGD) is particularly recommended for choosing a surgical method to be used with asymptomatic patients and for the assessment of symptomatic patients prior to sleeve gastrectomy. The presence of hiatal hernia, for instance, is a relative contraindication. EGD is used for malignancy scanning as well as surgical planning, but seems inefficient in determining postoperative complications. OBJECTIVE: Our aim was to investigate the effectiveness of the pathological evaluation of endoscopic biopsies obtained with esophagogastroduodenoscopy (EGD) according to Sydney classification prior to sleeve gastrectomy in identifying the risk of staple line leak, independently of clinical diagnosis. SETTING: Bakirköy Dr. Sadi Konuk Training and Research Hospital, Department of General Surgery. METHODS: Patients who underwent laparoscopic sleeve gastrectomy between January 2014-December 2016 received preoperative EGD as per the clinic's protocol and upon obtaining ethics board approval and patient consent. Biopsies were taken from the patients according to the Sydney protocol. The pathology results were examined retrospectively by considering the exclusion criteria. The results were given in line with the Sydney classification, and patients with and without Staple Line Leak were statistically compared. RESULTS: A total of 630 patients were enrolled in the study. Of these, 71.1% (n = 448) were female and 28.9% (n = 182) were male. Mean age was 38.9 years (17-68), mean body weight was 130.8kg (94-240) and body mass index (BMI) values were 47.4kg/m2 (36-106). In evaluation of median values, no statistically significant relationship was found between staple line leak and H. pylori occurrence grade (P = 0.438; P>0.05), activation grade (P = 0.568; P>0.05) or intestinal metaplasia grade (P = 0.319; P>0.05). Atrophy (P = 0.001; P<0.01) and chronic inflammation grade (P = 0.026; P<0.05) were significantly higher in Staple Line Leak patients. CONCLUSIONS: EGD prior to sleeve gastrectomy and biopsies obtained in line with the Sydney protocol predict Staple Line Leak risk.


Assuntos
Fístula Anastomótica/etiologia , Endoscopia do Sistema Digestório , Gastrectomia , Hérnia Hiatal/cirurgia , Laparoscopia , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Feminino , Hérnia Hiatal/etiologia , Hérnia Hiatal/patologia , Humanos , Masculino , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Grampeamento Cirúrgico , Adulto Jovem
7.
Ann Thorac Surg ; 103(6): 1700-1709, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28433224

RESUMO

BACKGROUND: Older patients have an increased incidence of paraesophageal hernia (PEH) and can be denied surgical assessment due to the perception of increased complications and mortality. This study examines the influence of age and comorbidities on early complications and other short-term outcomes of PEH repair. METHODS: From 2000 to 2016, data of surgically treated patients with PEH were prospectively recorded in an Institutional Review Board-approved database. Only patients whose hernia involved over 50% of the stomach were included. Patients were stratified by age (<70, 70 to 79, ≥80 years of age) and compared in univariate and multivariate analyses. RESULTS: Overall, 524 patients underwent surgical PEH repair (<70: 261 [50%]; 70 to 79: 163 [31%]; ≥80: 100 [19%]). Patients greater than or equal to 80 years of age had higher American Society of Anesthesiologists class, more comorbidities, larger hernias, and higher incidences of type IV PEH and acute presentation. Patients greater than or equal to 80 years of age had more postoperative complications, but not higher grade complications (Clavien-Dindo grade ≥IIIa). Median length of stay was 1 day longer for patients greater than or equal to 80 years of age (5 days versus 4 days for patients <70 and 70 to 79 years of age, respectively). Objective, radiologic hernia recurrence at 4.3 months postoperation was 17.3% and was not increased in the greater than or equal to 80 years of age group. After adjustment for comorbidities and other factors, age greater than or equal to 80 years was not a significant factor in predicting severe complications, readmission within 30 days, or early recurrence. CONCLUSIONS: PEH repair is safe in physiologically stable patients, irrespective of age. Incidence of complications is higher in older patients, but complication severity and mortality are similar to those of younger patients. Patients with giant PEH should be given the opportunity to review treatments options with an experienced surgeon.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hérnia Hiatal/patologia , Herniorrafia/métodos , Herniorrafia/mortalidade , Humanos , Incidência , Laparoscopia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Fatores de Risco
9.
Clin Respir J ; 11(2): 139-150, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25919863

