Treatment Of Diaphragmatic Hernia Research Articles

Hiatal Hernia with Acute Obstructive Symptoms After Minimally Invasive Oesophagectomy

BackgroundTo evaluate the incidence, treatment and postoperative outcomes of an acute hiatal hernia (HH) after totally minimally invasive esophagectomy (tMIE) for oesophageal cancer. MethodsThe incidence and treatment of acute HH were analysed from our prospective database including all patients that were surgically treated for oesophageal cancer in the period between January 2011 and December 2018. ResultsWithin the study period, the database contained 307 patients that underwent minimally invasive oesophagectomy. Patients’ characteristics were in line with the literature of Western data. The incidence of acute HH was 2.6% (N = 8). All patients presented with gastro-intestinal obstruction symptoms, that required acute operation, repositioning of the intrathoracic organs in combination with a crural repair. Mesh reinforcement was used in 38% (N = 3). In two patients, the intestines were partially resected due to ischemia. Postoperative complications, as atrial fibrillation, respiratory failure and anastomotic leakage, were seen in 63% (N = 5). Recurrence-rate was 38% (N = 3). ConclusionsThis present study demonstrates that an acute HH after tMIE is a serious complication with an incidence of 2.6%. When symptomatic and acute, HH requires surgical intervention and has high postoperative morbidity and recurrence-rate. Therefore, this requires treatment in a centre specialised in oesophageal surgery.

THE EFFECTIVENESS OF MESH REINFORCEMENT DURING LAPAROSCOPIC HIATAL HERNIA REPAIR

Purpose . To analyze short-term and long-term results of surgical treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease. Materials and methods . A retrospective analysis of short-term and long-term results of treatment of 98 patients for the period 2009–2016, who underwented surgical treatment of hiatal hernia with a hernia defect size 5 or more cm was performed. The first group included 69 patients underwent suture repair of hernia defect. The second group underwent mesh repair - 29 patients. Results . Intraoperative complications - 7 (10.1%) versus 2 (6.9%), postoperative complications - 6 (8.7%) versus 3 (10.4%), the duration of surgery - 141 ± 21.1 min versus 179 ± 28.4, duration of hospital stay - 6.7 ± 1.6 days versus 6.9 ± 1.8, postoperative dysphagia - 11 (15.9%) versus 6 (20.7%) were not noted. In 5 years after surgery, reccurence in the suture group were noted in 14 (20.3%) patients, in the mesh group - in 4 (13.8%) patients. The total GERD–HRQL questionnaire score was 6.4 ± 1.8 points in the suture repair group and 5.9 ± 2.1 points in the mesh group. 9 (13%) patients in the suture repair group and 5 (17.2%) in the mesh group evaluated their condition as unsatisfactorily. Conclusion . The analysis of long-term results in 5 years after the surgery showed the absence of benefit after using mesh reinforcement during laparoscopic repair of large hiatal hernias compared to usual suture cruroraphy both in recurrence rate and in assessing the quality of life.

Causes of unsuccessful surgical treatment of hiatal hernia

Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years in 60%. Four types of hiatal hernias (IIV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 1015 4060%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

Poor results of surgical treatment of hiatal hernias. Is there a solution to the problem?

Hiatal hernias are the most common violation of visceral anatomy. Indications for surgical treatment of this pathology include refractory gastroesophageal reflux or anatomical changes, which carry a risk of developing life-threatening conditions. An unresolved problem in this area of surgery is the high recurrence rate of the disease, reaching 1040%. Subjective causes of unsatisfactory results are technical errors in performing interventions and violations of perioperative management. Compliance with the methodology of operations and the rules of patient management can minimize this group of factors. Large size of the hiatal opening, mechanical weakness of diaphragm crura and shortening of the esophagus are considered to be objective causes for the recurrent disease. An effective way to increase the reliability of the plastic esophageal opening of the diaphragm is the use of prosthetic materials. When the esophagus is shortened, it is possible to increase its length with the stomach (gastroplasty) or with the formation of a fundoplication wrap in the chest. Another option to increase the reliability of the operation may be fixing the stomach to the anterior abdominal wall (gastropexia) to prevent its redeployment to the chest. The use of this arsenal of techniques allows to reduce the frequency of unsatisfactory results after surgical treatment of hiatal hernias by up to 510%.

