Diagnosis and treatment of internal hernia after laparoscopic surgery for gastric cancer / 中华消化外科杂志

With the development of laparoscopic surgery for gastric cancer, more and more surgeons use laparoscopic techniques and even totally laparoscopic techniques in gastric cancer surgery. However, technological progress brings not only smaller trauma, but also new problems and risks. Compared with traditional open surgery, the high incidence of internal hernia after laparoscopic gastric cancer surgery is an urgent problem to be solved. As the incidence of internal hernia often occurs after discharge, patients usually choose the nearest hospital for diagnosis and treatment due to the urgent course of disease. As a result, patients with internal hernia often have serious complications due to delayed treatment because of the difficulty in diagnosis. Sometimes, there are patients even death. The authors review the relevant research on postoperative internal hernia of gastric cancer in recent years and combine with practical experience to discuss the diagnosis and treatment strategy of internal hernia after laparoscopic surgery for gastric cancer, aiming to improve the clinicians′ attention to the disease and provide reference for its diagnosis and treatment.

Feasibility of endoscopic submucosal dissection for the treatment of large hiatal hernia combined with refractory gastroesophageal reflux disease (with video) / 中华消化内镜杂志

Objective:To study the safety and efficacy of hiatal hernia-endoscopic submucosal dissection (HH-ESD) for the treatment of giant hiatal hernia (>3 cm in length) complicated with refractory gastroesophageal reflux disease (GERD).Methods:Patients with giant hiatal hernia complicated with refractory GERD who voluntarily received HH-ESD at the Digestive Endoscopy Center of the Affiliated People's Hospital of Inner Mongolia Medical University from April 2018 to March 2020 were included in the clinical study. The completion of HH-ESD and the occurrence of complications were observed, and the changes of indicators before and after the treatment were observed, including gastroesophageal reflux disease-health related quality of life (GERD-HRQL) score, gastroesophageal reflux disease questionnaire (GERD-Q) score, endoscopy results, 24 h esophageal pH monitoring results, esophageal high-resolution manometry results and proton pump inhibitor (PPI) usage.Results:Data of 10 patients were collected during the study, with a medical history of 2-10 years. All patients successfully underwent HH-ESD treatment. No adverse events such as perforation and massive bleeding occurred during the operation, and the hospital stay was 6-12 days. Dysphagia occurred in 3 cases after the operation, which was relieved spontaneously within 3 or 6 months. The preoperative GERD-HRQL scores ranged from 19 to 29, which were reduced to 0-14 and 0-8 at 3 and 12 months after the operation, respectively. The preoperative GERD-Q score was 9-17, and the scores at 3 and 12 months after the operation were all 6-9, which were significantly lower than those before. Gastroscopy showed that esophagitis was improved in all patients, hernia sac was reduced, and Hill grade was reduced compared with that before. The preoperative DeMeester score was 30.3-247.1, and the postoperative 12-month score was 0.2-29.9, which was significantly lower than that before. The long diameter of hiatal hernia was 3.0-6.0 cm before the operation and 0-5.0 cm at 12 months after, which was smaller than that before. At 12 months of the follow-up, 7 patients had stopped PPI, and the remaining 3 had changed to intermittent oral PPI.Conclusion:Preliminary results show that HH-ESD is safe and effective for the treatment of giant hiatal hernia complicated with refractory GERD.

Impact of body mass index on perioperative outcomes for complex hiatus hernia by videolaparoscopy / Impacto do índice de massa corporal nos resultados perioperatórios de hérnia de hiato complexa por videolaparoscopia

