Biological Mesh Repair of Paraesophageal Hernia: An Analysis of Our Outcomes.

Introduction: Symptomatic paraesophageal hernia (PEH) is an indication for surgical repair. Laparoscopic suture repair has high recurrence rates. Many surgeons prefer mesh repair to reduce PEH recurrence. Several types of mesh, synthetic and biological, are in use. Synthetic mesh has a risk of erosion and stricture, hence we preferred biological mesh repair. Our aim in this study is to assess medium-term outcomes of PEH repair with the use of biological mesh reinforcement over the cruroplasty. We also aimed to correlate clinical recurrences with radiological recurrences. Materials and Methods: This is a retrospective study of 154 consecutive patients from a single centre who underwent a standardized laparoscopic suture repair of the hiatus reinforced with an on-lay patch of Surgisis (porcine small intestine submucosa) and fundoplication. The mean age of the patients was 65 years. All patients were called for regular clinical follow-up and a barium study. Modified GERD-HRQL symptom severity instrument was used to assess postoperative symptoms and satisfaction. Results: The mean follow-up for barium swallow and clinical assessment were 28.42 ± 21.2 and 33.69 ± 23.46 months. The mean patient satisfaction score after surgery was 4.43 ± 1.09 (0-5). Follow-up barium swallow was performed in 122 (79.22%), 87 (56.49%) patients completed clinical follow-up questionnaire, and 77 (50%) had both. Symptomatic recurrence was noted in 25 (28.73%), recurrence on barium swallow 25(20.4%), and 10 (12.98%) had both. The reoperation rate was 3.25%. Mann-Whitney U test showed no statistical significance in reflux-related score between radiological recurrence group compared with no radiological recurrence (P = .06). Conclusions: Biological mesh repair of PEH is safe and well accepted by patients. There is significantly high PEH recurrence rate in long-term follow-up, even with mesh repair. Majority of these recurrences are small, asymptomatic, and the reoperation rate is very low.

Poor awareness of symptoms of oesophageal cancer.

Oesophageal cancer presents as advanced disease; in the majority of patients the symptoms are present for many months prior to diagnosis. Dysphagia has been described as the key to an early diagnosis of oesophageal cancer. This study aims to assess the public perception of the importance of this symptom. Ninety-six patients completed a questionnaire. This evaluated patient understanding of symptoms of dysphagia compared to the finding of a breast lump, haemoptysis, chest pain and loss of weight concerning urgency, probable cause of symptoms and treatment required. Sixty-five patients (71%) would visit their GP within 24 h of finding a breast lump or suffering from haemoptysis (82%) or having chest pain (82%). Forty-seven patients (51%) who experienced dysphagia would seek medical advice after one week and further 18 (19%) after one month (P<0.0001). Only eight patients (10%) associated dysphagia with cancer compared to 53 patients (57%) with the finding of a breast lump (P<0.031). This study concludes that there is poor understanding of the main symptoms of oesophageal cancer. New health campaigns are needed if the cancer is to be detected at an earlier and potentially curable stage.

Laparoscopic hiatus hernia repair and simultaneous sleeve gastrectomy: a novel approach in the treatment of gastroesophageal reflux disease associated with morbid obesity.

Abstract Obesity is associated with significantly increased risk of gastroesophageal reflux disease and recurrence of reflux symptoms following surgical intervention, compared to individuals with normal body-mass index (BMI). The severity of reflux symptoms and obesity is associated with a decreased quality of life. In this article, we report a novel approach to the treatment of morbid obesity and hiatus hernia in a 36-year-old female with a BMI of 40 kg/m(2) who failed the conservative treatment. A laparoscopic hiatal repair, using a commercially available on lay reinforcement biologic mesh and a sleeve gastrectomy performed at the same time was successful in controlling the reflux symptoms and reducing her body weight.

Laparoscopic pyloromyotomy is both safe and effective in a district hospital.

INTRODUCTION: Functional operations of the gastrointestinal tract are ideal indications for minimal-access surgery. The aim of this paper was to assess the safety and potential benefits of the laparoscopic Ramstedt pyloromyotomy using the experience of a single surgeon in a district general hospital. METHODS: 90 consecutive infants underwent pyloromyotomy: 35 open procedures and 55 laparoscopic procedures. This is a retrospective study but the operative data of the laparoscopic group were collected prospectively. RESULTS: There were no differences in demographic data between the groups. The open group had a shorter mean operating time, 22.14 min, than the laparoscopic group, 26.04 min (p = 0.022). There was no significant difference in the time to full feed between the two groups (p = 0.076). 62.9% of the infants in the open group vomited compared with only 43.4% in the laparoscopic group (p = 0.058). The laparoscopic group had shorter postoperative stay, 62.33 hours, compared to 91.89 hours (p = 0.001). There was one reoperation in each group: for complete wound dehiscence in the open group and for incomplete myotomy in the laparoscopic group. CONCLUSIONS: Laparoscopic pyloromyotomy (LPM) is as safe as the open procedure and has the potential benefits of shorter hospital stay and improved cosmesis.

Gastroduodenal intussusception due to gastrointestinal stromal tumor (GIST) treated by laparoscopic billroth II distal gastrectomy.

Gastrointestinal stromal tumors are rare tumors of the gastrointestinal tract. They, however, occur most commonly in the stomach where they present with abdominal pain, bleeding, and obstruction. Many are asymptomatic and are discovered incidentally or at postmortem. We present a case-report of a rare complication of gastrointestinal stromal tumors of the stomach causing gastroduodenal intussusception and how patient was successfully managed by laparoscopic Billroth II distal gastrectomy.