Role of Laparoscopy in Treatment of Diaphragmatic Hernia in Adult

Abstract Background congenital diaphragmatic hernia in adult is a rare condition, most of cases are asymptomatic and discovered accidental. We reported 10 cases of diaphragmatic hernia repaired successfully via the laparoscopic approach. Objectives to describe the role of laparoscopy in treatment of congenital and traumatic diaphragmatic hernia in adult. Methods prospective study was conducted on 10 adult patients suffering from diaphragmatic hernia to evaluate the role of laparoscopy in treatment of diaphragmatic hernia in adult. The study was conducted at general surgery department of Ain shams university hospitals and Kafr ash Shaykh general hospital including all symptomatic types of diaphragmatic hernia on both adult male and female patients with age more than 18 years. Results We achieved satisfactory intracorporeal repair of these diaphragmatic defects. The patients had excellent recovery and started on oral diet one to two days postoperative except one patient (10%) started on the 5th day due to resection anastomoses, and then were discharged with symptomatic relieve after surgery. Conclusion The minimally invasive advantage of laparoscopic approach offers a secure, reliable and satisfactory way to confirm the diagnosis and achieve the repair of diaphragmatic hernia.

Thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm

Objective To explore the initial experience of thoracoscopic repair with simplified mattress sutures in the treatment of diaphragmatic hernia in neonates without posterolateral rim of diaphragm. Methods A retrospective review of the new simplified technique in 10 cases from March 2015 to October 2017 was performed.Of the patients, 6 cases were male, 4 cases were female.The age was 10min-1d, 7 cases were term newborns, and 3 cases were premature.The mean weight was 2.88 kg(ranged 2.3-3.5kg). All the 4 cases were left-sided.Two to three primary suture sites were taken from the relative intercostal region of the body surface projection of the defect.A snip incision about 1 mm of the skin was done.Two 2-0 non-absorbable sutures round the rib were inserted between the front edged of the defect and the diaphragm muscle through a syringe needle.The first thread was brought out of the body by the ring of the second thread and knot tying was made extracorporally.The posterolateral defect was closed; the knot was under the skin of intercostals space. Results Ten neonates with CDH were repaired successfully using this new simplified technique.The mean operative time was 37.5min(ranged 25-60min) for each CDH repair.No cases required conversion to open surgery, blood loss was minimal.The 10 cases were followed up for 16.5 months(ranged 5-24 months), with no death and no recurrence.One neonate complicated with subcutaneous emphysema postoperatively and healed in one week. Conclusion The new technique of thoracoscopic repairing with simplified mattress sutures when no posterolateral rim of diaphragm exists has all the advantages of thoracoscopy in neonates combined with the advantages of reduced operative time, simplicity, feasibility and definite curative effect and has the value of clinical popularization. Key words: Hernia, diaphragmatic; Thoracoscopy; Reconstructive surgical procedures; Infant, newborn

Laparoscopic treatment of Morgagni hernia

We report a case of diaphragmatic hernia of Morgagni with a unique clinical presentation. It is important to know all the possible complications and acute presentations of Morgagni hernia. Before the innovation of laparoscopy in the treatment of diaphragmatic hernia, it is used to be treated either through abdominal approach or, in most cases, thoracic approach.

P54 INCIDENCE AND OUTCOME OF HIATAL HERNIA AFTER OESOPHAGECTOMY: COMPARISON OF TRADITIONAL OPEN AND MINIMALLY INVASIVE APPROACH

