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

After proper training and observation, I started performing laparoscopic cholecystectomy at the community hospital in August 1990. Since then, and after further advanced training, I have performed 172 procedures, including appendectomy, hernia repair, lysis of adhesions, retroperitoneal biopsy, paraesophageal hernia repair, exploration of the common bile duct, repositioning of CAPD catheters, and colon resection with excellent results. This experience confirms that video endoscopic surgery can become the approach of choice in the community for many of what today are still considered open procedures, without undue risk, as long as adequate training is obtained and proper preparation observed when more advanced procedures are attempted.
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PMID:Video endoscopic surgery in the community hospital. 804 67

A massive incarcerated hiatal hernia is a frequent finding in elderly people. The aim of this report has been to review from 1987 to 1992 the clinical aspects, therapeutic options and results of surgical treatment in a series of twenty-eight patients (23 females and 5 males) with a large incarcerated hiatal hernia. Age averaged 66 +/- 10 years; thirteen patients (46.5%) had a sliding type of hernia, 8 (28.5%) a mixed one, and 7 (25%) a paraesophageal hernia. In 9 patients (32%) there was a chronic volvulus of the incarcerated stomach. Twenty-seven patients underwent elective repair; one patient developed a perforated gastric ulcer into the pericardial sac with pneumopericardium and died before surgery. The surgical technique included reduction of the hernia, closure of the hiatus and an antireflux procedure (Nissen 25, Toupet 1 and Dor 1). There was no mortality and the morbidity (18%) was not directly related to the surgical procedure. In our series there were no cases of acute volvulus requiring emergency surgery. Our results suggest that surgical correction of massively incarcerated hiatal hernias is well tolerated in the elderly, it relieves symptoms, and avoids potential serious complications.
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PMID:[Incarcerated giant hiatal hernia]. 812 90

Paraesophageal hiatus hernia can be a morbid and even lethal condition. Although many complications from this entity have been described, they almost always involve gastric incarceration and its related complications. Occasionally, the transverse colon or spleen may be involved in the hernia, causing additional symptoms. An unusual case of paraesophageal hiatus hernia involving incarceration of the pylorus, proximal duodenum, and pancreatic head is described. The patient's presentation, operative management, and perioperative course are discussed to emphasize the importance of early elective repair of paraesophageal hiatus hernia before the development of such occurrences.
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PMID:Acute pancreatitis secondary to incarcerated paraesophageal hernia. 817 67

Mortality rate from congenital diaphragmatic hernia (CDH) is still high despite current therapeutic advances. For some time now we have been looking for prognostic parameters which be enable us to determine, in the prenatal and postnatal period, the patients who will die from their pulmonary hypoplasia in spite of treatment and those who will survive. The authors review 94 newborns with CDH diagnosed during the first 24 hours of life. The following prognostic parameters were studied: preoperative arterial gases, position of stomach, right or left sided hernia, liver in thorax and presence of postoperative pneumothorax. All these factors were related to mortality. The arterial gases were the most sensitive factor. Eighty per cent of patients with poor gasometric prognosis died. Thoracic stomach is also a poor prognostic parameter with a 76.7% mortality rate, however we think this does not justify prenatal surgical measures. The remaining parameters were not significant with regard to mortality.
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PMID:[Prognostic factors in congenital diaphragmatic hernia. Can they modify our therapeutic approach?]. 821 3

The traditional surgical treatment of gastric volvulus involves upper abdominal laparotomy with gastric detorsion, fixation, and, when present, repair of associated diaphragmatic hernia. We describe a case of organoaxial gastric volvulus associated with a paraesophageal hernia in a poor risk patient, which was successfully treated with laparoscopic detorsion and percutaneous endoscopic gastropexy. This approach avoided the morbidity of a laparotomy and allowed the rapid recovery of gastric function.
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PMID:Laparoscopic reduction of acute gastric volvulus. 848 4