ABSTRACT BACKGROUND: The influence of body mass index on perioperative complications of hiatal hernia surgery is controversial in the surgical literature. AIMS: The aim of this study was to evaluate the influence of body mass index on perioperative complications and associated risk factors for its occurrence. METHODS: Two groups were compared on the basis of body mass index: group A with body mass index <32 kg/m2 and group B with body mass index ³32 kg/m2. A multivariate analysis was carried out to identify independent predictors for complications. Complications were classified based on the Clavien-Dindo score. RESULTS: A total of 49 patients were included in this study, with 30 in group A and 19 in group B. The groups were compared based on factors, such as age, Charlson Comorbidity Index, surgical techniques used, type and location of hiatal hernia, and length of stay. Findings showed that 70% of patients had complex hiatal hernia. In addition, 14 complications also occurred: 7 pleuropulmonary and 7 requiring reoperation. From the seven reoperated, there were three recurrences, two gastrointestinal fistulas, one diaphragmatic hernia, and one incisional hernia. Complications were similar in both the groups, with type IV hiatal hernia being the only independent predictor. CONCLUSIONS: Body mass index does not affect perioperative complications in anti-reflux surgery and type IV hiatal hernia is an independent predictor of its occurrence.

RESUMO RACIONAL: O impacto do índice de massa corpórea nos resultados da cirurgia de hérnia de hiato é controverso na literatura. OBJETIVOS: avaliar o impacto do índice de massa corpórea nas complicações perioperatórias em pacientes submetidos a cirurgia de hérnia hiatal, e seus possíveis preditores. MÉTODOS: análise retrospectiva 49 pacientes submetidos a tratamento cirúrgico de hérnias hiatais complexas por videolaparoscopia, divididos em dois grupos pelo índice de massa corpórea (grupo A<32kg/m2 - 30 pacientes e grupo B ³32 kg/m2 — 19 pacientes) e comparados quanto suas características e complicações. A análise multivariada foi aplicada para avaliar as variáveis preditoras independentes de complicações. As complicações foram classificadas conforme Clavien Dindo. RESULTADOS: Os grupos foram similares conforme a idade, índice de comorbidade de Charlson, técnica operatória empregada, tipo de hérnia de hiato, área do hiato esofageano, e tempo de internação pós-operatória. Setenta por cento dos pacientes possuíam hérnias de hiato complexas (gigantes ou recidivadas). Catorze complicações foram observadas: 7 pleuro pulmonares e 7 necessitando reoperação, sendo destas 3 recidivas, 2 fístulas digestivas, 1 hérnia diafragmática e 1 hérnia incisional. As complicações foram semelhantes em ambos os grupos, e a hérnia de hiato tipo IV foi o único preditor independente. CONCLUSÕES: O índice de massa corpórea não influencia nos resultados perioperatórios e a hérnia de hiato tipo IV é o único preditor independente de complicações.

Pancreatitis aguda necrosante secundaria a hernia de hiato grado IV complicada: Presentación de un caso y revisión de la literatura / Acute necrotizing pancreatitis secondary to complicated grade IV hiatal hernia: A case report and literature review

Introducción. En las hernias paraesofágicas tipo IV se produce la herniación del estómago junto a otros órganos abdominales. La herniación del páncreas es muy infrecuente.Caso clínico. Varón de 57 años que acude por dolor torácico, disnea e intolerancia al decúbito. En la tomografía computarizada toracoabdominal se observa hernia diafragmática que contiene colon transverso, intestino delgado y páncreas, con reticulación de la grasa alrededor del mismo, compatible con pancreatitis aguda. Conclusión. La asociación de hernia hiatal con páncreas herniado y pancreatitis es extremadamente infrecuente. El diagnóstico se estableció mediante tomografía computarizada y el tratamiento fue conservador, con cirugía diferida de la hernia de hiato.

Introduction. In type IV paraesophageal hernias, the stomach is herniated along with other abdominal organs. Herniation of the pancreas is very rare. Clinical case. A 57-year-old man presented with chest pain, dyspnea, and intolerance to decubitus. The thoracoabdominal computed tomography shows a diaphragmatic hernia containing the transverse colon, small intestine and pancreas, with reticulation of fat around it, compatible with acute pancreatitis. Conclusion. The association of hiatal hernia with herniated pancreas and pancreatitis is extremely rare. The diagnosis was established by computerized tomography and the treatment was conservative, with delayed surgery for the hiatal hernia.