Abstract Aim The primary aim of this retrospective study is to evaluate the incidence of symptomatic and asymptomatic hiatal hernia (HH) in patients who have undergone intended curative open or minimally invasive oesophagectomy (MIO) for cancer of the oesophagus in a high-volume surgical centre. The secondary aim is to describe the treatment and outcome after HH treatment. Background & Methods MIO for the treatment of oesophageal cancer has emerged as an alternative to traditional open oesophagectomy without compromising disease free or overall survival1. HH of abdominal viscera other than the gastric conduit is an infrequent but potentially life-threatening complication following oesophagectomy. HH may present with grievous complications, such as severe respiratory failure, intestinal ischemia with perforation, bowel obstruction, and strangulation leading to emergency surgery2,3. Surgical repair of these HHs is associated with a high morbidity rate and in the emergent setting even a high mortality4. In meta-analysis, the pooled incidence of symptomatic HH after MIO was 4.5 %, compared to a pooled incidence of 1.0 % after open oesophagectomy5. However, studies on the subject, often do not describe whether patients are asymptomatic or simply have not been examined for the existence of HH. The actual HH incidence may therefore be underestimated and may be more sufficiently reported when including patient material with comprehensive follow-up. This retrospective cohort study includes all patients (n≈455) who have undergone curative intended resection for malignant disease in the oesophagus at The Department of Surgery, Odense University Hospital, from 1th January 2012 – 31th December 2018. Patient demography, perioperative data including surgical approach and follow-up, including occurrence and treatment of hiatal hernia, mortality and recurrence of malignant disease will be extracted from complete electronic patient records. Follow-up ranges from 6-84 months. Primary outcome is occurrence of hiatal hernia after oesophagectomy determined by CT-scan or during surgery. Results As of abstract deadline for ESDE 2019, we have only just received permission for the study from The Danish Patient Safety Authority and can unfortunately not present our results yet. However, we expect that results are ready for presentation at ESDE 2019 and hope for your understanding.

A535 Hiatal Hernia Repair and Conversion to Omega Loop Bypass after Sleeve Gastrectomy

Sleeve Gastrectomy alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although many patients remain asymptomatic, many complain of severe reflux symptoms not responsive to medical management. To describe the diagnosis and treatment of hiatus hernia after sleeve gastrectomy with conversion to Omega Loop Bypass and using fixation suture technique.

Acute hiatal hernias

In surgical practice, hiatal hernias are often related to gastro esophageal reflux disease treatment in which continuous proton pump inhibitor administration is very successful. In large hiatal hernias, life threatening complications may occur. However, planned surgical repair of hiatal hernias is associated with very good functional outcomes with alow risk of postoperative complications. The incidence of large hiatal hernias grows with increasing age of the patient. In geriatric patients, internal comorbidities are also more frequent, including serious conditions. In these patients, one may hesitate whether to perform surgery with regard to the possible risk of postoperative complications. Conservative treatment of hiatal hernias is associated with ahigher risk of stomach volvulus or severe bleeding as the most frequent complications. We performed aretrospective study of patients operated on for alarge hiatal hernia at the Department of Surgery, University Hospital Brno, between 2010 and 2016 (86 months). The patients were divided into 2 groups depending on the type of operation: acute (A) and elective (B). We evaluated demographic data, the nature of preoperative symptoms, type of surgery and postoperative complications. 120 patients were operated on for large hiatal hernia in this period of time. Group Ainvolved 22 operated patients, group B 98 patients. There was asignificantly higher number of laparotomies in the acute patient group compared to the elective group B (72.7% vs. 23.5%, p.

Late presentation of diaphragmatic hernia as small bowel obstruction in pregnancy

Spontaneous diaphragmatic hernia without any apparent history of trauma is a rare entity and is very difficult to diagnose. Only a few cases of rupture of diaphragm without any history of trauma have been recorded in the literature. Diaphragmatic hernias complicating pregnancy are not a common problem but they can have catastrophic consequences. They can present to the surgeon as a life‐threatening emergency or pose a management dilemma when detected incidentally. Complications include volvulus, incarceration, strangulation, haemorrhage and perforation of a hollow viscus. CT scan is the best imaging modality to diagnose diaphragmatic hernias. Surgery is the only treatment of diaphragmatic hernia in complicate cases irrespective of the status of pregnancy. The majority of these defects can be repaired safely with nonabsorbable sutures without the need for a prosthetic mesh as one in this case.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЛАПАРОСКОПИЧЕСКОЙ И РОБОТ-АССИСТИРОВАННОЙ ФУНДОПЛИКАЦИИ ПРИ ГРЫЖАХ ПИЩЕВОДНОГО ОТВЕРСТИЯ ДИАФРАГМЫ

