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

A prospective study of the incidence of hiatus hernia and/or reflux oesophagitis was carried out in 670 patients referred for routine upper alimentary endoscopy. Hiatus hernia was found in 16.6% and reflux oesophagitis in 15.1% of the patients. Forty-two per cent of the patients with hernia did not have oesophagitis, whereas 63% of the patients with reflux oesophagitis had hernia. In patients without reflux oesophagitis the incidence of hiatus hernia was 8%. Reflux oesophagitis was significantly (p less than 0.001) related to hiatus hernia. The severity of the oesophagitis was significantly (p less than 0.05) related to the presence and the size of hernia, and severe oesophagitis without hernia was significantly (p less than 0.01) related to chronic alcoholism. The results suggest that a sliding hiatus hernia may play a role in the development of reflux oesophagitis.
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PMID:Relationship of hiatus hernia to reflux oesophagitis. A prospective study of coincidence, using endoscopy. 395 52

Fifty-five operations for paraesophageal hiatus hernia were performed at the Lahey Clinic, Burlington, Mass, between January 1970 and October 1985. Pain was present in 35 of 51 patients. Other less common symptoms were anemia and vomiting. Reflux symptoms were rare. Esophageal manometry disclosed a mean lower esophageal sphincter pressure of 18.2 mm Hg and a length of 3.5 cm. An anterior crural repair (Collis procedure) was employed in all patients. In 22 patients Stamm gastrostomies were also performed. In two patients, a Nissen fundoplication was also carried out because of coexisting gastroesophageal reflux. One patient died postoperatively of a pulmonary embolus. Of the patients, 88.4% benefited from the operation. Of the five poor results, four were due to hernial recurrence and only one was due to severe reflux symptoms. Gastroesophageal reflux is rare in patients with paraesophageal hiatus hernia. An antireflux procedure should be added to surgical correction of the anatomic defect only if evidence of a hypotensive lower esophageal sphincter is clearly present preoperatively or intraoperatively. The addition of gastrostomy to the procedure protects against recurrence of hernia.
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PMID:Paraesophageal hiatus hernia. 395 87

A series of patients showing a previously unrecognized type of sliding hiatus hernia is presented and analyzed. This type of hernia is characterized by reflux of the mucous membrane of the Hiss angle into the lumen of the esophagus. The occurrence of mucosal prolapse is a secondary phase of gastroesophageal reflux. The mucous plug prevents further reflux of the acid contents of the stomach into the esophagus and mouth. After the appearance of mucosal prolapse, the symptoms and signs of esophagitis disappear. The most characteristic complaint of the patients is retrosternal pain on lying and bending down. Endoscopy with provocative tests reveals the mucosal prolapse. Tooth erosions due to previous acid reflux into the mouth are diagnostic. The symptoms of this new subtype of sliding hiatus hernia were cured by the Nissen fundoplication.
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PMID:A new type of sliding hiatus hernia. 401 20

Experience of 30 cases with reoperation for recurrent symptoms after hiatal hernia repair is reported. The primary operation had been transabdominal in 21 cases (11 simple cruroplasty, 7 Nissen, 3 Hill) and transthoracic in 9 (5 Husfeldt, 4 simple cruroplasty). Stenosis and/or esophageal shortening were present in at least 8 patients at the primary operation. Symptoms recurred within a year in 26 of the 30 patients. A transthoracic approach was used for all reoperations. At the time of reoperation, 14 patients had no reflux complications or had esophagitis only. At follow-up (2-12 years) 13 were symptom-free and 1 was improved: X-ray showed hernia in one case and 3 had positive standard reflux test. Of the 16 patients with severe reflux complications before reoperation, 12 had shortened esophagus, combined with stricture in 6 cases, and 4 had isolated stricture. The results were less satisfactory in this complicated group, though all were postoperatively improved. There was no operative mortality. Initial failure to recognize esophageal shortening and inadequate repair were common causes of recurrent hernia. Symptomatic relief after reoperation was comparable with that after primary repair.
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PMID:Surgical treatment of symptomatic gastroesophageal reflux recurring after hiatal hernia repair. 405 Feb 76