Migración de la malla a la unión gastroesofágica: una complicación infrecuente de la reparación de una hernia hiatal gigante / Mesh migration into the gastroesophageal junction: a rare complication of giant hiatal hernia repair

Resumen El reparo de la hernia hiatal es un tema de debate debido a las posibles complicaciones asociadas que han cambiado a través de los años. En la literatura se reportan complicaciones asociadas al procedimiento hasta en un 30 % de los casos. Las complicaciones diferentes a la recurrencia y a largo plazo son infrecuentes, reportadas en menos del 9 % de los casos. La inclusión de la malla protésica en el esófago es una rara complicación y solo se han reportado pocos casos sobre esta. Entre los factores asociados a este desenlace se encuentran descritos: el material protésico, la técnica quirúrgica y la tensión de la malla sobre el tejido intervenido; sin embargo, es difícil establecer asociaciones directas de cada factor dado que la literatura actual solo cuenta con reportes de casos. A continuación, se muestra el caso clínico de un paciente, quien, después de una reparación de hernia hiatal con malla, presenta la inclusión de material protésico en el esófago; se aborda el diagnóstico y el manejo de la misma.

Abstract Hiatal hernia repair has been a subject of debate due to the possible associated complications that have changed over the years. The literature reports up to 30% of cases with complications associated with the procedure. Complications other than recurrence and long-term complications are rare and reported in less than 9% of cases. The migration of the prosthetic mesh into the esophagus is a rare complication and only a few cases have been reported. The factors associated with this outcome include prosthetic material, surgical technique, and mesh tension on the intervened tissue. However, it is difficult to establish direct associations of each factor since the current literature has only case reports. The following is a clinical case of a patient in whom the prosthetic material migrated into the esophagus after a hiatal hernia repair with mesh. The diagnosis and treatment offered are discussed.

Cuando no todo es lo que parece_: masa extracardíaca en la aurícula izquierda: reporte de un caso en Uruguay / When not everything is what it seems_: extra-cardiac mass in the left atrium: a case report in Uruguay / Quando nem tudo é o que parece_: massa extracardíaca em átrio esquerdo: relato de um caso no Uruguai

La hernia hiatal es una entidad relativamente frecuente y puede ser un hallazgo incidental en un estudio ecocardiográfico. Describimos el caso de una paciente con diagnóstico de masa en la aurícula izquierda (AI) sin clara etiología, a quien se le realiza el diagnóstico de hernia hiatal por resonancia magnética cardíaca (RMC) y luego se demuestra mediante ecocardiografía de contraste el contenido gástrico de la masa tras la ingestión de una bebida carbonatada, lo que permite de forma rápida y sencilla aclarar el diagnóstico.

Hiatal hernia is a relatively common entity, and may be an incidental finding in an echocardiographic study. We describe the case of a patient with a diagnosis of a mass in the left atrium with no clear etiology, in whom the diagnosis of hiatal hernia is made by cardiac magnetic resonance imaging and then demonstrated by contrast echocardiography the gastric content of the mass after the ingestion of a carbonated drink, which allows quickly and easily to clarify the diagnosis.

A hérnia de hiato é uma entidade relativamente comum, e pode ser um achado incidental em um estudo ecocardiográfico. Descrevemos o caso de um paciente com diagnóstico de massa em átrio esquerdo sem etiologia definida, em que o diagnóstico de hérnia de hiato é feito por ressonância magnética cardíaca e posteriormente demonstrado por ecocardiografia contrastada com uma bebida gaseificada, permitindo esclarecer de forma rápida e fácil o diagnóstico.

