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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Since 1979 our policy for management of esophageal perforation has included correction of underlying esophageal disorder as part of the initial treatment in selected cases. A series of 23 patients is presented, of whom 3 were managed conservatively and 20 surgically. The overall mortality rate was 8.7%. Concomitant operation of underlying esophageal disease and perforation was done in eight cases within 12 hours of the perforation. These operations included emergency resection and esophagogastrostomy in five patients (4 with stenosis and 1 with cancer). A Heller myotomy was done in addition to suture repair in two patients with achalasia, and a Belsey Mark IV hernia repair was added to the esophageal suture closure in a patient with gastroesophageal reflux and hiatal hernia. A postoperative fistula healed spontaneously in one of the eight patients, and the early postoperative course was uncomplicated in the other seven. Simultaneous correction of underlying esophageal disease in patients with iatrogenic perforation of the esophagus seems to be safe when perforation is diagnosed at an early stage. Such a radical approach is clearly beneficial.
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PMID:Advisability of concomitant immediate surgery for perforation and underlying disease of the esophagus. 652 78

The application of S-VHS video system has made it possible to easily detect the functional disease. Among several position, left posterior prone position where gravitational force could be ignored, and spontaneous, physiological movement could be registered in the recording of the esophagocardiac movement. Through the observation and the classification of the movement at this position, we evaluated the contribution of this method to the assessment, and the study of the functional diseases such as achalasia, hiatus hernia, and the study of the organic diseases such as carcinoma. In our present study on normal 60 cases, the time from the inflowing first phase to the inflowing interrupted phase in the last period becomes longer as the age of the subjects gets older. The continuous contractive period was divided into three types, shorter type, medium type and longer type. The shorter type seems to correspond to the type closer to hernia. The longer type is regarded as the type closer to achalasia.
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PMID:[X-ray VTR analysis for the inflowing movement of the contrast medium in the esophagocardiac region: the inflowing movement of contrast medium on healthy people]. 837 42

Although hiatal hernia is reported with a 40-50% frequency in the general population, its occurrence and potential implications in achalasia are less well known. We reviewed the medical records and radiographic examinations of 120 patients with achalasia to assess the prevalence of hiatal hernia and its importance in evaluation and management of this motility disorder. Hiatal hernia was present in only 10 (8.3%) patients. Age, sex distribution, prevalence of dysphagia and regurgitation, and lower esophageal sphincter pressure measured manometrically were not significantly different in patients having hiatal hernia compared to those without hernia. Most patients (88%) underwent pneumatic dilatation and five esophageal perforations occurred, but all in patients without hiatal hernia. In conclusion, hiatal hernia is uncommon in patients with achalasia for reasons not known. Age, sex, symptoms, and results of esophageal manometry were not significantly different in those with hiatal hernia. Finally, the presence of hiatal hernia is not a contraindication to treatment of achalasia by pneumatic dilatation.
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PMID:Achalasia associated with hiatal hernia: prevalence and potential implications. 843 97