In a sliding hiatus hernia, the esophagogastric junction is above the diaphragm. It is called a sliding hernia because anatomically it resembles a sliding inguinal hernia and not because of an upward and downward motion through the esophageal hiatus. Symptoms may arise from the hernia because it becomes distended or bleeds; much more commonly the hernia is said to produce gastroesophageal reflux with its secondary complications. However, certain clinical and manometric data suggest that the hernia may be an associated and inconsequential finding so that reflux probably depends upon the lower esophageal sphincter efficiency rather than the presence of a hernia. The role of the phrenoesophageal ligament and its actual existence are still debated. A lower esophageal ring cannot be assumed to indicate that a hernia is present; more than likely the ring marks the upper limits of the lower esophageal sphincter. Although inadequate data are available concerning the natural history of the symptom complex attributed to a hernia, in a large proportion of such patients, symptoms become mild or may disappear on so-called medical therapy. Consequently, the results of surgical therapy need to be cautiously evaluated.
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PMID:Does a sliding hiatus hernia constitute a distinct clinical entity? 495 Nov 49

The gastrointestinal abnormalities encountered in 125 patients with the Ehlers-Danlos syndrome have been described. Spontaneous perforation of the intestine and massive gastrointestinal haemorrhage are uncommon but potentially lethal complications of the Ehlers-Danlos syndrome. Less dangerous abnormalities, such ;as external hernia, hiatus hernia, eventration of the diaphragm, intestinal diverticula, and rectal prolapse were all encountered in patients in the series. Abdominal surgery in affected patients may be made difficult by fragility of tissues and a bleeding tendency. In the postoperative period, tearing out of sutures and wound dehiscence may occur.
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PMID:Gastrointestinal complications of the Ehlers-Danlos syndrome. 530 59

The augmented histamine test was performed in 150 cases of oesophageal hiatal hernia with and without duodenal ulcers and the results have been analysed. There was no significant difference in the result compared with normals. In addition there is no correlation between the acid secretion and either symptoms or size of the hernia. The pathogenesis of heartburn is briefly discussed.
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PMID:Augmented histamine test in the treatment of symptomatic hiatal hernia. 581 Sep 69

Most operations on elderly patients are of an urgent nature. If time permits, measures to improve cardiac, respiratory and renal functions in the appropriate ways should be undertaken. During recovery from anesthesia careful but adequate sedation will reduce the risk of myocardial ischemia. Throughout the postoperative period constant encouragement of the older patient is particularly helpful.Transverse abdominal incisions and the frequent use of temporary gastrostomy are advocated.External hernia, hiatus hernia, peptic ulcer, carcinoma of the stomach, biliary disease, appendicits, intestinal obstruction, and carcinoma of the large intestine are discussed specifically, with special reference to the practical details of management in the elderly patient.
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PMID:Some aspects of abdominal surgery in the elderly patient. 582 19

We studied the anatomy of the esophageal hiatus using axial CT scans in 320 patients. Normally, the diaphragmatic crura are tightly opposed and closely related to the esophagus. Widening of the esophageal hiatus is readily demonstrated by CT as a separation of the diaphragmatic crura and an increased distance between the crura and esophageal wall. The incidence of widening increases with age, lending support to the hypothesis that the abnormality is acquired. In 100 patients who also had barium studies of the upper gastrointestinal tract, a sliding hiatus hernia was found in 37/43 (86.4%) patients who had a widened esophageal hiatus shown by CT. In 26 of 37 (70.2%) patients, the hernia was demonstrated on CT as a pseudomass usually filled with contrast material lying within and/or above the esophageal hiatus. Small hiatus hernias were shown without a widened esophageal hiatus in only two patients.
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PMID:Incidence and significance of a widened esophageal hiatus at CT scan. 650 34

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


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