Estudio comparativo de precisión diagnóstica preoperatoria y la confirmación laparoscópica de hernia hiatal / Comparative study of preoperative diagnostic precision and laparoscopic confirmation of hiatal hernia

Resumen Introducción: La hernia hiatal (HH) de tipo I por deslizamiento es el tipo más frecuente, siendo difícil de definir objetivamente, por lo que el principal foco de controversia es su diagnóstico. El objetivo del presente trabajo es reportar los resultados respecto de la precisión diagnóstica del estudio preoperatorio y confirmarlo con el diagnóstico laparoscópico de este tipo de HH. Materiales y Método: Estudio prospectivo descriptivo de serie que incluyen pacientes con síntomas típicos de enfermedad por reflujo gastroesofágico, los cuales se sometieron a estudio con esófago-gastro-duodenoscopía, estudio manométrico y radiológico de esófago, estómago y duodeno con bario. Se incluyen sólo los pacientes en los cuales la endoscopía revela la existencia de HH por deslizamiento ≪ 5 cm. Estos pacientes se sometieron a tratamiento quirúrgico confirmándose o no la existencia de HH al momento de la exploración laparoscópica. Resultados: El valor predictivo positivo y sensibilidad para manometría fue de un 51,2% y 70%, para la radiología 91,7% y 80,5% y para endoscopia 80,3% y 70,7% respectivamente. Conclusión: Para el diagnóstico confiable de HH antes del tratamiento, las tres investigaciones mencionadas deben ser obligatorias antes de la cirugía.

Introduction: Being type I hiatal hernia (HH) the most frequent, is difficult to define objectively and therefore, the main focus of controversy is the diagnosis. The aim of this paper is to report the results regarding the diagnostic accuracy of the preoperative study and to confirm it with the laparoscopic diagnosis of hiatal hernia. Materials and Method: This descriptive and prospective study includes patients with typical symptoms of gastroesophageal reflux disease who underwent esophageal-gastro-duodenoscopy, manometry and radiological study of esophagus with barium swallow. Only patients in whom endoscopy reveals the existence of HH by sliding ≪ 5 cm are included. These patients underwent surgical treatment confirming or not the existence of HH at the time of laparoscopic exploration. Results: The positive pre- dictive value and sensibility for manometry was 51.2% and 70%, for radiology 91.7% and 80.5%, and for endoscopy 85.3% and 70.7% respectively. Conclusion: For the reliable diagnosis of HH before treatment, the three mentioned investigations must be mandatory before the surgery.

Causa infrecuente de hipo crónico / Rare cause of chronic hiccups

Resumen El hipo crónico es un síntoma que puede provocar una invalidez significativa y a menudo revela una enfermedad subyacente. A continuación, se presenta el caso de un varón de 68 años que ingresó con hipo de más de 3 meses de duración que se asociaba con epigastralgia, vómitos posprandiales y pérdida ponderal. Había sido intervenido en 2 ocasiones debido a una enfermedad por reflujo gastroesofágico y hernia hiatal, una primera en la que se realizó una fundoplicatura y, posteriormente, una reintervención consistente en el cierre de los pilares diafragmáticos y re-Nissen laparoscópico. La clínica se debía a una obstrucción hiatal por acodamiento de la fundoplicatura previa y fue resuelta mediante la reposición hiatal a los parámetros anatómicos y desmontaje del Nissen previo.

Abstract Chronic hiccups is a rare symptom that can lead to significant disability and often reveals an underlying disease. The following is the case of a 68-year-old man who was admitted due to hiccups that had lasted more than 3 months associated with epigastric pain, postprandial vomiting, and weight loss. He had undergone surgery twice due to gastroesophageal reflux disease and hiatal hernia. During the first procedure, a fundoplication was performed, and then, he underwent a reoperation consisting of diaphragmatic pillars closure and laparoscopic Nissen. The symptoms were caused by a hiatal obstruction due to the kinking of the previous fundoplication and were resolved by repositioning the hiatus to anatomical parameters and dismantling the previous Nissen.

