569 LAPAROSCOPIC REPAIR OF A VOLUMINOUS SYMPTOMATIC HIATAL HERNIA USING AN ABSORBABLE SYNTHETIC MESH

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
E Cocozza ◽  
M Berselli ◽  
L Livraghi ◽  
V Quintodei ◽  
L Latham
Keyword(s):  
Hiatal Hernia ◽  
Laparoscopic Repair ◽  
Oral Intake ◽  
High Volume ◽  
Synthetic Mesh ◽  
Esophageal Hiatus ◽  
Trimethylene Carbonate ◽  
Hernia Sac ◽  
Mesh Placement ◽  
One Year

Abstract   In symptomatic voluminous paraesophageal hiatal hernias not only a laparoscopic surgical approach, but also the use of mesh can be considered too. The use of surgical protesis in hiatal henia repair was a debated surgical topic in the last years A laparoscopic repair of a symptomatic type III hiatal hernia by plastic of the hiatus, fundoplicatio and use of an absorbable glycolic acid/trimethylene carbonate synthetic mesh is showed. Methods The patient was a 59 years old male suffering from recurrent aspiration pneumonias. Surgery was performed by a standardized tecnique in a high volume laparoscopic surgical centre. The hernia sac was removed and the plastic of the esophageal hiatus was performed. After the mesh placement a Nissen fundoplicatio was performed. No drain was placed. Results In the postoperative period a contrat-soluble swallow was performed and it resulted in a good transit witout any sign of recurrence. The patient was discharged with an appropiate oral intake. One year after surgery the patient is asymptomatic and in good conditions. Conclusion A voluminous symptomatic hiatal hernia can be successfully treated in a high-volume and long-term experienced laparoscopic surgical. The use of an absorbable, handily positionable and synthetic mesh can help to gain a lower rate of recurrence without any risk for the patients. The technical skill and all the surgical steps never are renounceable because of the presence of the mesh. Further studies with a longer-term follow-up and a international live debate are necessary. Video https://www.dropbox.com/s/384ujzm3rnoqe0a/Hiatal%20Hernia%20Dr.%20Cocozza%20ISDE%202020.mp4?dl=0

scholarly journals Resorbable Synthetic Mesh Supported With Omentum Flap in the Treatment of Giant Hiatal Hernia

2014 ◽  
Vol 99 (5) ◽  
pp. 551-555
Author(s):  
F. J. Pérez Lara ◽  
R. Marín ◽  
A. del Rey ◽  
H. Oliva
Keyword(s):  
Hiatal Hernia ◽  
Synthetic Mesh ◽  
Omental Flap ◽  
Esophageal Hiatus ◽  
Complication Rates ◽  
Esophageal Erosion ◽  
Basic Procedure ◽  
Giant Hiatal Hernia ◽  
Omentum Flap

Abstract Covering a large hiatal hernia with a mesh has become a basic procedure in the last few years. However, mesh implants are associated with high complication rates (esophageal erosion, perforation, fistula, etc.). We propose using a synthetic resorbable mesh supported with an omental flap as a possible solution to this problem. A 54-year-old female patient with a large hiatal defect (9 cm) was laparoscopically implanted with a synthetic resorbable mesh supported with an omental flap. The surgical procedure was successful and the patient was discharged on postoperative day 2. On a follow-up examination 6 months after surgery, she remained free of relapse or complication signs. Supporting an implanted resorbable mesh with an omental flap may be a solution to the problems posed by large esophageal hiatus defects. However, more studies based on larger patient samples and longer follow-up periods are necessary.

scholarly journals A Comparative Study Between Laparoscopic Versus Open Incisional Hernia Repair

2016 ◽  
pp. 29-33
Author(s):  
Md Noor A Alam ◽  
Md Rajibul Haque Talukder ◽  
Md Roushan Iqbal ◽  
Raihan Anwar ◽  
Humayun Kabir Chowdhury
Keyword(s):  
Incisional Hernia ◽  
Hospital Stay ◽  
Laparoscopic Repair ◽  
Open Repair ◽  
Laparoscopic Group ◽  
Incisional Hernia Repair ◽  
Synthetic Mesh ◽  
Open Procedure ◽  
Significant Difference ◽  
One Year

Aims: This study aims to compare between laparoscopic and open incisional hernia repair.Methods and Materials: The study was conducted in different tertiary hospitals of Dhaka between January 2011 to December 2012 and in 96 patients with incisional hernia. Among them, 68 patients underwent open repair and 28 underwent laparoscopic repair. Both procedures usually consisted of applying a synthetic mesh overlapping the defect. They were followed up for one year to observe the clinical outcome.Results: Mean operative time was shorter in laparoscopic group in comparison to open procedure and mean post operative hospital stay was less than 3 days in laparoscopic group and above 7 days in open group. In the laparoscopic group return to normal activities/work after surgery was less than 2 weeks but after open procedure it was more than 3 weeks. Analgesics requirement was also lower in the laparoscopic group. Post operative complications were observed in 33.82% (23) patients in open hernioplasty group and in 7.14% (2) patients in laparoscopic group which showed significant difference (p<0.05). There was no recurrence in the laparoscopic group during one year follow-up.Conclusion: Data suggest laparoscopic repair is superior to open repair because of less complications, relapses and short hospital stay but long term follow up is required.Birdem Med J 2015; 5(1) Supplement: 29-33

