Significant Reflux Disease Research Articles

565. LAPAROSCOPIC TREATMENT OF HIATAL HERNIAS COMBINED WITH MODIFIED TOUPET FUNDOPLICATION. SURGICAL TECHNIQUE

Abstract Introduction Hiatal hernias are a common finding on radiographic or endoscopic studies. Hiatal hernias may become symptomatic or, less frequently, can incarcerate or become a volvulus leading to organ ischemia. This review examines latest evidence on the diagnostic workup and management of hiatal hernias. Aim This study aims to describe our surgical technique of laparoscopic repair in hiatal hernias, including sliding, paraesophageal and mixed types. Material and Methods A total of 65 consecutive patients underwent laparoscopic hiatal hernia repair by the same surgical team within 4 years. Results Asymptomatic hiatal and paraesophageal hernias become symptomatic and necessitate repair at a rate of 1% per year. Watchful waiting is appropriate for asymptomatic hernias. Symptomatic hiatal hernias and those with confirmed reflux disease require operative repair with an anti-reflux procedure. Key operative steps include the following: reduction and excision of hernia sac en bloc, 3 cm of intra-abdominal esophageal length, crural closure and an effective anti-reflux procedure as our modified Toupet fundoplication. Conclusions Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have significant reflux disease, an operative repair is required. A minimally invasive approach is safe and can provide excellent outcomes in the hand of experts. https://we.tl/t-KgcOuSyEMt

Roux-en- Y Diversion for Intractable Reflux After Esophagectomy

Reflux esophagitis is a significant problem after esophagectomy and gastric reconstruction. When mixed reflux damages the esophageal remnant or results in aspiration problems, appropriate medical management is in order. If medical management fails, a surgical option is available. This study reports results of a Roux-en-Y diversion in postesophagectomy patients affected by debilitating reflux complications. Between 1990 and 2006, 4 of 223 esophagectomy patients required surgical correction for mucosal damage to their esophageal remnant or repeat aspirations. Patient, clinical, operative, histopathologic, and postoperative data were collected. Two of 3 patients with a substernal reconstruction underwent antrectomy with a 60-cm Roux-en-Y diversion. One patient with significant reflux disease and aspiration episodes also had a gastrobronchial fistula. The gastric interposition was defunctionalized, and a staged reconstruction with antrectomy and a Roux-en-Y diversion was completed. One patient with a prevertebral reconstruction had a Roux-en-Y diversion without antrectomy. There was no mortality and minimal morbidity. Two patients are asymptomatic and 2 are improved. Endoscopic assessment documented normal mucosa in the esophageal remnant for 2 of the 4 patients postoperatively; in 2 others, metaplastic columnar mucosa persisted. Active inflammation regressed in all 4 patients. Complete duodenal diversion with a 60-cm Roux-en-Y gastrojejunostomy is an effective operation to correct debilitating reflux complications after esophagectomy. Reflux symptoms are corrected and the mucosa is allowed to heal. The surgical approach is influenced by the position of the gastric transplant. Protection of the vascular supply to the gastric tube is the challenge of the operation.

Esophageal Myotomy and Gastroesophageal Reflux

Esophageal myotomy for motor disorders may result in significant reflux disease. The precise role of the various factors in the development of reflux and the prevention of reflux is reviewed.