Reparación laparoscópica de hernia hiatal gigante: técnica quirúrgica y seguimiento clínico, endoscópico y radiológico / Laparoscopic repair of giant hiatal hernia: surgical technique, and clinical, endoscopic and radiological follow-up

Introducción. La reparación laparoscópica es el estándar de tratamiento en hernia hiatal gigante. Sin embargo, a pesar de su baja morbilidad, la tasa de recurrencia sigue siendo alta. Nuestro objetivo fue describir los resultados de la reparación laparoscópica de hernia hiatal gigante, independientemente de la técnica de cruroplastia empleada.Métodos. Se llevó a cabo un estudio retrospectivo de pacientes llevados a reparación laparoscópica de hernia hiatal gigante en el periodo 2009-2017. Se analizaron los datos demográficos, la técnica quirúrgica, las complicaciones y la estancia hospitalaria. Se revisaron los resultados de la endoscopia, la radiografía de vías digestivas altas y la escala de síntomas GERD-HRQOL, obtenidos luego de un año de cirugía. Resultados. Se incluyeron 44 pacientes con un tamaño promedio de la hernia de 7 cm. Se practicó cruroplastia con sutura simple en 36,4 %, sutura más refuerzo con politetrafluoroetileno (PTFE) o dacrón, en 59,1 %, y se usó malla en 4,5 %. Hubo 12 complicaciones, la estancia hospitalaria promedio fue de 3,5 días y no hubo mortalidad. Se encontró recurrencia endoscópica o radiológica en 6/20 pacientes, todas pequeñas y asintomáticas. En 23 pacientes, la escala GERD-HRQOL reportó un valor promedio de 7,7 y 78 % de satisfacción. Solo un paciente requirió cirugía de revisión. Conclusión. El método preferido de reparación laparoscópica de la hernia hiatal gigante es la cruroplastia sin malla, técnica asociada a baja morbilidad y adecuado control de los síntomas. La tasa de recurrencia es similar a la reportada en la literatura. Se requieren estudios prospectivos con seguimiento completo a largo plazo para validar estos resultados

Introduction: Laparoscopic repair is the standard treatment for giant hiatal hernia. However, despite its low morbidity, recurrence rate remains high. Our goal was to describe the results of laparoscopic repair of giant hiatal hernia, regardless of the technique used for cruroplasty.Methods: A retrospective study of patients undergoing laparoscopic repair of giant hiatal hernia was carried out from 2009 to 2017. Demographic data, surgical technique, complications, and hospital stay were analyzed. The results of endoscopy, radiography of upper digestive tract, and GERD-HRQOL symptoms scale, obtained after one year of surgery, were reviewed.Results: Forty-four patients with an average hernia size of 7 cm were included. Simple suture cruroplasty was performed in 36.4%, suture plus reinforcement with polytetrafluoroethylene (PTFE) or Dacron in 59.1%, and mesh repair in 4.5%. There were 12 complications, the average hospital stay was 3.5 days, and there was no mortality. Endoscopic or radiological recurrence was found in 6/20 patients, all small and asymptomatic. In 23 patients, the GERD-HRQOL scale reported an average value of 7.7 and 78% patient satisfaction. Only one patient required revision surgery.Conclusion: The preferred method of laparoscopic repair of giant hiatal hernia is meshless cruroplasty, a technique associated with low morbidity and adequate symptom control. The recurrence rate is similar to that reported in the literature. Prospective studies with long-term follow-up are required to validate these results

Effect of body mass index on surgical outcomes of laparoscopic surgery for esophageal hiatal hernia: A propensity score matching study / 中国胸心血管外科临床杂志

@#Objective    To explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia. Methods    We divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups. Results    There was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741). Conclusion    The operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.

Hiatal hernia repair: prevention of mesh erosion and migration into the esophagogastric junction / Correção de hérnia hiatal: prevenção de erosão e migração de tela na junção esofagogástrica

ABSTRACT Background: Erosion and migration into the esophagogastric lumen after laparoscopic hiatal hernia repair with mesh placement has been published. Aim: To present surgical maneuvers that seek to diminish the risk of this complication. Method: We suggest mobilizing the hernia sac from the mediastinum and taking it down to the abdominal position with its blood supply intact in order to rotate it behind and around the abdominal esophagus. The purpose is to cover the on-lay mesh placed in "U" fashion to reinforce the crus suture. Results: We have performed laparoscopic hiatal hernia repair in 173 patients (total group). Early postoperative complications were observed in 35 patients (27.1%) and one patient died (0.7%) due to a massive lung thromboembolism. One hundred twenty-nine patients were followed-up for a mean of 41+28months. Mesh placement was performed in 79 of these patients. The remnant sac was rotated behind the esophagus in order to cover the mesh surface. In this group, late complications were observed in five patients (2.9%). We have not observed mesh erosion or migration to the esophagogastric lumen. Conclusion: The proposed technique should be useful for preventing erosion and migration into the esophagus.