Paraesophageal hernia comprises only 2 approximately 5% of all hiatal hernias but is prone to incarceration and strangulation. For this reason they must be recognized and repaired as expeditiously as possible. The laparoscopic approach has already been successfully applied to the repair of the more common sliding hiatal hernia and it seems reasonable to propose that the paraesophageal hernia, provided it is not complicated, might also be repaired by the laparoscopic technique. We present here a case of paraesophageal hernia which has been successfully repaired by the laparoscopic approach. A 73-year-old female suffering from postprandial fullness in the retrosternal area was diagnosed preoperatively with paraesophageal hiatal hernia with gastroesophageal acid reflux and was submitted for laparoscopic repair. The procedure entailed reduction of the hernia, mobilization of the esophagogastric junction with crural repair and partial fundoplication. At the 9th-month follow-up, the patient had remained asymptomatic and follow-up studies revealed no evidence of hernia or acid reflux. As a result of this favorable experience with minimal morbidity, early hospital discharge, and effective control of symptoms without adverse sequalae, laparoscopic repair can be considered as the curative and minimal invasive method in the management of paraesophageal hernia.
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PMID:A case of paraesophageal hernia repaired by laparoscopic approach. 871 38

A patient with a large paraesophageal hernia had a Nissen fundoplication via laparoscopy. He returned a year later with the transverse colon herniated into the chest. At operation, the hernia ostium was found to be the aortic hiatus. We believe that the original ostium was missed because of the limited exposure of the video-laparoscopic technique.
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PMID:Sequential herniation of stomach, then colon through the aortic hiatus. 907 10

The paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with life-threatening mechanical problems. Elective repair is recommended at the time the condition is diagnosed, and open surgery can be accomplished with a low incidence of complications. The option of performing these repairs through a laparoscopic approach may further reduce morbidity and recovery time associated with surgical intervention. The purpose of this report was to review available options for laparoscopic repair and to present our experience with a tension-free technique for large paraesophageal hernias. Three patients with large diaphragmatic defects had laparoscopic repairs using an expanded polytetrafluorethylene (PTFE) patch secured with intracorporeal suturing techniques. One of these patients also underwent laparoscopic Toupet fundoplication in conjunction with repair of the hernia. In the other two patients, the fundus was secured to the right diaphragmatic crus to reduce the potential for recurrence and minimize postoperative reflux symptoms. All patients underwent successful repair without perioperative complications and had excellent long-term results. Laparoscopic repair of paraesophageal hernias can be accomplished by a number of different reported techniques. The use of a tension-free repair with PTFE may be particularly suitable for large diaphragmatic defects. An antireflux operation may be added selectively depending on clinical circumstances.
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PMID:Laparoscopic tension-free repair of large paraesophageal hernias. 907 17

From January 1960 to June 1995, 185 patients underwent reoperation without esophageal resection for symptoms of recurrent gastroesophageal reflux disease. There were 102 men and 83 women. Median age was 58 years (range 20 to 84 years). A single previous antireflux operation had been performed in 147 patients, two in 33, and three in 5. The median interval between the reoperation and the previous operation was 36 months (range 1 to 291 months). Indications for reoperation were symptoms in 184 patients and a large paraesophageal hernia in one patients. The surgical approach was by means of a thoracotomy in 133 patients (71.9%), laparotomy in 27 (14.6%), and a thoracoabdominal incision in 25 (13.5%). A Nissen fundoplication was performed in 107 patients (57.8%), Belsey fundoplication in 47 (25.4%), truncal vagotomy and antrectomy with Roux-en-Y reconstruction in 17 (9.2%), anatomic hernia repair in 12 (6.5%), and Hill gastropexy in 2 (1.1%). A Collis gastroplasty was added to the fundoplication in 116 patients (62.7%), and a pyloroplasty was performed in 17 (9.2%). There was one operative death (0.5%). Complications occurred in 47 patients (25.4%). Median postoperative hospitalization was 9 days (range 5 to 58 days). Follow-up was complete in 156 patients (84.3%) and ranged from 3 to 283 months (median 44 months). Improvement occurred in 137 patients (87.8%). Functional results were classified as excellent in 65 patients (41.6%), good in 29 (18.6%), fair in 43 (27.6%), and poor in 19 (12.2%). No single operative approach or procedure proved to be functionally superior. We conclude that reoperation with esophageal preservation after a failed antireflux procedure will result in significant functional benefit and can be performed with low mortality and acceptable morbidity. The type of repair should be tailored to the individual patient.
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PMID:Long-term results after reoperation for failed antireflux procedures. 908 Nov 1

Paraoesophageal hernia is a type of hiatal hernia. The clinical signs are specific, different from those of the axial hernia. The diagnosis is often delayed. Once the diagnosis is made, surgical correction is mandatory. We present a new case of a patient with chest pain episodes who proved to have an intermittently volvulating paraoesophageal hernia.
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PMID:An intermittently volvulating paraoesophageal hernia mimicking angina pectoris. A case report. 916 89


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