Achalasia is a functional disorder of the alimentary tract due to decreased or absent peristalsis of the esophageal body and obstructive outlet of the esophagus. Surgical treatment, eg. esophagomyotomy of the lower esophageal sphincter (LES), was one choice for resolving the problem and its effect was affirmative from reviews of many internationally authorized articles. However, few reports have ever questioned the long-term effects of it. From January 1968 to May 1996, 159 esophageal achalasic patients, 90 males and 69 females, were admitted due to dysphagia or food regurgitation. One hundred and forty-five patients had received 158 operations related to this benign motor disorder. The majority of patients received either modified Heller esophagomyotomy (M) or M plus modified Belsy Mark IV antireflux procedure (M+W) for primary treatment of their esophageal disorder, while conditional selection with addition of esophageal resection as advanced procedures for failure of primary surgery. We retrospectively studied these patients, collected their preoperative and postoperative clinical results, analyzed the causes of recurrent symptoms, compared the long-term results in different surgical procedures and searched for the pathogenesis of their failure. The results disclosed that the overall success rate for both methods was 73.1% with 85.7% for patients receiving M+W (56) and 64.9% of M (77) only. Through long-term follow-up, we had an improvement rate of 97.4% at an early stage and 53.3% for M at a late stage and 98.4% and 55.6% for M+W, respectively. The postoperative natural course of achalasic patients could be seen and progressive deterioration of the operated patients with time was noted. Several factors might contribute to the causes of unsuccessful surgery. We summarized them as incomplete myotomy, fused or healed myotomy, gastroesophageal reflux (GER), mucosal hernia and co-combined antireflux procedure by hypercalibrated or floppy wrapping. Esophagomyotomy or myotomy plus antireflux procedure for the esophagus could be concluded to rather effective in the long-term but palliative treatments for achalasia chronic deterioration of the results could be found for both of them. Defective myotomy and GER may be the major causes for their failure. The choice of types of surgery between M and M+W was not the cause of the unsuccessful results whereas the operative strategy and procedures would have a certain significance on the long-term effect.
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PMID:Surgery for achalasia: long-term results in operated achalasic patients. 991 58

Esophageal perforation is a serious complication of pneumatic dilatation. We studied the cases of 4 patients (2 men and 2 women, mean age 58 years, range 56-62) who had surgical treatment for achalasia, two of which had had previous dilatation. The main symptoms were pain and dyspnea. Pneumomediastinum was present in all patients, pleural effusion in 2 and cervical emphysema in 1. Esophagographic results showed evidence of perforation in all four cases and gastric patches were surgically placed on the esophageal tear within 12 hours. Three patients received enteral nutrition for an average of 13 days. Mean hospital stay was 14 days. No post-operative complications were exhibited although one patient did develop gastroesophageal reflux 3 months later and underwent surgery to repair a hernia in the thorax 5 years later. Early and aggressive treatment is considered the best therapy and the gastric patch, in our opinion, is an effective and reliable technique for esophageal perforation repair in achalasia patients.
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PMID:[Perforation of the esophagus during pneumatic dilatation in achalasia]. 1051 19

Many centers besides radiography and endoscopy, perform manometric measurements in the diagnostics of diseases concerning esophagus and cardia. They which allow to determine esophageal body peristalsis, LES length with spatial distribution of pressures (Vector Volume). The aim of our study was the estimation of usefulness the esophageal and cardial computed manometry in disorders concerning motor activity of the upper part of gastrointestinal tract. In our hospital between March 1997 and March 1998 we examined 12 patients with cardial achalasia, 9 patients with hiatal hernia, 2 ones with features of gastroesophageal reflux without hernia and 1 patient with diffuse esophageal spasm. All patients were examined preoperatively, on the 7th postoperative day and postoperatively--after a month. Computer recording of pressures was made. In postoperative examination we revealed favourable improvement in gastroesophageal passage with marked decrease of LES pressures in patients after dilation. However in patients after Nissen's operation LES pressures exceeded upper normal range on the 7th day postoperatively, but they came back to normal range within a month after operation.
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PMID:[Manometric examinations in esophageal peristalsis disorders]. 1094 2

Benign tumours of the oesophagus are rare, with an incidence of ten percent. Leiomyomas are the most common benign tumours and are located frequently in the middle and lower third of the oesophagus. Coexisting achalasia cardia is very rare. We present a 63-year-old man with coexisting leiomyoma and achalasia presenting with dysphagia for 25 days. Endoscopy and manometry revealed achalasia cardia at the lower third. Barium swallow showed a tumour proximal to the narrowing. Laparoscopic transhiatal enucleation and cardiomyotomy with Toupet fundoplication was successfully performed. Several conditions have been described to coexist with achalasia cardia, such as cancer, paraoesophageal hernia and hiatal hernia. Based on our experience, we feel that lower oesophageal tumours are best approached by a laparoscopic transhiatal route and the presence of achalasia in this case did not change the approach as cardiomyotomy with fundoplication could also be simultaneously performed. Minimally-invasive surgery for benign oesophageal tumours reduces the morbidity of thoracotomy or laparotomy.
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PMID:Laparoscopic surgery for an unusual case of dysphagia: lower oesophageal leiomyoma co-existing with achalasia cardia. 1820 55

