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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hiatus hernia and peptic esophagitis in children lead in 20% of the cases to peptic stenosis, thus rendering a reflux-preventing operation mandatory in many patients. We consider fundoplication as the operation of choice and have used it for 17 years. The early and late mortality varies between 1.2% and 1.4% and can be lowered even further through improvement of treatment. Functional complications such as "gas bloat syndrome," dysphagia, diarrhea, disappear spontaneously in the first 2-3 months after surgery. The only severe late complication is the development of a paraesophageal hernia months after surgery: This complication can be avoided through better technique. Out of 61 patients who were examined 10 or more years after operation, 58 are totally free of symptoms.
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PMID:[Reflux esophagitis: operative procedures in children: fundoplication (author's transl)]. 73 34

The combined Collis-Nissen operation has been performed in 353 patients. Forty-five percent had reflux esophagitis without stricture; 20%, peptic stricture; 72%, a sliding hiatal hernia; 17%, a paraesophageal hernia; 21%, previous antireflux operation; 15%, esophageal spasm; 8%, scleroderma; and 32%, marked obesity. There were 4 postoperative deaths (mortality rate, 1.1%). Complications occurred in 28 patients (8%) and included wound infection (2.2%), esophageal or gastroplasty tube leak (1.7%), bleeding (1.1%), splenic injury, gastric atony, and crural repair dehiscence (each less than 1%). Follow-up includes personal interview, esophageal manometry, and standard acid reflux testing. The average length of follow-up for 261 patients (74%) followed at least 12 months is 43.8 months. Fifty-eight percent have been followed at least 36 months; 41%, 48 months; and 29%, 60 months or longer. Subjectively, in these 261 patients, reflux has been eliminated in 75%, is mild in 11%, is moderate in 9%, and is severe in 5%. Eight percent have postthoracotomy pain; 3%, early satiety ("bloats"); and 1%, postvagotomy diarrhea. Seventeen percent require either periodic or regular esophageal dilations for dysphagia. Objectively, intraesophageal pH studies show good reflux control in 91% and poor reflux control in 9%. Twenty-six patients (10%) have required reoperation for recurrent reflux or dysphagia. These results substantiate satisfactory reflux control using the Collis-Nissen operation in patients at risk for recurrence after standard repairs, but also emphasize that, like other antireflux procedures, the Collis-Nissen operation is not without some degree of postoperative adverse symptoms.
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PMID:Continued assessment of the combined Collis-Nissen operation. 291 6

Eighty-seven adults have undergone reoperation for recurrent gastroesophageal reflux or complications of prior antireflux procedures. Operations performed included the transthoracic Collis-Nissen procedure (59), Collis-Belsey repair (14), Nissen fundoplication (one), repair of acute postoperative paraesophageal hernia (one), division of obstructing crural suture (one), and esophageal resection (23). Among the 73 patients undergoing an additional hiatal hernia repair, there were two postoperative deaths. Follow-up averages 28 months. Subjectively, results have been excellent or good (no or mild reflux symptoms or dysphagia) in 47 (67%); fair in eight (12%), who have moderate dysphagia or reflux symptoms controlled medically; and poor in 15 (21%), 12 of whom have required additional operations. Early postoperative esophageal dilations were required in 25 patients (36%) and regular dilations in seven (10%). Among the 23 patients undergoing esophageal resection, four had a distal esophagectomy and short-segment colon interposition and 19 had a transhiatal esophagectomy without thoracotomy; stomach was used for esophageal replacement in 14 and colon in five. There were no operative deaths. Follow-up averages 17 months. Thirteen patients have had esophageal dilations (nine early and four regularly), and one has clinically significant reflux. Overall, subjective results are good or excellent in 64 (76%). The results of "redo hiatal hernia operation" are far from ideal. Optimal surgical treatment after the failed antireflux operation requires careful analysis of the existing anatomy and experience to decide when esophageal resection is a safer and more reliable approach than another hiatal hernia repair.
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PMID:Surgical treatment after the failed antireflux operation. 376 98