RESUMO Racional: Com a colocação de tela foi têm sido publicadas erosões e migrações para o lúmen esofagogástrico após correção de hérnia hiatal laparoscópica. Objetivo: Apresentar manobras cirúrgicas que buscam diminuir o risco dessa complicação. Método: Sugerimos mobilizar o saco de hérnia do mediastino e levá-lo à posição abdominal com o suprimento sanguíneo intacto, a fim de girá-lo para trás e ao redor do esôfago abdominal. O objetivo é cobrir a malha colocada sobre a forma "U" para reforçar a sutura da crura haital. Resultados: Realizamos reparo laparoscópico de hérnia hiatal em 173 pacientes (grupo total). Complicações pós-operatórias precoces foram observadas em 35 pacientes (27,1%) e um morreu (0,7%) devido a tromboembolismo pulmonar maciço. Cento e vinte e nove pacientes foram acompanhados por média de 41+28 meses. A colocação da tela foi realizada em 79 desses pacientes. O saco remanescente foi girado atrás do esôfago para cobrir a superfície da tela. Nesse grupo, complicações tardias foram observadas em cinco pacientes (2,9%). Não observamos erosão da tela ou migração dela para o lúmen esofagogástrico. Conclusão: A técnica proposta pode ser útil para prevenir a erosão e a migração para o esôfago de telas na correção de hérnias hiatais.

Atrial Fibrillation and Anemia Associated Hiatal Hernia

Atrial fibrillation (AF) is the most common cardiac arrhythmia.It is an irregular and often rapid heart rate that can increaseyour risk of strokes, heart failure and other heart-relatedcomplications. There are many reasons in the etiology of AF.Hiatal hernia (HH) is rare but one of them.Case report: In this case, we present a case of AF associatedwith HH. HH causes protrusion of the abdominal contents intothe chest cavity, and can directly impinge on the left atrium.Conclusion: The anatomical proximity of the left atrium toherniated gastric contents raises the possibility of mechanicalirritation of the atria, autonomic neural connections orinflammation that may increase the risk for AF.

Avaliação clínica e endoscópica em pacientes com sintomas gastroesofágicos / Clinical and endoscopic evaluation in patients with gastroesophageal symptoms