A 6-month-old domestic shorthair female cat was presented with suspected diaphragmatic hernia (DH) that was later confirmed by thoracic radiography. The cat underwent exploratory celiotomy with a diaphragmatic rupture (DR) repair and recovered. Six days later, it was represented with vomiting and anorexia. Megaoesophagus (MO) and gastric dilatation were diagnosed by contrast radiography. A second celiotomy revealed no abnormalities and gastropexy was performed. Endoscopy demonstrated MO, oesophagitis and gastro-oesophageal reflux. MO persisted for several weeks and was an unexpected complication as no association between DR (or DH) and MO has never been described in the veterinary literature. The cat was treated medically with aggressive prokinetic and antacid therapy along with prolonged temporary oesophageal diversion (percutaneous endoscopic gastrostomy tube) with an excellent outcome.
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PMID:Transient megaoesophagus and oesophagitis following diaphragmatic rupture repair in a cat. 1824 47

Achalasia and gastroesophageal reflux disease (GERD) represent diverse physiologic disorders both of which result from lower esophageal sphincter (LES) dysfunction. Fortunately, both diseases are benign and amenable to surgically corrective therapies. Achalasia is characterized by destruction of the smooth muscle ganglion cells of the myenteric plexus (Auerbach) resulting in motor dysfunction, incomplete LES relaxation, and progressive esophageal dilation. GERD is frequently characterized by hypotonia or shortening of the LES. Local anatomical derangements such as a hiatal hernia (eg, sliding type I hernia) can predispose to GERD. Other predisposing factors for GERD include obesity, smoking, alcohol, and pregnancy. Transient LES relaxation is the most significant factor in the development of GERD. Transient LES relaxations last from 10 to 45 seconds and are not related to swallowing. The diagnostic workup of achalasia and GERD may include barium esophagram, upper gastrointestinal endoscopy, pH monitoring, and esophageal manometry. The different medical treatment options for achalasia comprise pharmacologic treatment, botulinum toxin, and balloon dilation. Surgical interventions include Heller myotomy, which is usually combined with a partial fundoplication. GERD is managed by treating the predisposing factors, using medications (ie, anatacids or proton pump inhibitors) and surgery (ie, fundoplication). Recently, endoluminal therapy has been employed in the treatment of GERD with promising short-term results.
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PMID:Recent advances in the surgical treatment of achalasia and gastroesophageal reflux disease. 1836 81

Background. The optimal treatment for management of esophageal achalasia in pregnancy is controversial. Little information exists about pregnancy outcome after successful myotomy. Case. Achalasia in pregnancy was diagnosed when a patient presented with pneumomediastinum from microrupture of the overdistended esophagus. An attempt at surgical correction failed due to the development of aspiration pneumonia with general anesthesia. Conservative medical therapy was undertaken, but fetal growth restriction developed. The patient underwent interval surgical correction, but subsequent pregnancy 6 months later was complicated by acute diaphragmatic hernia necessitating preterm delivery. Conclusion. Prior to surgery in pregnancy, emptying the dilated esophagus via nasoesophageal tube suctioning maybe warranted to avoid aspiration. Women, despite having undergone successful myotomy, should be counseled on the risks of pregnancy and to avoid pregnancy for at least 1 year thereafter.
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PMID:Diaphragmatic hernia after laparoscopic esophagomyotomy for esophageal achalasia in pregnancy. 2199 32


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