Case histories of 25 patients are reported in whom complications after a Nissen fundoplication were sufficiently severe to require reoperation. Patients were classified by complications as having postoperative dysphagia (14), recurrent reflux (seven), "gas bloat" syndrome (two), and paraesophageal hernia (two). Six of the 14 patients with dysphagia had no esophageal peristalsis, one had a panmural fibrous stricture, and had a "slipped" Nissen, and in six the wrap was presumed to have been fashioned too tightly. Too tight a wrap was also responsible for the seven instances of recurrent reflux and the two of "gas bloat" syndrome. Revision of the fundoplication relieved the symptoms in the 15 patients in whom it was done. A variety of surgical procedures were performed on the other 10, all but one of whom experienced a good result. Proper selection of patients for operation coupled with attention to certain technical surgical details will ensure good results in 90% of patients after a Nissen fundoplication.
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PMID:Reoperation for complications of the Nissen fundoplication. 745 21

Large paraesophageal hernias are generally repaired by reduction of the stomach into the abdomen, sac excision, crural closure, and gastropexy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combined laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias. Ten adults, six males and four females, with type III paraesophageal hernias underwent laparoscopic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38-81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplication performed and one patient had a diaphragmatic gastropexy. The procedure was completed laparoscopically in all ten cases and the median operating time was 282 min (range 165-430). Two complications occurred, an intraoperative gastric laceration, and a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative day. Eight of nine patients were asymptomatic at last follow-up (mean 8.9 months postop). One patient has mild dysphagia and heartburn from partial migration of the fundoplication into the chest. One patient died 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard surgical techniques.
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PMID:Laparoscopic repair of paraesophageal hernia. New access, old technique. 759 86

From January 1992 to July 1993, 94 patients with symptomatic gastroesophageal reflux and/or hiatal hernia underwent laparoscopic Nissen-Rossetti fundoplication. The median follow-up was 4.5 months. There was no conversion to open surgery and no postoperative mortality. Laparoscopic reoperation was necessary in 2 patients haemorrhage and there were 2 cases of food impaction. 6 patients developed a chest postoperative infection. 6 cases of dysphagia extending beyond 2 months were observed. In 3 of these cases, endoscopic dilatation provided effective treatment of dysphagia, and in 3 others, a further laparoscopic operation achieved cure. We observed 2 relapses of hiatal hernia, one of which was a voluminous recurrent paraesophageal hernia, and the other was a patient with slipped-Nissen. 84% of patients were satisfied with the surgical result. Laparoscopic fundoplication is an effective the treatment for gastroesophageal reflux.
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PMID:[Results of the celioscopic treatment of gastroesophageal reflux according to Nissen-Rossetti. Apropos of 94 cases]. 852 43

Three years experience of laparoscopic surgery for treatment of gastroesophageal reflux, large paraesophageal hernia and morbid obesity is presented. One hundred and thirty-six patients with reflux esophagitis and 6 patients with large paraesophageal or combined hiatal hernias have been laparoscopically treated with hiatal hernias have been laparoscopically treated with hiatal hernia repair and a 360 degrees Rosetti (N = 109) or semitotal Toupet (N = 33) fundoplication. Sixteen patients with morbid obesity have been treated with laparoscopic placement of a variable band around the cardia. Twelve months follow-up is available for 74 of the esophageal reflux patients. 90% of the patients are completely satisfied. One patient has been reoperated due to recurrent reflux and one due to hiatal fibrosis. The cardia banded patients achieved the desired dysphagia to control food intake. Complication rates are low in all groups. Laparoscopic fundoplication, closure of large hiatal defects and cardia banding are feasible with low morbidity and comparable outcome to open surgery. Further studies are needed to investigate to what extent the laparoscopic technique is beneficial to the patient and cost effective.
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PMID:Laparoscopy in the gastroesophageal junction. 874 Jun 74

