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

Twenty-nine patients who underwent Nissen fundoplication for the treatment of symptomatic, sliding, esophageal hiatal hernia are reported. Fourteen of these patients also underwent parietal cell vagotomy (PCV) without a drainage procedure. Simulatenous cineradiography and manometric studies, esophagoscopy and gastric analysis were performed pre- and postoperatively. Esophageal acid clearing and pH reflux studies were performed postoperatively. All but 3 patients had reflux and/or esophagitis preoperatively. Cineradiography and the pH reflux test were the most reliable tests for diagnosis of reflux. There was no operative mortality. The mean followup period was 20 months. Dysphagia occurred in 5 patients. Correction of dysphagia in one patient required operation. The dysphagia in the remaining patients was temporary and mild, responding to dilatation. Two patients had mild diarrhea. One patient who had had a previous gastric resection developed severe diarrhea after bilateral truncal vagotomy. No patient developed the "bloat syndrome". A close correlation did not exist between reflux and preoperative sphincter pressure. The mean LES pressure increased 10 mmH2O postoperatively and the two patients with persistent reflux postoperatively had normal LES pressure. Correction of reflux after Nissen fundoplication is probably due to some mechanism other than increased LES pressure. Recurrent or persistent hiatal hernia was diagnosed in 4 patients by cineradiography. Two of these patients had reflux but only the patient who had undergone PCV was without symptoms or esophagitis. The technical performance of the Nissen hiatal hernia repair was greatly facilitat ed by PCV. This procedure also provided adequate treatment for patients with concomitant duodenal ulcer disease. PCV, unaccompanied by a drainage procedure, was not associated with increased morbidity, mortality or the adverse effects usually attributed to vagotomy. In the event of recurrent hernia and reflux, PCV may prevent the development of esophagitis.
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PMID:Evaluation of the Nissen fundoplication for treatment of hiatal hernia: use of parietal cell vagotomy without drainage as an adjunctive procedure. 23 37

The lower esophageal ring, or Schatzki's ring, consists of a thin, submucosal, circumferential scar which forms a thin incomplete diaphragm in the lower esophageal lumen. The symptoms may be either episodic aphagia or progressive dysphagia, and the severity of symptoms is related to the diameter of the ring. Between 1970 and 1978, we saw 24 patients with lower esophageal rings and complaints of episodic aphagia or progressive dysphagia. Symptoms of esophagitis were present in 20 of the 24. Twenty were treated surgically by interrupting the rings and repairing the sliding hiatal hernias. Two were treated by dilatation and two received no treatment to the ring. Hiatal hernias have recurred in two patients. In one, there is a recurrent ring and in the other, an acid peptic stricture. The ring has responded to dilatation and the peptic stricture to dilatation and repair of the recurrent hernia. Two patients without symptoms of esophagitis, treated by dilatation, are doing well but the follow-up period is so far too short to draw any conclusion.
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PMID:Symptomatic lower esophageal ring: treatment of 24 patients. 47 13

Findings in this study correlated a low circulating gastrin level with an incompetent lower esophageal sphincter mechanism and abnormal reflux. Such reflux, in amounts causing esophagitis distally, was treated surgically by a mechanically simple method of fundoplication. The success of this reefing method of fundoplication was explained by using physiologically active sling fibers of the gastric fundus to augment the lower esophageal sphincter. Available gastrin was used more effectively in this manner. The high incidence of associated foregut diseases suggested an embryologic factor in the development of gastroesophageal reflux. The dilated hiatus and its attendant hernia had no apparent relationship to the development of reflux esophagitis. The term symptomatic sliding hiatal hernia, therefore, seemed to be a diagnostic and therapeutic misnomer.
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PMID:The role of gastrin in the treatment of sliding hiatal hernia with reflux using the reefing method of fundoplication. 78 38

A series of 207 cases of carcinoma of the cardia and thoracic oesophagus was reviewed. Ten patients (9-8% of those with carcinoma of the cardia) had a hiatal hernia with a coexisting adenocarcinoma. Five other patients (2-4%) had long-standing records of hiatal hernia, and chronic peptic oesophagitis with stricture before the development of carcinoma. In the cases of hiatal hernia coexisting with carcinoma, there is insufficient evidence of the hernia predisposing to carcinoma. The relationship is thought to be purely coincidental. However, malignant changes may occur in long-standing cases of chronic oesophagitis with peptic stricture.
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PMID:Carcinoma of the cardia and thoracic oesophagus coexisting with and following sliding hiatal hernia and peptic stricture. 88 49

Panmural esophagitis results in esophageal thickening and shortening and prevents adequate reduction of a hernia. Twenty patients with panmural esophagitis, treated by Belsey repair, have been followed up for more than 5 years; 9 of them remain asymptomatic and 11 have symptomatic reflux, 7 of whom have required further surgery. Belsey also has reported a 45 per cent recurrence rate in patients with this type of disease. Preoperative recognition of panmural esophagitis allows a planned surgical approach and the use of a surgical technique designed for the management of an irreducible hernia. The ability to predict these changes was studied in 124 patients, who were evaluated by history, radiology, endoscopy, and manometry prior to transthoracic hernia repair. The esophagus was inspected at operation to determine the presence of panmural changes. History was of no value in assessment. Radiologically, a large and irreducible hernia was associated with panmural changes, but these changes also occurred in the absence of ulceration. Manometric studies allowed accurate prediction of mural changes. Over 90 per cent of patients with panmural esophagitis have more than 40 per cent disordered motor activity (DMA) in the distal part of the esophagus, and 75 per cent of such patients have more than 60 per cent DMA. Combining these investigative data allowed the accurate prediction of panmural changes in 90 per cent of the 124 patients.
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PMID:Preoperative assessment of esophageal pathology. 96 83

