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

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

On the basis of analysis of the results of treatment of diaphragmatic hernia in 115 patients, the authors, recommend for more precise establishment of a diagnosis and choice of a method for surgical intervention, to perform in patients with axial hiatal hernia roentgenoscopy and roentgenography of the stomach and intestine, esophagogastroduodenoscopy and pH-metry, and in patients with traumatic diaphragmatic hernia--roentgenography of the chest and contrast roentgenological study of the stomach and intestine. In axial hiatal hernia and small paraesophageal hernia, the A. A. Shalimov operation is a method of choice; in large paraesophageal hernia--the left-sided thoracotomy with plasty of the hiatus according to Allison and Belsey.
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PMID:[Diagnosis and treatment of diaphragmatic and hiatal hernia]. 180 91

Paraesophageal hiatal hernia accounts for only five per cent of all diaphragmatic defects but is a potentially dangerous lesion. Herniation of the entire stomach, at times accompanied by the omentum, transverse colon, and small bowel, may occur in some patients, and incarceration and strangulation may be the result. Three patients underwent repair of large paraesophageal hernias, in one instance as an emergency. Symptoms of pain, bloating, and occasional regurgitation had been present for 17, 30, and 40 years. The operations included repair of the hiatal defect, anterior gastropexy, and Nissen fundoplication in two patients. In the third patient, a pyloromyotomy was performed as well. A subsequent thoracotomy was necessary in one patient to excise a persistent large hernia sac, which was densely adherent to the lung and mediastinal structures. All patients were asymptomatic after periods of 9 months, 1 year, and 7 years. The unique anatomic and clinical features of large paraesophageal hernias containing intrathoracic abdominal viscera, as well as the technique of operative repair, are presented.
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PMID:Repair of large paraesophageal hernia with complete intrathoracic stomach. 192 81

The pathophysiology and treatment of herniations through the esophageal hiatus remain controversial. For the majority of patients with a sliding hiatal hernia, medical treatment is preferred. Antireflux surgical techniques are reserved for those who fail medical treatment or have specific complications. A paraesophageal hernia may be life-threatening and requires surgical correction when diagnosed. Definitive surgical treatment consists of reduction of the hernia, excision of the sac, and partial closure of the widened hiatus anterior to the esophagogastric junction. Temporary gastrostomy is also advisable. A few patients have mixtures of the two types of hernia, and only those with incompetence of the lower esophageal sphincter require an antireflux procedure.
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PMID:Diaphragmatic hiatal hernias. Recognizing and treating the major types. 197 84

The case of an 80-year-old woman with an incarcerated paraesophageal hernia is presented. Among diaphragmatic hernias, the paraesophageal or type II hernia occurs with an incidence of 5%, sliding or type I hernia occurs with an incidence of 95%. Incarcerated paraesophageal hernia is a surgical emergency requiring rapid decompression and reduction to minimize catastropic consequences of hemorrhage, perforation, and visceral infarction. The clinical presentation and diagnostic workup of the patient with incarcerated type II diaphragmatic hernia are discussed.
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PMID:Incarcerated paraesophageal hernia. 229 32

A case of distal volvulus of the stomach as a cause of acute intestinal obstruction in a paraesophageal hernia is presented. The patient, an old woman aged 82, had been suffering from abdominal pain and vomiting for about 48 hours. She successfully underwent emergency operation for the reduction of hernia and plasty of the hiatus anterior the esophagus. On the basis of personal experience and review of literature data, stress is laid on the high incidence of paraesophageal hernia complications and the importance of early diagnosis and surgical repair is underlined.
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PMID:[Distal gastric volvulus as a cause of acute occlusion in paraesophageal hernia. Considerations on a clinical case]. 262 60