RESUMO

BACKGROUND AND AIMS: Studies assessing hiatal hernia (HH)-related effects on lung volumes derived by body plethysmography are limited. We aimed to evaluate the effect of hernia size on lung volumes (including assessment by body plethysmography) and the relationship to functional capacity, as well as the impact of corrective surgery. METHODS: Seventy-three patients (70 ± 10 years; 54 female) with large HH [mean ± standard deviation, intra-thoracic stomach (ITS) (%): 63 ± 20%; type III in 65/73] had respiratory function data (spirometry, 73/73; body plethysmography, 64/73; diffusing capacity, 71/73) and underwent HH surgery. Respiratory function was analysed in relation to hernia size (groups I, II and III: ≤50, 50%-75% and ≥75% ITS, respectively) and functional capacity. Post-operative changes were quantified in a subgroup. RESULTS: Total lung capacity (TLC) and vital capacity (VC) correlated inversely with hernia size (TLC: 97 ± 11%, 96 ± 13%, 88 ± 10% predicted in groups I, II and III, respectively, P = 0.01; VC: 110 ± 17%, 111 ± 14%, 98 ± 14% predicted, P = 0.02); however, mean values were normal and only 14% had abnormal lung volumes. Surgery increased TLC (93 ± 11% vs 97 ± 10% predicted) and VC (105 ± 15% vs 116 ± 18%), and decreased residual volume/total lung capacity (RV/TLC) ratio (39 ± 7% vs 37 ± 6%) (P < 0.01 for all). Respiratory changes were modest relative to the marked functional class improvement. Among parameters that improved following HH surgery, decreased TLC and forced expiratory volume in 1 s and increased RV/TLC ratio correlated with poorer functional class pre-operatively. CONCLUSIONS: Increasing HH size correlates with reduced TLC and VC. Surgery improves lung volumes and gas trapping; however, the changes are mild and within the normal range.


Assuntos
Hérnia Hiatal/patologia , Hérnia Hiatal/cirurgia , Pulmão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Medidas de Volume Pulmonar , Masculino , Espirometria , Resultado do Tratamento , Capacidade Vital
10.
Dis Esophagus ; 30(3): 1-5, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-27862648

RESUMO

The Air Flow Sphincter Locator (AFSL) is marketed as an alternative method to manometry for localizing the lower esophageal sphincter (LES) for pH probe placement. Such a system is desirable due to the additional time, cost, and discomfort associated with dual nasal intubation, but its accuracy has never been assessed. To assess the accuracy of the AFSL in localizing the LES. Fifty consecutive outpatients presenting for pH and manometry studies were included. The upper border of the LES was determined using HRM and the AFSL by two technicians independently. LES locations measured by technicians using AFSL versus manometry, as well as the manometrically determined LES locations by technicians versus MDs were compared. Differences in LES locations determined by HRM as read by MDs versus technicians were small; none were >3 cm, and 92% were within 2 cm. Comparison between LES locations determined by technicians using HRM versus the AFSL revealed that 52% had a difference of 2-3cm and 32% had a difference of >3 cm. Hiatal hernia was associated with a difference in LES location of >3 cm. Excluding patients with hiatal hernia, nonetheless, still produced a >3 cm difference in 24% of studies. Prior reports have suggested that a difference greater than +/-3 cm in pH probe placement is considered unacceptable for clinical studies. Based on our study, the AFSL placed the LES outside of this range in 32% of patients, and may be particularly inaccurate in the setting of a hiatal hernia. This suggests that the device may not be an acceptable alternative to manometry in determining LES location for pH probe placement.


Assuntos
Cateteres , Esfíncter Esofágico Inferior/cirurgia , Monitoramento do pH Esofágico/instrumentação , Manometria/métodos , Adulto , Idoso , Esfíncter Esofágico Inferior/patologia , Monitoramento do pH Esofágico/métodos , Feminino , Hérnia Hiatal/patologia , Hérnia Hiatal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
11.
Surg Endosc ; 31(4): 1591-1598, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27924393

