China
Africa
Explore chapters and articles related to this topic
Symptomatic Giant Hiatal Hernia with Intrathoracic Stomach
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Surgical repair in either the emergency or elective situation is performed the same way. A laparoscopic approach is preferred whenever feasible, with a low rate (2%) of conversion to open surgery expected. The hernial sac must be excised from the hiatal pillars before being reduced entirely with its contents. The sac does not need to be excised from the stomach. An interrupted non-absorbable (e.g. 2/0 Novafil®) suture repair of the hiatal defect posteriorly should then occur. If greater than five hiatal repair sutures are required posteriorly, care should be taken to avoid anterior angulation of the esophagus over the repair, and anterior sutures may need to be placed if further hiatal closure is required. A 52- or 54-Fr bougie can be used to calibrate the repair. There is no evidence that the addition of either absorbable or non-absorbable mesh to the hiatal crural repair reduces long-term revisional surgery rates [5]. While the “short esophagus” has been described historically, the author has never encountered the situation where the gastroesophageal junction cannot be easily situated in the abdominal cavity. Theoretically, a Collis gastroplasty can be used if such a situation were ever encountered. Once the hiatal repair is appropriately snug around the esophagus, the gastroesophageal junction is secured in the abdominal cavity. This can be done with a combination of esophagopexy sutures to the hiatal rim, and either an anterior cardiopexy or partial fundoplication. Formal fundoplication is only required for those with significant reflux symptoms.
The oesophagus
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The issue of oesophageal shortening continues to provoke debate. There can be no doubt that, in the presence of a large sliding hiatus hernia, the oesophagus is short, but this does not necessarily mean that, with mobilisation from the mediastinum, it cannot easily be restored to its normal length. The extent to which severe inflammation in the wall of the oesophagus causes fibrosis and real shortening is less clear. If a good segment of intra-abdominal oesophagus cannot be restored without tension, a Collis gastroplasty should be performed (Figure62.24). This produces a neo-oesophagus around which a fundoplication can be done (Collis-Nissen operation).
Esophageal dysmotility and other preoperative factors associated with acid suppressive therapy after fundoplication
Published in Scandinavian Journal of Gastroenterology, 2020
Carol Rouphael, Sampurna Shakya, Zubin Arora, Scott Gabbard, Thomas Rice, Rocio Lopez, Siva Raja, Sudish Murthy, Prashanthi N. Thota
All surgeries were performed at our institution between January 2006 and December 2013, as follows: When shortened esophagus was suspected, these hernias were approached with an upper midline laparotomy. Type III and Type IV hiatal hernia, failed prior fundoplication as well as type I and II hiatal hernia with a specter of shortened esophagus (peptic stricture) were often repaired with an esophageal lengthening procedure, i.e. Collis gastroplasty. The hernia sac was circumferentially mobilized and ultimately resected with care to preserve the vagal nerves. All short gastric vessels along with the GE junction fat pad were taken down. After adequate mediastinal mobilization, esophageal length was assessed with the esophagus off tension. If there was less that 3 cm of tension free intra-abdominal esophagus, then a Collis gastroplasty was added [20]. Next, the crus was repaired in a complex fashion where there left crus – often the crus with the most laxity – was imbricated superiorly until the left and right crus were roughly the same length, and then the posterior aspect of the crural decussation was closed to a normal aperture. Lastly, a Nissen (posterior 360 degree) or Toupet (posterior 270 degree) fundoplication was added based on preoperative manometry. The fundoplication was sutured to the crus to prevent torsion. Type I and II hiatal hernia without suspicion of shortened esophagus, had a laparoscopic approach used for repair. For small hernias where the diaphragmatic defect was small, only posterior crural closure was performed. For patients with failed fundoplication, the prior fundoplication was completely unwrapped prior to assessing the esophageal length. A Collis gastroplasty was added when the esophagus was shortened after confirming the absence of any unexpected injury by upper endoscopy.