Attach importance to the influence of obesity on disease treatment of hernia and abdominal wall surgery / 中华消化外科杂志

With the great improvement of living and material conditions in China, obesity concomitant with hernia and abdominal wall diseases become very common. As the particularities of obesity and associated metabolic diseases, a series of pathophysiological changes caused by obesity will significantly affect the treatment of hernia and abdominal wall diseases. In the authors' opinions, accurately evaluation the severity of obesity and associated metabolic diseases and effec-tively controlling are important prerequisites for determining the timing of surgery and surgical planning. Weight loss before surgery is the basic principle of the treatment and immediate or staged individualized surgical treatment is the guarantee of the successful treatment for obesity patients with hernia and abdominal wall disease.

The lymphadenectomy around esophageal hiatus in 4K laparoscopic gastrectomy with the surgeon on left position / 中华消化外科杂志

The lymphadenectomy around esophageal hiatus during the laparoscopic gastrectomy has been a conflict issue. The 4K laparoscopic technique take the advantages in recognition of vessel, nerve, lymph node and fat tissues. Therefore, the detailed anatomy under the 4K laparoscopy can significantly reduce the volume of intraoperative blood loss, and accurately the extent of lymph node dissection. The author discusses the extent and steps for lymphadenectomy around esophageal hiatus in 4K laparoscopic gastrectomy with the surgeon on left position.

Reintervenciones por fallo de la cirugía antirreflujo / Reinterventions for Failed Antireflux Surgery

RESUMEN Introducción: En la actualidad, la fundoplicatura laparoscópica se considera el tratamiento de elección para la enfermedad por reflujo gastroesofágico con resultados excelentes en más del 90 por ciento de los pacientes. Sin embargo, a pesar de estos resultados, el 30 % de los pacientes presentan persistencia de los síntomas y del 3 por ciento al 10 por ciento requieren reintervención por fallo de la cirugía antirreflujo. Objetivo: Describir las causas del fracaso de la cirugía antirreflujo y las técnicas realizadas en la reintervención. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, de una serie de pacientes a los cuales se les realizo cirugía antirreflujo en el Centro Nacional de Cirugía de Mínimo Acceso desde enero de 1994 hasta diciembre de 2016. Las variables analizadas fueron: reintervenciones y sus causas, tratamiento quirúrgico, morbilidad y el índice de conversión. Resultados: De un total de 1 550 pacientes operados, 37 (2,3 por ciento) fueron reintervenidos. Las causas más frecuentes de reintervención fueron la recidiva de los síntomas y la presencia de disfagia. La herniación de la fundoplicatura fue el hallazgo transoperatorio más frecuente. El índice de conversión fue bajo y no hubo fallecidos en las reintervenciones. La morbilidad triplicó la del total de la serie, así como la estadía hospitalaria. Conclusiones: Las reintervenciones por fallo de la cirugía antirreflujo resultan de gran complejidad pues aumentan considerablemente la morbilidad y la estadía hospitalaria. Debe realizarse en centros que acumulen una alta experiencia en estas técnicas(AU)

ABSTRACT Introduction: Nowadays, laparoscopic fundoplication is considered the treatment of choice for gastroesophageal reflux disease, showing excellent results in more than 90 percent of patients. However, despite these results, 30 percent of patients present with persistent symptoms, while 3 percent to 10 percent require reintervention for failed antireflux surgery. Objective: To describe the causes of failed antireflux surgery and the techniques performed in the reintervention. Method: A descriptive, retrospective and longitudinal study was conducted with a series of patients who underwent antireflux surgery at the National Center for Minimally Access Surgery, from January 1994 to December 2016. The variables analyzed were reinterventions and their causes, surgical treatment, morbidity and the conversion rate. Results: From among 1550 patients operated on, 37 (2.3 percent) were reintervened. The most frequent causes of reintervention were the recurrence of symptoms and the occurrence of dysphagia. The fundoplication herniation was the most frequent transoperative finding. The conversion rate was low and there were no deaths in the reinterventions. The morbidity tripled that of the total of the series, as well as hospital stay. Conclusions: Reinterventions for failed antireflux surgery are very complex, since they increase morbidity and hospital stay considerably. It must be performed in centers that accumulate a high experience in these techniques(AU)