370 LAPAROSCOPIC HIATAL HERNIA REPAIR: INSIGHTS FROM A HIGH-VOLUME CENTER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
L Giulini ◽  
D Razia ◽  
S Mittal
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Laparoscopic Repair ◽  
Operative Time ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Hiatal Hernia Repair ◽  
Laparoscopic Hiatal Hernia Repair

Abstract   When a hiatal hernia (HH) becomes symptomatic, surgical repair is indicated. The surgical procedure can be safely carried out laparoscopically with good results. However, it is unclear whether the size of the hernia affects perioperative outcomes. The aim of this study was to assess whether laparoscopic repair of large hiatal hernias (L-HH) has comparable results to laparoscopic repair of small hernias (S-HH). Methods After approval from the Institutional Review Board, a prospectively maintained database was reviewed for data on patients who underwent primary laparoscopic HH repair at our center between August 2016 and December 2019. All procedures were performed by a single surgeon (SKM). HHs were defined as “large” when at least 50% of the stomach was herniated through the hiatus. Data on perioperative results and mid-term follow-up were analyzed. The Clavien-Dindo (CD) classification was used to define complications. Results Of 170 identified patients, 55 had L-HH; 115 had S-HH. Mean ages were 72 ± 10 for L-HH and 61 ± 11.3 years for S-HH (p &lt; 0.001). Median operative time was 95 (IQR, 80–110) and 75 minutes (IQR, 65–90) for L-HH and S-HH, respectively (p &lt; 0.001). L-HH patients had longer hospital stays (median 2 vs 1 days, IQR 1–2 for both; p = 0.001) and more complications (12/55 [21.8%] vs 4/115 [3.5%]; p &lt; 0.001) than S-HH patients. Two L-HH patients had CD grades IIIb and IVa. At follow-up (20.9 ± 8.7 months), gastroesophageal reflux disease quality of life scores were comparable between groups (6.4 ± 11.7 vs 5.2 ± 0; p = 0.9). Conclusion Laparoscopic HH repair is safe and feasible; however, is more technically challenging and is associated with longer operative time, longer hospital stay, and increased morbidity when performed as treatment for L-HH (ie, at least 50% of the stomach herniated through the hiatus). Nonetheless, good quality of life outcomes can be achieved at mid-term follow-up in both patients with S-HH and patients with L-HH who undergo treatment by an experienced surgeon.

scholarly journals Paraesophageal Hernia as a Cause of Chronic Asymptomatic Anemia in a 6 Years Old Boy; Case Report and Review of the Literature

2017 ◽  
Vol 60 (2) ◽  
pp. 76-81
Author(s):  
Dimitrios Patoulias ◽  
Maria Kalogirou ◽  
Thomas Feidantsis ◽  
Ignatios Kallergis ◽  
Ioannis Patoulias
Keyword(s):  
Hiatal Hernia ◽  
Paraesophageal Hernia ◽  
Esophageal Hiatus ◽  
Type Ii ◽  
Hernia Sac ◽  
Esophageal Hiatal Hernia ◽  
Type Iv ◽  
Abdominal Organs ◽  
Total Fundoplication ◽  
Sliding Hiatal Hernia

Esophageal hiatal hernia is defined as the prolapse of one or more intra-abdominal organs through the esophageal hiatus. Four types are identified: type Ι or sliding hiatal hernia, type II or paraesophageal hernia (PEH), type III or mixed hernia and type IV. Congenital type II esophageal hiatal hernia is caused by a remaining gap after the formation of pleuroperitoneal membrane. We present a case of a six years old boy admitted to our department, appearing with asymptomatic anemia, who was incidentally diagnosed with Type II esophageal hiatal hernia. After diagnostic investigation, the prolapsing stomach pouch was reduced, the hernia sac was excised, the crura of diaphragm were converged and a total fundoplication was performed, via open method. The patient had an uncomplicated postoperative period. We conclude that: 1) esophageal hiatal hernia should be included within diagnostic approach of a child with chronic non-hereditary anemia, 2) after a Type II esophageal hiatal hernia is diagnosed, a hernia repair surgery is indicated in short time, due to the severity of possible complications and 3) through the performance of total fundoplication, it is secured that the subdiaphragmatic abdominal part of esophagus will be retained, preventing the development of post-operative gastroesophageal reflux disease.

scholarly journals Hiatal hernia repair: prevention of mesh erosion and migration into the esophagogastric junction

2020 ◽  
Vol 33 (1) ◽  
Author(s):  
Italo BRAGHETTO ◽  
Owen KORN ◽  
Jorge ROJAS ◽  
Hector VALLADARES ◽  
Manuel FIGUEROA
Keyword(s):  
Hernia Repair ◽  
Hiatal Hernia ◽  
Late Complications ◽  
Mesh Erosion ◽  
Hiatal Hernia Repair ◽  
Hernia Sac ◽  
Mesh Placement ◽  
Early Postoperative Complications ◽  
Laparoscopic Hiatal Hernia Repair ◽  
And Migration

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.

