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

One hundred and sixteen patients operated upon for hiatal hernia with gastro-oesophageal reflux and with or without reflux complications were postoperatively examined by personal interview, X-ray study, pH measurements and study of the oesophageal motility 1 to 10 years postoperatively. The patients without severe reflux complications were operated upon mainly with a modified Husfeldt hernia repair and the patients with complications, such as oesophageal stricture and shortening, underwent various surgical procedures. The main reason for unsatisfactory clinical results, with persistent reflux symptoms, was gastro-oesophageal reflux uncorrected by the surgical procedure. However, gastro-oesophageal reflux was detected even in completely asymptomatic patients. It was found that the reflux symptoms were influenced by the oesophageal motility. The clinical results were better and recurrence of hernia and the occurrence of pathological reflux were lower in patients operated upon for hernia without severe reflux complications. Creation of a competent antireflux barrier between the oesophagus and stomach for control of gastro-oesophageal reflux is much more difficult in patients with severe reflux complications.
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PMID:Gastro-oesophageal reflux after surgical treatment of hiatal hernia with and without severe reflux complications. A follow-up study. 3 60

During a 10-year period, 1967-1976, 57 patients were operated upon for hiatal hernia and gastro-oesophageal reflux complicated by oesophageal stricture. Forty-four patients were managed by various surgical antireflux procedures combined with dilation of the stricture. In 12 patients the stricture was resected and the oesophageal continuity restored by oesophagogastrostomy. The primary mortality was 3.5%. Fifty-two patients were carefully followed up postoperatively by periodic control examiniations. The results of the treatment are presented. The main cause of unsatisfactory postoperative results was gastro-oesophageal reflux uncorrected by the surgical procedure. In the patients subjected to a hernia repair the failure of the antireflux procedure was due mainly to a shortened oesophagus associated with the stricture. It is concluded that most of these strictures can be successfully treated by dilation after establishment of control of the pathological reflux by means of an antireflux surgical procedure. The location, width, length and rigidity of the stricture, as revealed at the preoperative examination, are not decisive for the choice of therapeutic approach.
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PMID:Hiatal hernia complicated by oesophageal stricture. Surgical treatment and results. A follow-up study. 49 60

The existence of an anatomically shortened oesophagus in patients with hiatal hernia, and its influence on the results of surgical repair of the hernia, is the subject of great controversy. One hundred and forty patients operated upon for hiatal hernia were studied for presence of shortened oesophagus. The method of examination and criteria for evaluation of the oesophageal shortening are described. The oesophagus was found to be anatomically shortened in 52 of these patients. None of the findings obtained at the preoperative examinations employed in the study could be used as a pathognomonic sign for diagnosing a shortened oesophagus. Irreducibility of the cardia below and the diaphragm, as observed radiologically, in association with other severe reflux complications, such as oesophageal stricture and/or ulcerative, makes it presence very likely, however. The incidence of shortened oesophagus in this series was higher in patients with a long history of symptomatic gastro-oesophageal reflux. The influence of the shortened oesophagus on the result of the surgical repairs used in this study, and aimed mainly at restoring the abdominal segment of the oesophagus, was clearly unfavourable.
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PMID:Hiatal hernia and shortened oesophagus. 49 61

The results obtained from diagnosis and treatment of six patients with cardioesophagic junction cancer, diagnosed by histopathologic study during surgery, are presented. Three patients presented with diaphragmatic hernia as well. Esophagogastroduodenal roentgenological study was interpreted as neoplasia in three patients only; it was supposed that the other three patients had a benign esophageal stricture. Endoscopy oriented the malignity diagnosis in four patients, and for benign lesion in the other two. Biopsy showed malignant lesion in three patients and it was negative in the other three. Exfoliative cytology was positive in four patients and negative in two. Esophagogastric resection was done in four patients. One of them died post-operatively. The other have survived 36, 22 and 16 months.
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PMID:[Surgical treatment of carcinoma of the esophagogastric junction]. 123 75

A total of 82 patients with gastroesophageal reflux were consecutively treated with stapled, uncut gastroplasty and complete fundoplication over a 12-year period. The conditions treated included symptomatic reflux; esophageal stricture; massive hernia; collagen esophagus; short esophagus; Barrett's esophagus; recurrent, massive bleeding or anemia; small gastric remnant after gastrectomy; and acute volvulus. The transthoracic approach of stapled, uncut gastroplasty gives superb exposure. Outstanding features of the procedure are the safety and versatility resulting from the small amount of fundus required, no need either to ligate short gastric vessels or to suture the esophagus itself, and preservation of anatomical continuity between the wrapping fundus and the wrapped gastric tubular segment. There have been no deaths and no cases of anatomical or symptomatic recurrence in the series. Complications included some nondebilitating and mainly self-limiting symptoms.
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PMID:Stapled, uncut gastroplasty for hiatal hernia: 12-year follow-up. 638 91

Ninety-seven consecutive patients with hiatal hernia were operated upon with a modified Husfeldt hernia repair during a ten-year period. Thirty-two of the patients had severe reflux complications, such as ulcerative oesophagitis, oesophageal stricture and shortened oesophagus. Ninety patients were carefully followed up postoperatively. The mean duration of follow-up was 5 years. Analysis of the postoperative results in relation to the type of hernia showed no difference between sliding and combined hernia. Recurrence of hernia, unsatisfactory clinical results and gastro-oesophageal reflux were recorded more often in patients with severe reflux complications. The main cause of unsatisfactory results in these patients was found to be a shortened oesophagus. The method proved to be a reliable procedure for surgical treatment of not only uncomplicated hernias, but also cases complicated by oesophageal stricture if the stricture was not associated with shortened oesophagus. It is considered that a shortened oesophagus is a contra-indication for employment of the Husfeldt method.
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PMID:Husfeldt hernia repair: indications and results. A follow-up study. 737 86