RESUMO

INTRODUCTION: Autologus augmentation of wound remodeling with platelet concentrate is a burgeoning field with promising results. We hypothesized that the addition of filtered platelet concentrate (fPC) to an acellular biologic graft would improve crural healing and tissue integrity in hiatal hernia repair. METHODS: Sixteen healthy Yorkshire female pigs were divided into three groups: hiatus repair (HR) (n = 7), HR with biologic graft (HRM; n = 8, and HR with biologic graft and fPC (fPC; n = 9). Surgeries were performed by a single surgeon. Animals were euthanized at 8 weeks, and the distal esophagus with hiatus was harvested en-block. Tissue was graded by a histopathologist on collagen deposition, vascularization, and inflammation at the graft-hiatal interface. Tensile strength testing was performed using the Teststar IIs (MTS), coupled with a strain extensometer (Epsilon). Samples of equal dimensions were preloaded to 1 N and deformed at a constant rate of 0.2 mm/s. Statistical analysis was performed via Kruskal-Wallis one-way analysis of variance. RESULTS: Aspirate analysis revealed a mean platelet count of 3 million platelets/1 mL of aspirate. Animals in the fPC group had significantly increased mean chronic inflammation (3.1 ± 1.1 vs. 1.8 ± 1.6, 1.2 ± 1.2, p = 0.04) compared to HR alone and HR + biologic graft. Vascular deposition did not differ between groups (p = 0.8). A trend toward increased collagen deposition was demonstrated for the fPC group (1.4 ± 1.1 vs. 2.0 ± 0.6 in HR group and 3.0 ± 1.2 in HRM group, p = 0.06). There was a statistically significant increase in tensile strength, yield force, and Young's modulus in the fPC group compared with HR and HR + biologic mesh (p < 0.01). CONCLUSION: A trend toward increased collagen deposition and vascularity of the fPC group was demonstrated. In addition, there was an increase in tensile strength and yield force in the fPC group. Use of autologous fPC appears a safe and promising adjunct to wound remodeling and healing in a swine model.


Assuntos
Hérnia Hiatal/terapia , Herniorrafia/métodos , Transfusão de Plaquetas/métodos , Suínos , Animais , Plaquetas , Modelos Animais de Doenças , Feminino , Hérnia Hiatal/patologia , Hérnia Hiatal/cirurgia , Procedimentos de Redução de Leucócitos , Ativação Plaquetária , Suínos/cirurgia , Cicatrização
12.
Arch Kriminol ; 239(1-2): 36-44, 2017 01.
Artigo em Alemão | MEDLINE | ID: mdl-29791113

RESUMO

Two rare causes of iatrogenic pericardial effusions are presented. In the first case, a 61-year-old woman who had undergone laparoscopic surgery for a diaphragmatic hernia was resuscitated without success the next day. As cause of death circulatory failure as a result of post-operative pulmonary embolism was reported. Autopsy results showed that the pericardium and the heart had been sewn to the diaphragm. The suture was torn from the tissue, which caused a hemorrhage into the pericardium and the chest cavity, so that death was diagnosed to be due to cardiac tamponade and hemothorax after an iatrogenic heart injury. In the second case, a 62-year-old man who had developed a massive incisional hernia after treatment of an abdominal gunshot wound underwent open herniotomy with mesh repair. Postoperatively, the man complained about increasing pain and shortness of breath. He was transferred to another hospital for further assessment, where a cardiac tamponade was diagnosed. Autopsy results showed that three of the plastic staples used to fix the mesh had perforated the diaphragm and the pericardium thus injuring the adjacent right ventricle with subsequent perforation and development of a hemopericardium.


Assuntos
Tamponamento Cardíaco/patologia , Erros de Diagnóstico/legislação & jurisprudência , Prova Pericial/legislação & jurisprudência , Doença Iatrogênica , Imperícia/legislação & jurisprudência , Causas de Morte , Feminino , Traumatismos Cardíacos/patologia , Hérnia Hiatal/patologia , Hérnia Hiatal/cirurgia , Herniorrafia/legislação & jurisprudência , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas/efeitos adversos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/legislação & jurisprudência
13.
Dig Dis Sci ; 61(12): 3537-3544, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27730315

RESUMO

BACKGROUND: The Chicago classification has recently added a morphological subclassification for the esophagogastric junction (EGJ). Our aim was to assess the distal esophageal acid exposure in patients with this new Chicago EGJ-type IIIa and IIIb classification. STUDY DESIGN: From a prospectively collected high-resolution manometry (HRM) database, we identified patients who underwent 24-h pH study between October 2011 and June 2015 and were diagnosed with EGJ-type III based on HRM. Chicago EGJ-type III is defined as the inter-peak nadir pressure ≤gastric pressure and a lower esophageal sphincter (LES)-crural diaphragm (CD) separation >2 cm [IIIa-pressure inversion point (PIP) remains at CD level and IIIb-PIP remains at LES level]. We classified the patients into reflux group [DeMeester score >14.72 or Fraction time pH (<4) > 4.2 %] and non-reflux group based on 24-h pH study. RESULTS: Fifty patients were identified that satisfied the study criteria, of which 37 patients (74 %) were EGJ-type IIIa. In those with EGJ-type IIIb, abdominal LES length (AL) in reflux group was significantly shorter than the non-reflux group (0.8 vs. 1.8, p < 0.05). EGJ-type IIIa patients showed significantly higher value for DeMeester score and Fraction time pH and more often had a positive pH study than EGJ-type IIIb patients (DeMeester score: 26.7 vs. 11.7, p < 0.05; Fraction time pH: 7.9 vs. 2.6, p < 0.05; positive pH study: 81.1 vs. 30.8 %, p < 0.001). Reflux was more common in LES-CD ≥ 3 cm than that in LES-CD < 3 cm (85 vs. 56.7 %, p < 0.05). CONCLUSION: A subset of patients with >2-cm LES-CD separation (type IIIb) maintain a physiological intra-abdominal location of the EGJ and are less likely to have reflux. A LES-CD ≥ 3 cm seems to discern a hiatus hernia of clinical significance.