ABSTRACT BACKGROUND: The gastroesophageal reflux disease (GERD) is the most common esophageal disease in medical practice, and it is suspected according to patients' symptoms. GERD can be classified in erosive esophagitis (EE) according to the presence of upper gastrointestinal endoscopy findings. OBJECTIVE: To evaluate endoscopic findings in patients with symptoms suggestive of GERD comparing epicemiological and risk factors. METHODS: Upper endoscopy reports were examined retrospectively from patients with symptoms of GERD such as heartburn, regurgitation, cough, throat clearing, globus and chest pain. EE was determined based on Los Angeles classification. Comparisons between risk factors in EE and non-EE groups were done with statistical analysis. RESULTS: A total of 984 endoscopic reports were examined and 676 selected for analysis (281 with EE and 395 with non-EE form). Most were female 381 (56.36%) with a mean age of 44.01±15.40 years. Hiatal hernia was present in 47(6.96%) and smoking in 41(6.07%). Univariate logistic regression showed that male (OR=2.24, CI 95%, 1.63-3.06) and hiatal hernia (OR=4.52, CI 95%, 2.30-8.89) were independent predictors of erosions in the EE group. The presence of hiatal hernia (OR=12.04, CI 95%, 3.57-40.62), smoking (OR=8.46, CI 95%, 3.28-31.32) and aged patients (OR=8.01, CI 95%, 2.42-26.49) were also indicated as a risk factor for severe EE (grades C and D of Los Angeles). CONCLUSION Male gender and hiatal hernia were associated with EE. Aged patients, smoking and hiatal hernia were related to severe EE. It is suggested that the risk factors for EE and non-EE types are different. Cohort studies are necessary to identify the exact mechanisms involved in each disease form.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma das doenças digestivas mais comuns na prática médica e deve ser suspeitada de acordo com os seus sintomas clínicos, podendo ser classificada em esofagite erosiva (EE) de acordo com os achados de endoscopia. OBJETIVO: Avaliar os achados endoscópicos em pacientes com sintomas sugestivos de DGRE comparando fatores de risco e epidemiológicos. MÉTODOS: Resultados de endoscopias digestiva foram examinados retrospectivamente de pacientes com sintomas relacionados com DRGE como pirose, regurgitação, tosse, pigarro, globus e dor torácica. EE foi determinada de acordo com a classificação de Los Angeles. Comparação de fatores de risco entre os grupos EE e não-EE foram feitos com análise estatística. RESULTADOS: Um total de 984 endoscopias foram examinadas e 676 endoscopias selecionadas para análise (281 com EE e 395 sem EE). A maioria dos pacientes era do sexo feminino 381 (56,36%) com uma idade média de 44,01±15,40 anos. Hérnia hiatal esteve presente em 47 (6,96%) e tabagismo em 41 (6,07%). Regressão logística uni variada mostrou que sexo masculino (OR=2,24 - IC 95%: 1,63-3,06) e hérnia hiatal (OR=4,52 - CI 95%: 2,30-8,89) foram fatores de risco independentes de EE. A presença de hérnia hiatal (OR=12,04 - CI 95%: 3,57-40,62), tabagismo (OR=8,46 - CI 95%: 3,28-31,32) e pacientes idosos (OR=8,01 - CI 95%, 2,42-26,49) foram fatores de risco no grupo de EE grave (classes C e D de Los Angeles). CONCLUSÃO: Sexo masculino e hérnia hiatal foram associados com EE. Idade avançada, tabagismo e hérnia hiatal foram relacionados à forma grave de EE. É sugerido que os fatores de risco de pacientes com e sem EE sejam diferentes. Estudos de coorte são necessários para identificar os mecanismos exatos envolvidos em cada forma da doença.

Herniorrafia hiatal y fundoplicatura laparoscópica de Toupet en un paciente con esófago corto / Hiatal herniorrhaphy and Toupet laparoscopic fundoplication in a patient with short esophagus

El esófago corto es una complicación infrecuente del reflujo gastroesofágico, polémico para algunos autores. Su diagnóstico se hace de manera intraoperatoria, ante la imposibilidad de conservar un esófago intrabdominal mayor a tres centímetros desde el hiato diafragmático. Algunos expertos niegan la existencia de esta entidad, argumentando que se debe a una mala disección del esófago. En este artículo, se presenta el caso de un paciente sometido a herniorrafia hiatal con colocación de malla, con gran dificultad para conservar una adecuada longitud del esófago abdominal, y que no requirió gastroplastia (AU)

Short esophagus is an uncommon complication of gastroesophageal reflux, controversial for some authors. The diagnosis is made intraoperatively when , the impossibility of leaving an intra-abdominal esophagus longer than 3 cm becomes patent. Some experts, however, doubt about the existence of this entity, arguing that it is due to a bad dissection of the esophagus. In this article, we present the case of a patient where a hiatal herniorraphy was performed with great difficulty to conserve an adequate length of the abdominal esophagus, without requiring gastroplasty (AU)

Surgical treatment of obesity comorbid with hiatal hernia / 中华消化外科杂志

Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus. Morbidly obese patients usually have metabolic syndromes, as such, surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity. Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux, which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons. It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications.