Abstract 11974: Impact of Routine ECPR Service on Availability of Donor Organs

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Jana Smalcova ◽  
Katerina Rusinova ◽  
Iván Ortega-Deballon ◽  
Eva Pokorna ◽  
Ondrej Franek ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Single Case ◽  
Organ Donor ◽  
High Volume ◽  
Donation After Cardiac Death ◽  
Daily Routine ◽  
Organ Donors ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
One Year ◽  
Transplanted Organs

Introduction: In refractory cardiac arrest, extracorporeal cardiopulmonary resuscitation (ECPR) may increase the chance of survival. However, in brain death or donation after cardiac death scenario, ECPR may also become an important organ donor source. Hypothesis: We hypothesized that 1/ the implementation of ECPR into the daily routine of a high volume cardiac arrest centre might increase the availability of organ donors, and 2/ ECPR might assure the same long-term function of donated organs as non-ECPR care. Methods: We retrospectively evaluated pre-ECPR (2007-2011) and ECPR (2012-2020) periods in terms of donors recruited from the out-of-hospital and in-hospital cardiac arrest population. We assessed the number of donors referred, the number of organs harvested and their one- and five-year survival. Results: In the pre-ECPR period, 11 donors were referred, of which 7 were accepted. During the ECPR period, the number of donors increased to 80, of which 42 were accepted. The number of donated organs in respective periods were 18 and 119, corresponding to 3,6 vs 13,2 (p =0.033) organs per year harvested. One-year survival of transplanted organs was 94.4% vs 100%, and five-year survival was 94.4% vs 87,5%, in relevant periods. Survival of organs obtained from donors after CPR and ECPR at one year (98.9% vs 100%) and five years (90,2% vs 88.9%) was the same. Graft failure was not the cause of death in any single case. Conclusions: Establishing a high volume cardiac arrest/ECPR centre may lead to a higher number of potential and subsequently accepted organ donors. The length of survival of donated organs is high and comparable between ECPR vs non-ECPR cardiac arrest donors.

scholarly journals Evaluating the Safety and Efficacy of a Highly Viscous 33-mg/mL Hyaluronic Acid Volumizing Filler in the Treatment of Facial Wrinkles: An Open-Labeled, Clinical Trials

2019 ◽  
Vol 8 ◽  
pp. e1148
Author(s):  
Elnaz Razavian ◽  
Setareh Tehrani
Keyword(s):  
Hyaluronic Acid ◽  
High Volume ◽  
Soft Tissue Augmentation ◽  
Nodule Formation ◽  
Safety And Efficacy ◽  
Significant Correction ◽  
Clinically Significant ◽  
One Year ◽  
First Time

Background: The 33-mg/mL hyaluronic acid (HA) formulation is a highly concentrated, cross-linked, cohesive, smooth, and completely reversible volumizing filler approved by Conformité Européene. For the first time, we aimed to evaluate the long-term efficacy and safety of the 33-mg/mL HA filler for soft tissue augmentation in the treatment of facial wrinkles. Materials and Methods: After optimal wrinkle correction was achieved in the patients undergoing treatment by injecting the 33-mg/mL HA filler at the injection site plus one touch-up at a 2-week interval, the safety and efficacy of the filler were assessed on the 5-point Facial Volume Loss Scale through the 1-year study period. Patients were evaluated daily for 14 days and after 6 and 12 months post-treatment. Results: A total of 86 subjects were treated. The mean wrinkle scores of the patients were 3.95+0.79 (range of 3-5) before treatment, 2.3+0.94 (range 1-5) six months after treatment, and 2.93+1.29 (range of 1-5) one year after treatment. Clinically significant mean wrinkle correction (P=0.001) was still evident at>12 months of treatment through 33-mg/mL HA formulation. A clinically significant correction at>12 months after treatment was maintained by 79% of patients. Nodule formation and swelling were more frequent when the 33-mg/mL HA filler was used compared with the use of less concentrated HA fillers. One patient developed angioedema-like swelling and induration last few months. Conclusion: The 33-mg/mL HA filler can provide long-term correction lasting for one year or more. Adverse effects, especially swelling and nodule formation were more common in this filler compared with less concentrated HA fillers. The side effects were correlated with the volume of the injected filler. We recommend using this concentration with low volume or combining high volume with lower concentration. [GMJ.2019;8:e1148]

Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome

2016 ◽  
Vol 27 (03) ◽  
pp. 274-279
Author(s):  
Koji Fukumoto ◽  
Masaya Yamoto ◽  
Hiroshi Nouso ◽  
Masakatsu Kaneshiro ◽  
Mariko Koyama ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Duodenal Obstruction ◽  
Abdominal Cavity ◽  
The Other ◽  
Esophageal Hiatus ◽  
Thoracic Cavity ◽  
Toupet Fundoplication ◽  
Cavity Volume ◽  
Upper Gastrointestinal ◽  
Asplenia Syndrome

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

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