Assuntos
Diafragma/fisiopatologia , Esfíncter Esofágico Inferior/fisiopatologia , Monitoramento do pH Esofágico , Refluxo Gastroesofágico/fisiopatologia , Hérnia Hiatal/fisiopatologia , Manometria , Diafragma/patologia , Esfíncter Esofágico Inferior/patologia , Junção Esofagogástrica/patologia , Junção Esofagogástrica/fisiopatologia , Feminino , Refluxo Gastroesofágico/patologia , Hérnia Hiatal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão
14.
World J Gastroenterol ; 22(35): 7908-25, 2016 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-27672287

RESUMO

Iron deficiency anemia (IDA) is associated with a number of pathological gastrointestinal conditions other than inflammatory bowel disease, and also with liver disorders. Different factors such as chronic bleeding, malabsorption and inflammation may contribute to IDA. Although patients with symptoms of anemia are frequently referred to gastroenterologists, the approach to diagnosis and selection of treatment as well as follow-up measures is not standardized and suboptimal. Iron deficiency, even without anemia, can substantially impact physical and cognitive function and reduce quality of life. Therefore, regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical. While the range of options for treatment of IDA is increasing due to the availability of effective and well-tolerated parenteral iron preparations, a comprehensive overview of IDA and its therapy in patients with gastrointestinal conditions is currently lacking. Furthermore, definitions and assessment of iron status lack harmonization and there is a paucity of expert guidelines on this topic. This review summarizes current thinking concerning IDA as a common co-morbidity in specific gastrointestinal and liver disorders, and thus encourages a more unified treatment approach to anemia and iron deficiency, while offering gastroenterologists guidance on treatment options for IDA in everyday clinical practice.


Assuntos
Anemia Ferropriva/complicações , Anemia/complicações , Gastroenteropatias/complicações , Hepatopatias/complicações , Anti-Inflamatórios não Esteroides/uso terapêutico , Cirurgia Bariátrica , Doença Celíaca/microbiologia , Fezes , Gastrite/microbiologia , Hemorragia Gastrointestinal/complicações , Neoplasias Gastrointestinais/complicações , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Hepatite Crônica/complicações , Hérnia Hiatal/patologia , Humanos , Ferro/química , Hepatopatia Gordurosa não Alcoólica/complicações , Prevalência , Qualidade de Vida
16.
Dysphagia ; 31(4): 587-91, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26753928

RESUMO

Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication.


Assuntos
Tosse/etiologia , Transtornos de Deglutição/etiologia , Divertículo Esofágico/complicações , Hérnia Hiatal/complicações , Refluxo Laringofaríngeo/etiologia , Divertículo Esofágico/patologia , Esôfago/patologia , Hérnia Hiatal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Laríngeo Recorrente/patologia
17.
Klin Khir ; (9): 14-8, 2016.
Artigo em Ucraniano | MEDLINE | ID: mdl-30265463

RESUMO

Two procedures of laparoscopic plasty of large hiatal hernias (HH): cruroraphy (group I) and a two­layered plasty, using lightweight partially absorbable net (LPAN) Ultrapro (group II) were compared in prospective randomized investigation. The results of treat* ment were studied in terms from 24 to 27 mo, (24.4 ± 0.72) mo at average. The pure symptomatic anatomical recurrences rate, including those in conjunction with function* al recurrences, were trustworthily less in group II; duration of functional dysphagia (without stricture) did not differ in the groups trustworthily. Тhus, in large HH a two­lay* ered plasty conduction, using LPAN, permits to reduce the anatomical recurrences rate, not enhancing the complications rate, and it may be considered the operation of choice.