In order to better define the outcome of patients with neonatal congenital diaphragmatic hernia (CDH), 17 patients between 3 and 19 years of age, among 34 survivors from 100 CDH have been re-examined clinically. All had a lung radiography, lung function studies, and radionuclide (Technetium 99m, Xenon 133) lung scans. Three patients suffered from asthma, 2 had recurrent bronchitis, 4 poor tolerance to effort, 3 gastrooesophageal regurgitation leading to endobrachyoesophagus and oesophagitis in one, 3 had scoliosis. Lung scans demonstrated hypoperfusion of the herniated side (less than 40%) in 6 patients. Chest films showed hypovascularisation on the herniated side. Lung function studies, performed in 4 of these 6 patients, showed a restrictive syndrome in 1 patient. Our results confirm those in the literature: perfusion is more altered than ventilation. Chest films at one year of age, completed if necessary by radionuclide lung scans, allow identification of children who have important pulmonary hypoplasia. These children need a regular follow-up: respiratory, digestive and orthopedic complications must be treated in order to preserve the respiratory function in adulthood.
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PMID:[Long-term outcome of congenital diaphragmatic hernia. A study of 17 patients]. 179 45

Massive hiatal hernia is a lesion at risk of incarceration, volvulus, and obstruction. The true paraesophageal type is a very rare condition and probably often mistaken with end-stage slidind hernia. Furthermore reflux and oesophagitis are always possible. In this case report a small bowel loop was incarcerated with a massive hiatal hernia. This association was only possible because of the existence of an associated transverse mesocolis hernia giving way to the small bowel. An emergency operation was necessary. The need of surgical treatment of such lesions is stressed, if possible before acute complication, even if they are asymptomatic at the time of diagnostic, which is a quite common condition.
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PMID:[Pseudostriction of hiatal hernia. Apropos of a case with incarceration of the transverse mesocolon and small intestine]. 184 19

The incidence of reflux-esophagitis was studied in 574 dispensary patients and 217 patients operated upon for ulcer disease. It was found that reflux-esophagitis is observed in 19.8% of patients with ulcer disease and in 34% of such patients subject to operation. The main cause of it is incompetence of the cardiac sphincter without or in combination with a hernia of the esophageal opening. It was noted that vagotomy leads to a disturbance of the ligamentous system of the cardio-esophageal zone and in all cases leads to the development of reflux-esophagitis. Fundoesophagorraphy is thought to be the best method of preoperative treatment of reflux-esophagitis.
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PMID:[Prevention of postoperative reflux esophagitis in patients with duodenal ulcer]. 196 40

Of 55 children (age 3 months to 16 years) who had fundoplication, major complications occurred in nine (16 per cent): paraoesophageal hernia (five cases), prolonged ileus (two cases), recurrent gastro-oesophageal reflux (one case), and accidental perforation (one case). The single most important factor resulting in complications was the omission of crural repair; of seven patients without crural repair, five developed paraoesophageal hernia/recurrence. Four patients required repeat fundoplication for severe recurrent symptoms and one of these developed the unusual complication of pericardiogastric fistula. Thirteen patients had strictures before operation from reflux oesophagitis, six (46 per cent) resolved after fundoplication alone, six responded to dilatation (mean five sessions), and one required colon interposition. Our preliminary experience with balloon dilatation was encouraging: three of three patients responded after one dilatation only. These results confirmed the efficacy of surgery in controlling reflux: 100 per cent in the short-term and 89 per cent on a 1-6 year follow-up. Major complications might well be reduced by routine crural repair.
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PMID:Results of fundoplication in a UK paediatric centre. 202 53

The Angelchik prosthesis was used in 26 cases of gastroesophageal reflux disease resistant to medical therapy. The operations were crowned with success in 24 cases out of 26 (92.3%), with complete disappearance of reflux. The procedure failed in two cases: the prosthesis was removed in one case due to postoperative acute haemorrhagic gastritis with a subsequent positive outcome; in this patient the Angelchik ring had been removed as a precaution. Failure in the second case, a patient with oesophageal stenosis and a short oesophagus, was due to mediastinal migration of the prosthesis. In this latter case, a successful duodenal bypass was created with antrectomy and a long Roux-en-Y anastomosis. The only intraoperative complication in the patient sample was a splenectomy for rupture of the splenic capsule. Postoperative complications not directly related to the prosthesis were perforation of a duodenal ulcer not diagnosed preoperatively and treated with raphia without impairing the functional efficacy of the ring, one case of pulmonary embolism and one case of cardiac infarction, all resolved with medical therapy. In all, the prostheses were removed in 3 cases out of 26 (11.5%). In addition to the two cases already described, the prosthesis was removed in one patient one year after the operation at the patient's specific request for "psychological" reasons. Migration of the prosthesis occurred in four cases of severe oesophageal stenosis with a short oesophagus, in three of which the prosthesis functioned perfectly even in the intrathoracic site. At follow-up examinations there was radiological disappearance of the hiatal hernia in 20 cases out of 25. In one case there was no hernia even before the operation, and in four cases there was a short oesophagus with severe oesophagitis. Owing to the very easy performance of the operation together with its unquestionable antireflux efficacy, in our opinion three reliable indications emerge, namely: (i) in elderly patients at high surgical risk; (ii) in obese, brachytypical patients; and (iii) in the presence of severe oesophagitis, even with a short oesophagus.
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PMID:[Our experience on the use of the antireflux prosthesis by the Angelchik method (personal contribution of 26 cases)]. 263 19


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