Surgical treatment of obesity comorbid with hiatal hernia / 中华消化外科杂志

Bariatric surgery is an effective method for the treatment of obesity and type 2 diabetes mellitus.Morbidly obese patients usually have metabolic syndromes,as such,surgeons need to choose the reasonable surgical methods for patients according to their individuality and particularity.Hiatal hernia is a very common disease prevalent in obese patients and could induce gastroesophageal reflux,which increases the difficulty of bariatric surgery and proposes higher demands on choice of surgical methods to surgeons.It is important to recognize the presence of the hiatal hernia preoperatively and choose a more effective procedure of bariatric surgery to decrease the incidence of postoperative complications.

Plummer-vinson syndrome associated with lower esophageal ring (Schatzki's Ring)

We report a case of Plummer-Vinson syndrome (PVS) and lower esophageal ring with a small sliding hiatal hernia. PVS is a rare entity formed by the combination of dysphagia, cervical esophageal web and iron deficiency anemia. It occurs mainly in middle-aged women1,2,3. A lower esophageal ring and a small sliding hiatal hernia were also observed in this case. We documented clinical manifestations of iron deficiency anemia through images and esophageal abnormalities through barium esophagogram. (AU)

Hernia paraesofágica: un reto diagnóstico / Paraesophageal hernia: a diagnostic challenge

Resumen Se presenta un caso de hernia paraesofágica en una mujer con diagnóstico inicial de enfermedad ácidopéptica. El diagnóstico preciso requirió radiografía de tórax, radiografía de vías digestivas altas y tomografia axial computarizada. Fue tratada mediante abordaje por videolaparascopía; seis meses después estaba asintomática y sin complicaciones. El médico general debe considerar la probabilidad de hernia paraesofágica en pacientes añosos con síntomas del tracto digestivo superior inexplicados, especialmente cuando los síntomas son crónicos y sin respuesta adecuada al tratamiento con inhibidores de la bomba de protones.

Abstract A case of paraesophageal hernia in a woman with an initial diagnosis of peptic acid disorders. Precise diagnosis required chest radiography, upper gastrointestinal tract x-ray and computed tomography. She was treated by videolaparoscopic approach; six months later she was asymptomatic and suffered no complications. The General Practitioner should consider the likelihood of paraesophageal hernia in elderly patients with unexplained upper digestive tract symptoms, especially when the symptoms are chronic and unresponsive to treatment with proton pump inhibitors.

Reparación laparoscópica de hernia hiatal paraesofágica con material protésico / Laparoscopic repair of paraesophageal hiatal hernia with prosthetic material

El manejo quirúrgico de las Hernias Hiatales Paraesofágicas puede ser realizado por toracotomía izquierda o por laparoscopía. Ambos abordajes son aceptables, pero actualmente se ha incrementado mucho el abordaje laparoscópico por las características de mínima invasividad, pero con la utilización de material protésico como forma de refuerzo, cuando el hiato esofágico es superior a 5 cm. Los objetivos del abordaje laparoscópico son la reducción anatómica completa y la competencia del esfínter esofágico inferior. Estos objetivos se consiguen con el cierre de la crura diafragmática y la funduplicatura laparoscópica. Se presentan dos casos clínicos donde se ha utilizado malla de Poliester fijada con tackers colocada en forma de C con la apertura hacia la cara anterior y el solapamiento por delante del esófago. CONCLUSIÓN: El uso de material protésico en la reparación del defecto de las Hernias Hiatales Gigantes es una alternativa razonable.

The surgical management of Paraesophageal Hiatal Hernia can be performed by left thoracotomy or by laparoscopy. Both approaches are acceptable, but currently the laparoscopic approach has increased greatly due to the characteristics of minimal invasiveness, but with the use of prosthetic material as a form of reinforcement, when the esophageal hiatus is greater than 5 cm. The objectives of the laparoscopic approach are a complete anatomic reduction and lower esophageal sphincter competition. These objectives are achieved with the closure of the diaphragmatic crural and laparoscopic fundoplication. Two clinical cases were presented where Polyester mesh, fixed with tackers, was placed in a C shaped disposition with the opening facing the anterior and the overlap in front of the esophagus. CONCLUSION: The use of prosthetic material in the repair of the defect of Giant Hiatal Hernia is a reasonable alternative.