Assuntos
Esôfago/cirurgia , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Estômago/cirurgia , Telas Cirúrgicas , Adulto , Transtornos de Deglutição/patologia , Transtornos de Deglutição/cirurgia , Esôfago/patologia , Feminino , Azia/patologia , Azia/cirurgia , Hérnia Hiatal/patologia , Humanos , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Recidiva , Estômago/patologia , Resultado do Tratamento
18.
Klin Khir ; (12): 13-6, 2016.
Artigo em Ucraniano | MEDLINE | ID: mdl-30272409

RESUMO

Results of operative treatment of 168 patients, suffering hiatal hernia and gastroesophageal reflux disease, in Clinic of Surgery and Endoscopy in 2007 ­ 2016 yrs, were analyzed. The key causes for the operation success, performed for hiatal hernia; gastroesophageal reflux disease were considered: the surgeons' learning curve, choice of method of fundoplication and cruroraphy, preoperative compliance of the patient to antisecretory preparations, rate of postoperative morbidity, psychological state of the patient, atypical symptoms, esophageal function and the reflux type present. Standardization of intervention maintenance the good intervention maintenance the good indexes of postonerative prognosis, including, the conversion rate ­ 0.6%, postoperative morbidity ­ 3%, duration of postoperative stationary treatment ­ 3 days at average


Assuntos
Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/cirurgia , Laparoscopia/métodos , Cirurgia Vídeoassistida/métodos , Adulto , Idoso , Antiácidos/uso terapêutico , Competência Clínica , Feminino , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/patologia , Hérnia Hiatal/tratamento farmacológico , Hérnia Hiatal/patologia , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Cirurgiões/educação , Resultado do Tratamento , Cirurgia Vídeoassistida/instrumentação
19.
Folia Med Cracov ; 56(3): 61-66, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28275272

RESUMO

Upside-down stomach (UDS) represents the rarest type of hiatal hernia (<5%) and is characterized by herniation of the entire stomach or most gastric portions into the posterior mediastinum. We present here a very rare complication of such a condition which is incarceration of upside-down stomach. A 54 year-old female was admitted to the emergency department presenting signs of acute epigastric pain radiating into thorax. Computed tomography revealed a giant hiatal hernia with incarceration of the gastric trunk. Immediate operation for reduction of the incarcerated stomach and repair of the hiatal defect was performed. The patient was discharged without any complication and was followed up at the surgical outpatient department. The presented case confirms that differentiation of an acute epigastric or intrathoracic pain in adults should always exclude presence of hiatal hernia which in case of incarceration should be treated by prompt surgical management.


Assuntos
Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Volvo Gástrico/diagnóstico por imagem , Volvo Gástrico/cirurgia , Cavidade Abdominal/diagnóstico por imagem , Doença Aguda , Feminino , Hérnia Hiatal/patologia , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Volvo Gástrico/complicações , Volvo Gástrico/patologia , Tomografia Computadorizada por Raios X
20.
Surg Endosc ; 30(6): 2179-85, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26335079

RESUMO

INTRODUCTION: Laparoscopic hiatal hernia repair has a better chance of success if the hiatus is closed without tension. This study attempts to answer the following questions: (1) What is the rate of hiatal hernia recurrence in patients who undergo hiatal closure with diaphragmatic relaxing incisions? (2) Can biologic mesh be safely substituted for synthetic mesh as coverage of the relaxing incisions? METHODS: We identified all patients who underwent laparoscopic hiatal hernia repair at our institution between 2007 and 2013 and reviewed their clinical records. Radiologic recurrence was identified by an experienced radiologist and defined as the presence of any abdominal contents located above the diaphragm on esophagram. Clinical recurrence was defined as little or no improvement in symptoms, the development of a new symptom, or the need for medical, endoscopic, or surgical treatment of postoperative symptoms. RESULTS: A minimum of 6 months of radiologic and clinical follow-up was available for 146 (40 %) patients, including 16 with relaxing incisions. There were 66 (45 %) recurrent hernias detected on esophagram. There was no difference in the rate of recurrent hiatal hernia among the three groups: Primary closure of the hiatus (21/36 [58 %]), primary closure with biologic mesh reinforcement (36/94 [38 %]), and relaxing incision with biologic mesh reinforcement (9/16 [56 %]; p = 0.428). Two reoperations were performed on patients who underwent left relaxing incisions and developed symptomatic diaphragmatic hernias through the left relaxing incisions. There were no complications associated with use of biologic mesh at the hiatus. CONCLUSIONS: Rate of recurrent hiatal hernia is similar between patients who undergo diaphragmatic relaxing incisions and patients who undergo primary hiatal closure. Relaxing incisions can be safely performed on either crus; however, biologic mesh should not be used to patch a left-sided relaxing incision due to the risk of developing a diaphragmatic hernia.


Assuntos
Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia , Telas Cirúrgicas , Materiais Biocompatíveis , Feminino , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/patologia , Herniorrafia/instrumentação , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
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