The site of the stomach in 36 babies presenting postnatally with left sided congenital diaphragmatic hernia (CDH) was assessed as a predictor of outcome. Babies with a thoracic stomach had a higher mortality (P less than .0005), and more frequently developed significant persistent foetal circulation (PFC) (P less than .001), than babies in whom the stomach was normally sited. Normal stomach site was associated with 100% survival and only a 20% incidence of significant PFC. It is possible that stomach site may be the most accurate predictor of outcome in left-sided CDH diagnosed antenatally, and may thus help in planning perinatal and postnatal management. It may also open the door for prenatal surgical correction of CDH by predicting a poor prognostic group or, perhaps more importantly, by predicting those babies with a good prognosis in whom antenatal surgery should not be attempted.
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PMID:Could the stomach site help predict outcome in babies with left sided congenital diaphragmatic hernia diagnosed antenatally? 266 98

Fifteen patients with a paraesophageal hernia were studied with 24 hour esophageal pH monitoring and esophageal manometry to clarify the physiologic aspects of the cardia and resolve controversies over the type of surgical repair. The results were compared with those obtained in 34 randomly selected patients with a sliding hernia and 18 normal control subjects. Sixty percent of the patients with a paraesophageal hernia had an incompetent cardia on 24 hour pH studies which was associated with a lower esophageal sphincter of normal pressure, short overall length, and a small segment exposed to abdominal pressure. In comparison, 70 percent of patients with a sliding hernia had an incompetent cardia which was associated with a lower esophageal sphincter of low pressure, normal overall length, and a short segment exposed to abdominal pressure. With either type of hernia, symptoms were not helpful in determining the competency of the cardia. When urgent surgery is necessary, repair should include an antireflux procedure. If facilities and time permit, more specific evaluation of the cardia can be performed, and if competent, the repair should be limited to reduction of the stomach and closure of the defect.
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PMID:Effect of paraesophageal hernia on sphincter function and its implication on surgical therapy. 669 36

Large paraesophageal hernias are generally repaired by reduction of the stomach into the abdomen, sac excision, crural closure, and gastropexy or fundoplication. After gaining experience performing laparoscopic repair of sliding hiatal hernias and Nissen fundoplication we combined laparoscopic access with traditional surgical technique in treating patients with complex paraesophageal hernias. Ten adults, six males and four females, with type III paraesophageal hernias underwent laparoscopic repair between February 1993 and April 1994. The average age of the patients was 60.4 years (range 38-81). Using five ports (three 10 mm and two 5 mm), the stomach was reduced into the abdomen, the hernia sac was resected, and the defect was closed with pledgeted horizontal mattress sutures. In addition, nine patients had a Nissen fundoplication performed and one patient had a diaphragmatic gastropexy. The procedure was completed laparoscopically in all ten cases and the median operating time was 282 min (range 165-430). Two complications occurred, an intraoperative gastric laceration, and a postoperative mediastinal seroma. All patients were discharged on the 2nd or 3rd postoperative day. Eight of nine patients were asymptomatic at last follow-up (mean 8.9 months postop). One patient has mild dysphagia and heartburn from partial migration of the fundoplication into the chest. One patient died 3 months postoperatively of unrelated causes. Paraesophageal hernia can be reduced and repaired safely with laparoscopic access using standard surgical techniques.
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PMID:Laparoscopic repair of paraesophageal hernia. New access, old technique. 759 86

The charts of all the patients operated upon for paraesophageal hernia (HPO) were reviewed. 24 patients could be found between 1976 and 1992. The mean age was 64 years, with 15 men and 9 women. 15 patients had a pure HPO, whereas 9 had a mixed hernia (HPO and laxial hiatal hernia). 3 patients presented with acute symptoms, and 2 of them were operated on emergently. The remaining patients had elective surgery, consisting of reduction of the stomach (all cases), excision of the hernia sac (12), closure of the diaphragm (17) and gastropexy (8). There was no mortality. Due to the fact that acute complications occur in as much as 30-40% of the cases, elective surgery should be proposed to any patient with a known paraesophageal hernia if the operative risks are not prohibitive. A careful preoperative assessment including endoscopy and pH-manometry of the esophagus will provide arguments to add a antireflux procedure to the standard operation, which should include reduction of the stomach, resection of the sac, closure of the hiatal defect and gastropexy.
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PMID:[Therapeutic approach to para-esophageal hernia]. 787 24


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