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

Surgical intervention is usually indicated in reflux esophagitis when medical therapy fails to control symptoms. Since most patients with peptic esophagitis also have a sliding hiatal hernia, early procedures focused on hernia repair. Weakness of the lower esophageal sphincter is now known to be the pathogenetic mechanism, and Belsey, Nissen, and Hill have developed operations to restore sphincteric function. The Hill repair is used most often because of its low incidence of side effects, but the other procedures are recommended in specific situations. Stricture, the most common complication of reflux esophagitis, presents a special problem in treatment because interference with swallowing is added to the characteristic symptoms of reflux. Because of its high long-term success rate, the combined Thal-Nissen procedure is preferred to forceful dilation plus an antireflux operation.
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PMID:Surgical treatment of reflux esophagitis and stricture. 83 90

A long-term prospective follow-up of 113 children with vomiting due to a small hiatal hernia is described. When reviewed by the same clinical and radiological observers 20 or more years later, over 90% of unoperated non-stricture patients were asymptomatic whereas only 44% of the stricture and/or surgically treated group were without symptoms. Half or possibly more of the asymptomatic patients still had a hernia and it is possible that these may suffer a recurrence of symptoms later in adult life. The loculus of thoracic stomach tended to retain the same shape; there was a slightly better prognosis for the locular type of hernia compared with the tubular type. Complicating oesophageal strictures can decrease or disappear without surgery other than dilatation; the results of treatment by radical surgery were disappointing. There is need for an even more prolonged follow-up into later adult life.
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PMID:A 20-year prospective follow-up of childhood hiatal hernia. 87 83

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

The recurrent symptoms in 60 patients who had undergone surgical management of hiatal hernia with reflux were analysed with the help of manometry. Despite reduction of the hernia in 43 patients, the primary and important defect of sphincter incompetence was the commonest residual abnormality. Oesophageal spasm associated with reflux or occurring as a primary condition was another cause of recurrent symptoms. The addition of vagotomy and pyloroplasty to the hiatal hernia repair procedure in several patients did not prevent reflux. The use of valvuloplasty techniques such as the Hill posterior gastropexy, the Belsey Mark IV operation or the Nissen fundoplication should be encouraged when the primary defect is incompetence of the lower oesophageal sphincter.
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PMID:Hiatal hernia--manometric and symptomatic assessment of failed surgical management in 60 patients. 88 22

Food obstruction at the cricopharyngeal level is a common symptom of gastroesophageal reflux. In selected patients, cricopharyngeal myotomy is effective in relief of symptoms. We have used myotomy in patients whose only symptom was dysphagia, in patients too debilitated for major surgery, and in patients with persistent pharyngoesophageal dysphagia following hiatal hernia repair. All were studied by barium esophagogram, endoscopy, and manometry. Radiologic aspiration of barium was apparent in five of 19 patients. High-speed manometric tracings showed intermittent cricopharyngeal incoordination in the six consecutive patients most recently studied. This finding of incoordination has been shown to be present in 38 patients with reflux and in all with major cricopharyngeal symptoms. Myotomy was effective in relieving symptoms in patients in whom this was the only reflux symptom and in the five patients too debilitated for major surgery. Good symptomatic improvement was obtained in nine of the 12 with persistent dysphagia following hernia repair, but in three relief was partial, with persistent symptoms being secondary to distal esophageal obstruction. Investigation is necessary to exclude other causes of dysphagia. However, withcareful selection, myotomy has proved to be an effective method of treatment.
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PMID:Cricopharyngeal myotomy as a method of treating cricopharyngeal dysphagia secondary to gastroesophageal reflux. 91 11

There is currently controversy as to the importance of the radiologic demonstration of a hiatal hernia, reflux, or both as the explanation of heartburn. It is clear, however, that clinical-radiologic correlation requires additional observations such as the straightness of the potential path for reflux, the presence of a contractile esophagogastric region, the degree of extrinsic compression of the cuff of the stomach within the hiatus, the size of the hernia, and the peristaltic activity of the body of the esophagus. Vigorous or water-swallowing maneuvers to demonstrate reflux are unreliable in individual cases. Of importance is the concept that the so-called patulous cardia, or effaced abdominal esophagus or widened or absent "submerged segment," is a variety of sliding hiatal hernia that is often neglected radiologically but may be of considerable clinical significance.
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PMID:Heartburn. The role of radiology. 94 32

From an extensive review of the published cases of lesions of the esophagus and stomach brought about by vomiting and a supplemental review of local experience with the Mallory-Weiss syndrome, the influence of hiatus hernia on the lesion site can now be defined. Mallory-Weiss lesions located in the gastric cardia are commonly associated with hiatus hernia. By contrast, those occurring in the distal esophagus and those that overlie the cardioesophageal junction are only rarely associated with hernia. The Boerhaave lesion occurs most probably in the absence of hiatus hernia and in 2 of 3 previously reported cases wherein a hernia was present, a combined gastroesophageal rupture occurred. A newly recognized postemetic form of gastric rupture is clearly distinguished from other causes of this lesion and its characteristic location is described. A unifying hypothesis is proposed in which the location of lesions occurring during emesis is determined by the presence of a hiatus hernia during retching.
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PMID:Lesions brought on by vomiting: the effect of hiatus hernia of the site of injury. 95 56

We have previously reported the results of extended esophageal myotomy and Belsey hiatal hernia repair in 21 patients. Reflux was considered to be a late complication of this operation, and gastroplasty has subsequently been added. Thirty-four patients have now been surgically treated, 17 with myotomy and Belsey repair and 17 with myotomy, gastroplasty, and Belsey repair. Eight of the 17 with Belsey repair developed clinical and roentgenographic signs of reflux 6 to 27 months following operation without evidence of hernia recurrence; 5 of the 8 patients have required further operation, with the addition of gastroplasty for reflux control. Seventeen patients were treated primarily by extended myotomy, gastroplasty, and Belsey repair. None of the patients who underwent gastroplasty have reflux symptoms, and only 1 shows a trace of reflux radiologically.
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PMID:Reflux control following extended myotomy in primary disordered motor activity (diffuse spasm) of the esophagus. 96 14

Manometric, pH-metric, radiological and histological examinations were performed in 15 of 18 consecutive patients with gastro-esophageal reflux before and after fundoplication. In 13 of these 15 patients, reflux symptoms largely or completely disappeared after the operation. In the successfully operated patients, the reflux provocation test markedly improved but lower esophageal sphincter pressure did not rise. Six successfully operated patients in whom hiatus hernia was present after the operation and 7 patients without hernia had similar esophageal function tests. Therefore, success of surgery does not depend on resting pressure and position of the lower esophageal sphincter.
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PMID:[Esophageal function after fundoplication (Nissen)]. 99 98

Report of an experimental model of axial hiatal hernia in dogs, always combined with reflux (roentgenologic control). Using a new method of pressure measurement, the authors succeeded in proving the distention of the esophageal "sphincter". Morphologic investigations demonstrated, that in hernia the muscle fiber is no longer an apolar helical fiber, but runs nearly horizontally. The reduced susceptibility to pentagastrin is caused by diminished tension of the muscle fiber. The distal esophageal closing mechanism consequently seems to be a function of the whole organ and not of a hormonally regulated sphincter.
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PMID:[Morphological and functional changes in the closing sphincter of the lower esophagus after experimentally-induced hiatal hernia]. 103 94


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