In a retrospective study of 93 patients with benign peptic strictures, and 73 patients with malignancy of the lower third of the esophagus, 93% of benign strictures were associated with a hiatal hernia, and 4% without. In malignancy the majority were without hernia. The results provide a statistical basis for strong suspicion of malignancy in a lower esophageal stricture not accompanied by a hiatal hernia.
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PMID:Lower esophageal strictures, benign or malignant? 738 Aug 71

Recent reports indicate a significant incidence of gastroesophageal reflux (GER) and other nonpulmonary problems after the repair of congenital diaphragmatic defects. Reports of follow-up through adulthood are few and based on a small number of patients. From 1948 to 1982, 107 of 164 patients (65%) treated at the authors' institution survived after repair of congenital diaphragmatic hernia or eventration. Sixty of the 107 survivors (56%) (mean age, 29.6 years; SD, 9.0 years) were interviewed and examined clinically. Forty-one of the sixty (68%) underwent upper gastrointestinal endoscopy. Early postoperative GER was recorded for 11 of the 60 patients (18%). Two of them underwent fundoplication because of an esophageal stricture. At the time of the follow-up study, 38 of the 60 (63%) reported symptoms suggestive of GER. Endoscopic or histological GER (esophagitis, Barrett's esophagus) was present in 22 of 41 patients (54%). No significant correlation between the initial severity of the diaphragmatic defect or neonatal postoperative problems and the late GER could be verified. Intestinal obstruction requiring hospital admission occurred in 12 of the 60 patients (20%), eight of whom had surgical treatment between 1 month and 20 years after repair of the diaphragmatic defect. GER and intestinal obstruction are common among patients who have undergone repair of a congenital diaphragmatic defect. Investigations for GER should be performed routinely during the follow-up of these patients.
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PMID:Long-term gastrointestinal morbidity in patients with congenital diaphragmatic defects. 880 11

Although gastroesophageal reflux disease (GERD) can be effectively treated by proton-pump inhibitors, surgery is still the only means of definitive cure of the disease. After introduction of laparoscopic surgery, there has been a clear trend to surgical repair of the incompetent cardia. The indications for surgical treatment are: endoscopically proven esophagitis, persistent or recurrent complaints under medical treatment, esophageal stricture and/or pH-metrically proven acid reflux as well as reflux-induced coughing (chronic aspiration). Although the laparoscopic antireflux operations is a technically demanding procedure, it can be performed with similar results as compared to conventional surgery. The operative technique is reported in detail. From January 1992 to March 1997, 146 consecutive patients with GERD have been operated on laparoscopically. The overall conversion rate was 8.2% (n = 12). 133 patients were operated on according to the Nissen procedure including hiatoplasty. The Toupet operation was performed in only one case. 84 men and 42 women had a mean age of 49 years (20-76). The median duration of symptoms was 48 months (1-600). Except five patients all had medical treatment for at least 2 years. Twice pneumatic balloon dilatation of an esophageal stricture was necessary preoperatively. The median operation time was 210 minutes (70-660). Conversion to open surgery because of intraoperative complications was necessary in 6 patients. Postoperative complications occurred in 14 patients, all of them being successfully treated conservatively. No patient died. 121 patients (90.3%) had follow up examinations for at least 6 months. Retreatment was necessary in 5 cases: 1x slipped Nissen (laparoscopic repair), 1x intrathoracic hernia (conventional reoperation), 2x dysphagia > 4 months postoperatively (endoscopic balloon dilatation) and 1x recurrent ulcer (conventional operation). With a correct indication, laparoscopic Nissen repair for GERD is a suitable, safe and definitive treatment.
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PMID:Laparoscopic antireflux surgery--technique and results. 933 5

The authors present their long-term experience with surgical treatment of gastrooesophageal reflux (GER) in childhood. During the period between 1984-1993 they operated 243 children from neonatal age to 18 years. In 241 patients Nissen fundoplication was performed, once Thal's operation and once a modification of Boix-Ochoy's operation. Of 243 children 18 children (7.4%) died without any association with the operation, 5 children were re-operated on account of ileus, 5 developed a dehiscence of the surgical wound, 4 a paraoesophageal hernia and 2 a relapse of the reflux. The most frequent indication for surgery were relapsing bronchopneumonias 71 (29%), apnoe 44 (18%), impaired nutrition and growth 43 (17%), asthma bronchiale 38 (15%), oesophageal stricture 20 (8%), suffocating laryngitis 14 (6%) and incoordinated deglutition (5%). Two hundred and nine patients attended check-up examinations 3-13 years after surgery. 174 children (83%) do not have clinical manifestations of GER and no difficulties with swallowing. 27 children (13%) report marked improvement of the clinical manifestations of GER or slight difficulties when swallowing. Nissen fundoplication was a success in 96% children with GER. The authors recommend Nissen fundoplication for the surgical treatment of GER in child age because the long-term results with this method are favourable.
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PMID:[Late results after surgical treatment of gastroesophageal reflux in childhood]. 947 55


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