Laparoscopic Nissen fundoplication has replaced open approaches for refractory gastroesophageal reflux disease (GERD) in many major medical centers. Here we report our preliminary results of the Belsey Mark IV antireflux procedure performed by video-assisted thoracoscopy (VATS-Belsey). Fifteen patients underwent VATS-Belsey. The indications for surgery included GERD refractory to medical therapy (n=10), achalasia (n=2), diffuse esophageal spasms (n=1), epiphrenic esophageal diverticulum (n=1), and paraesophageal hernia (n=1). The median operative time was 235 min. There were three conversions to open minithoracotomy (8-10 cm) necessitated by severe adhesions (n=2) and repair of a gastric perforation (n=1). The median hospital stay was 4 days. Postoperative complications included persistent air leaks, requiring discharge with a Heimlich valve in one patient. There were no perioperative deaths. At a median follow-up of 19 months, ten patients (66%) were asymptomatic and were not taking any antacids. One patient who had taken proton pump inhibitors preoperatively required postoperative H2 blockers for mild heartburn. In three patients, recurrent GERD symptoms (mean follow-up 6 months) led to laparoscopic takedown of the Belsey and Nissen fundoplication. One patient with achalasia, who had recurrent dysphagia after 1 year of relief following VATS myotomy and Belsey, underwent esophagectomy. The Belsey Mark IV antireflux procedure is technically feasible by VATS with minimal morbidity. However, our preliminary results suggest that open thoracotomy for Belsey Mark IV should remain the standard operation for GERD with poor esophageal motility when a thoracic approach is desired. We have modified our approach to laparoscopic partial fundoplications (Toupet or Dor) for severe GERD and poor esophageal motility when an abdominal approach is possible.
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PMID:Preliminary results of thoracoscopic Belsey Mark IV antireflux procedure. 964 40

The complications of laparoscopic paraesophageal hernia repair at two institutions were reviewed to determine the rate and type of complications. A total of 76 patients underwent laparoscopic paraesophageal hernia repair between December 1992 and April 1996. Seventy-one of them had fundoplication (6 required a Collis-Nissen procedure). Five patients underwent hernia reduction and gastropexy only. There was one conversion to laparotomy. Traumatic visceral injury occurred in eight patients (11%) (gastric lacerations in 3, esophageal lacerations in 2, and bougie dilator perforations in 3). All lacerations were repaired intraoperatively except for one that was not recognized until postoperative day 2. Vagus nerve injuries occurred in at least three patients. Three delayed perforations occurred in the postoperative period (4%) (2 gastric and 1 esophageal). Two patients had pulmonary complications, two had gastroparesis, and one had fever of unknown origin. Seven patients required reoperation for gastroparesis (n = 2), dysphagia after mesh hiatal closure of the hiatus (n = 1), or recurrent herniation (n = 4). There were two deaths (3%): one from septic complications and one from myocardial infarction. Paraesophageal hernia repair took significantly longer (3.7 hours) than standard fundoplication (2.5 hours) in a concurrent series (P <0.05). Laparoscopic paraesophageal hernia repair is feasible but challenging. The overall complication rate, although significant, is lower than that for nonsurgically managed paraesophageal hernia.
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PMID:Complications of laparoscopic paraesophageal hernia repair. 983 51

In our initial experience of four cases from March to November 1994, large paraesophageal hernias were repaired by conventional primary closure of the hiatus with interrupted, nonabsorbable sutures, adding a 360 degrees fundoplication. In all four cases the hernia recurred. Subsequently, we modified the procedure. The technique and results are described. From March 1995 to May 1998, 12 patients with paraesophageal hernia (4 following a previous Nissen procedure) underwent elective laparoscopic repair. In all patients a "tension-free" hiatoplasty and a floppy 360 degrees fundoplication were performed. The hiatal defect was repaired with a polypropylene mesh, fixed to the diaphragm by staples. A gastrophrenic anchorage procedure was added in the eight patients undergoing surgery for the first time, utilizing the peritoneum of the hernia sac. There were no conversions to open surgery or intraoperative complications. Two patients developed postoperative pleural effusion, which was treated medically. Mean hospital stay was 5 days. Three patients developed postoperative transient dysphagia to solid food that lasted 10 days. At a mean follow-up of 22.7 months (range 1-40), all patients are asymptomatic without dysphagia, reflux, or hernia recurrence. Laparoscopic "tension-free" hiatoplasty, 360 degrees fundoplication, and anterior gastrophrenic anchorage are effective in the treatment of large paraesophageal hernias.
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PMID:"Tension-free" hiatoplasty, gastrophrenic anchorage, and 360 degrees fundoplication in the laparoscopic treatment of paraesophageal hernia. 1087 Nov 72


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