The upper gastrointestinal imaging performance of herniation of pure abdominal omental fat into esophageal hiatus / 实用放射学杂志

Objective To investigate the gastrointestinal imaging (GI)performance of herniation of pure abdominal omental fat (PAOF)into the esophagus hiatus(EH).Methods 7 cases of PAOF herniated into EH found by GI and MSCT were collected.The performance of GI was analyzed and compared with MSCT.Results 4 cases with large soft tissue shadow around lower segment esophagus,its density are lower,esophageal mucosa was showed coarse disorderly in the range of 2-4 cm of lower segment esophageal in the mucous membrane phase,of which 1 case with the mucosal line of esophagus at the j unction of esophagus and the superior border of the soft tissue slung up.Mild stenosis lumen of flexible wall was displayed in the filling phase,the upper bound of the lesions was often visible.3 cases with obtuse His angle,of which 1 case its change was shown with position.A more larger cystic fat density shadow was showed in MSCT right side of lower segment esophagus.3 cases were almost normal GI performance,among them 1 case of esophageal diaphragmatic ampulla lasting and a smaller cystic fat density shadow was showed in MSCT right side lower segment esophagus.The connection of the lower part of cystic fat density shadow to abdominal fat was showed all in 7 cases by MSCT MPR,and left gastric artery was shown to point to or protruded into EH by arcuate form.Conclusion A slight change of mucous membrane and lumen of lower segment esophagus which bounded above with larger and fade soft tissue density shadow and His angle obtuse variable were the special GI performance of the herniation of PAOF into EH,and the diagnose depended on MSCT.

Hernia hiatal: a propósito de un caso incidental / Hiatal hernia: about an incidental case

La Hernia Hiatal es la anormalidad que consiste en la herniación de una parte del estómago hacia la cavidad torácica a través del hiato esofágico. Se presenta en personas mayores de 50 años. Los pacientes con esta afección pueden presentar algunos síntomas relacionados con patología de esófago, pero la mayoría se diagnostica en forma incidental, como el presente caso.

Hiatal hernia is the abormality that involves the hernation of parto f the stomach into the thoracic cavity through the esophageal hiatos occurs in people older than 50 years. Patients with this condition may have some symptuns associated with esophageal pathology, bot most are diagnosed incidentally, as is the case.

Laparoscopic Therapy for Esophageal Hiatus Hernia and Reflux Esophagitis Complicated with Cholecystolithiasis:Report of 27 Cases / 中国微创外科杂志

Objective To explore the feasibility of laparoscopic surgery for esophageal hiatus hernia and reflux esophagitis complicated with cholecystolithiasis.Methods Five trocars were used for the patients to perform laparoscopic hiatal hernia repair,followed by fundoplication(Nissen fundoplication in 21 cases and Toupet fundoplication in 6),and then LC.Results The procedures were completed in all of the 27 cases.The postoperative mean esophageal pressure of the patients was significantly higher than that before the operations [(19.32?4.11) mm Hg vs(7.30?1.36) mm Hg,t=-16.407,P=0.000],while the 24-hour pH value were decreased markedly(9.20?2.15 vs 160.16?50.30,t=16.387,P=0.000).No hemorrhage,intra-abdominal infection,biliary leakage occurred in this series.The patients were followed up for 1 to 24 months(1-6 months in 7 cases,and 7-24 months in 20 cases),during which no esophageal stenosis or incisional hernia were detected.Conclusions It is feasible to perform primary laparoscopic surgery for patients suffering from esophageal hiatus hernia and reflux esophagitis complicated with simultaneous cholecystolithiasis,if no contraindications.