Elaparoscopic fundoplication has gained rapid surgery and is the gold standard in the treatment of hiatal hernia and gastroesophageal reflux disease. However, with the invention of robot-assisted laparoscopic technologies, disputes over this or that minimally invasive technology have not subsided. Methods. A group of authors from 2015 to 2019 y.e. 363 surgical treatments was performed for the treatment of hiatal hernia and gastroesophageal reflux disease. Patients were stratified on laparoscopic fundoplication or robot-assisted laparoscopic fundoplication. Intraoperative and postoperative results were evaluated. Results. All 363 patients completed Nissen fundoplication: laparoscopic fundoplication - 291 (80.17%) patients, robot-assisted laparoscopic fundoplication - 72 (19.83%) patients. Intraoperative and postoperative results are comparable with each other. Complications of Clavien-Dindo Classification >3 were observed in 3 patients in the laparoscopic fundoplication group. The follow-up period for patients of the laparoscopic fundoplication group ranged from 1 to 53 months (median - 19 months), for patients of the robot-assisted laparoscopic fundoplication group ranged from 1 to 41 months (median - 13 months). Conclusion. The observed values demonstrate that robot-assisted laparoscopic fundoplication is comparable to laparoscopic fundoplication in terms of a workable result.

Хирургическое лечение грыж пищеводного отверстия диафрагмы традиционным и лапароскопическим методами

Хирургическое лечение грыж пищеводного отверстия диафрагмы традиционным и лапароскопическим методами

A collective review of biological versus synthetic mesh-reinforced cruroplasty during laparoscopic Nissen fundoplication.

Background:Laparoscopic cruroplasty and fundoplication have become the gold standard in the treatment of hiatal hernia and gastro-oesophageal reflux disease (GERD). The use of a mesh-reinforcement of the cruroplasty has been proven effective; although, there is a lack of evidence considering which type of mesh is superior. The aim of this study was to compare recurrence rates after mesh reinforced cruroplasty using biological versus synthetic meshes.Methods:We performed a systematic review of all clinical trials published between January 2004 and September 2015 describing the application of a mesh in the hiatal hernia repair during Nissen fundoplication for both GERD and hiatal hernia. The primary outcome was the recurrence rate, and secondary outcomes were complication rate, mortality and symptomatic outcome.Results:We included 16 studies and extracted data regarding 1089 mesh operated patients of whom 385 received a biological mesh and 704 a synthetic mesh. The mean follow-up was 53.4 months. The recurrence rate in the synthetic mesh group was 6.8% compared to 16.1% in the biological mesh group (P < 0.05). The complication rate was 5.1% and 4.6% (P = 0.694), respectively, and there were 12 mesh-related complications. No mesh-related mortality was reported.Conclusion:Mesh reinforcement of hiatal hernia repair seems safe in the short-term follow-up. The available literature suggests no clear advantage of biological over synthetic meshes. Regarding cost-efficiency and short-term results, the use of synthetic nonabsorbable meshes might be advocated.

Modern diagnosis and treatment of hiatal hernias.

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. A literature review of contemporary and latest studies with highest quality of evidence was completed. This information was examined and compiled in review format. 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, 3cm of intraabdominal esophageal length, crural closure with mesh reinforcement, and an anti-reflux procedure. Repairs not amenable to key steps may undergo gastropexy and gastrostomy placement as an alternative procedure. Hiatal hernias are commonly incidental findings. When hernias become symptomatic or have reflux disease, an operative repair is required. A minimally invasive approach is safe and has improved outcomes.

Лапароскопическая клапанная фундопликация, как метод хирургического лечения грыж пищеводного отверстия диафрагмы

Лапароскопическая клапанная фундопликация, как метод хирургического лечения грыж пищеводного отверстия диафрагмы

A Rare Variant of Diaphragmatic Hernia through the Central Tendon: A Case Report.

