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

An important limitation of antireflux surgery is a 5%-10% failure rate. We investigated the correlation between various diaphragm stressors and failure of antireflux surgery. Forty-one study cases who underwent a reoperative antireflux operation from 1997 to 2001 and 50 control patients who had undergone a successful laparoscopic Nissen fundoplication during the same period without clinical or symptomatic evidence of failure were randomly selected for comparison. A retrospective analysis was conducted utilizing a standardized diaphragm stressor questionnaire, addressing the period between the primary and secondary operation. Stressors considered in the study included height, body mass index (BMI), postoperative gagging, vomiting, weight lifting (greater than 100 pounds), coughing, hiccuping, motion sickness, retching, belching, antidepressant use, smoking, preoperative grade of esophagitis, size of hiatal hernia, lower esophageal sphincter pressure, esophageal body pressures, and preoperative response to proton pump inhibitors. Of the potential stressors investigated, the following were significantly associated with surgical failure after adjusting for other variables through multivariate analysis: gagging (P = 0.005), belching (P = 0.02), and hernia size greater than 3 cm (P = 0.04; Table 1). Other potential risk factors show trends as obvious in Fig. 2. Vomiting was significant (P = 0.01) in the earlier models but lost significance when logistic regression was applied. Patients with postoperative gagging and an intraoperative hiatal hernia (greater than 3 cm) have a poorer outcome, whereas patients with postoperative belching have a better long-term outcome.
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PMID:Assessment of diaphragmatic stressors as risk factors for symptomatic failure of laparoscopic nissen fundoplication. 1636 86

Morgagni's hernia is result of penetration of the abdominal contents into the chest through an anterior retrocostoxiphoid defect in the anterior midline of the diaphragm. It can be manifested with symptoms since birth as a bloated feeling, nausea and belching after meals. We present a patient with symptomatic herniation of the torqued antral part of stomach and loops of the transverse colon. In our case, chest and abdominal radiography after oral intake of contrast are used to diagnose this condition. Herniation was reduced surgically by a transabdominal approach. At the control examination one year after surgery in our patient all symptoms have disappeared, and was given 15 kg of body weight.
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PMID:Hernia of Morgagni--case report. 2339 Aug 52