Diaphragmatic hernia through the central tendon is a very rare entity. We report on a case that developed to acute intestinal obstruction, secondary to herniation of the small intestine through a small defect in the central tendon of the diaphragm. The patient never had any trauma to his chest or abdomen and had no history suggestive of congenital nature of the diaphragmatic hernia. However, he had coronary artery bypass grafting with saphenous vein used as a graft, done almost 17years back; hence, we suspect it to be an iatrogenic hernia. A laparoscopic herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Iatrogenic diaphragmatic hernias are a very rare entity. We are reporting on a central tendon hernial defect in the diaphragm after coronary artery bypass with saphenous vein as a graft material. There are reported cases with post coronary artery bypass graft diaphragmatic hernia in which the right gastroepiploic artery was taken as the graft material. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. CT scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients.

Right diaphragmatic iatrogenic hernia after laparoscopic fenestration of a liver cyst: report of a case and review of the literature

Iatrogenic right diaphragmatic hernia is very rare. We report the first case of a patient who had a diaphragmatic hernia after laparoscopic fenestration of liver cyst. A herniorrhaphy of the diaphragmatic defect was carried out after reducing the herniated organ. The postoperative course was uneventful. Diaphragmatic hernias are not as common as the traumatic type. Surgeons can easily miss diaphragmatic injuries during the operation especially after laparoscopy. Late diagnosis of iatrogenic diaphragmatic hernias is frequent. Ct scan is helpful for diagnosis. Surgery is the treatment of diaphragmatic hernia at the time of diagnosis, even with asymptomatic patients. The incidence of iatrogenic diaphragmatic hernia after surgery may be reduced if the surgeon checks for the integrity of the diaphragm before the end of the operation. A review of the literature is also performed regarding this rare complication.

Diaphragmatic Hernia Revealed by Post-Partum Respiratory Distress

Introduction: Diaphragmatic hernias occurring during pregnancy or during labor are very rare. This kind of injury or complication is mostly diagnosed with delay. Case report: A 30-year-old, primigravida woman presented an acute respiratory distress three weeks after childbirth by emergency caesarian section. The past history was uneventful till a car crash three years ago with whiplash injury without blunt abdominal trauma. The diagnostic of the dyspnea was assured by thorax CT scan. Symptoms of gastrointestinal obstruction were not recorded. An emergency thoracotomy was performed. The incarcerated gastric fundus had to be resected. The central diaphragmatic hernia could be closed by sutures. An abdominal approach was not necessary. The postoperative follow-up was uncomplicated. Discussion and Conclusion: Incarceration of abdominal viscera by diaphragmatic hernia is an uncommon cause of pleural empyema. Her happening during pregnancy or during the peri-partum period is increasingly rarely and represents a life-threatening event for the pregnant woman and her fetus. Early diagnosis and surgery in an emergency setting are required. Diagnose and treatment of diaphragmatic hernias in women in child-bearing age should happen before pregnancy in matter to avoid potential lethal complications for the expectant mother as well as for the fetus.

Histopathological Characterization of a Cameron Lesion

Cameron lesions are linear erosions located at the neck of a hiatal hernia (HH) in patients with a large HH. The prevalence has been seen in up to 5% of patients with HH who undergo esophagogastroduodenoscopy, and they can be associated with overt gastrointestinal bleeding or anemia. These lesions occur due to vascular compression by the diaphragm in a large sliding HH. Histopathologic changes seen in the biopsy tissue of a Cameron lesion are due to ischemia, but this ischemia is reversible with treatment of HH. The existence of this entity and the histopathologic picture of a Cameron lesion is not well known to pathologists, and therefore, a microscopic picture of a Cameron lesion can be easily confused with ischemic gastritis. Ischemic gastritis is the result of atherosclerosis, usually seen in older people, unrelated to HH, and is not easily reversible. The authors received a gastric biopsy of a hiatal hernia without any associated clinical diagnosis of a Cameron lesion conveyed to the pathologist. This biopsy tissue showed ischemic changes in the gastric mucosa on microscopic examination. Diagnosis of ischemic gastritis was considered but ruled out after the case was discussed with the gastroenterologist. The correct diagnosis was made once the clinical diagnosis of HH with Cameron lesion (ie, a vertical red erosion) was made known to the pathologist. By reporting this case, the authors aim to increase awareness of Cameron lesion among pathologists so that they ask about the presence of a Cameron lesion before making the diagnosis of ischemic gastritis.