scholarly journals Induced Opening of the Gastroesophageal Junction Occurs at a Lower Gastric Pressure in Gerd Patients and in Hiatal Hernia Subjects than in Normal Control Subjects

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Anil Vegesna ◽  
Ramashesai Besetty ◽  
Amit Kalra ◽  
Umar Farooq ◽  
Annapurna Korimilli ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Normal Control ◽  
Reflux Disease ◽  
Gastroesophageal Junction ◽  
Normal Pattern ◽  
Normal Volunteers ◽  
Control Subjects ◽  
Gastric Pressure

Purpose. To determine intragastric pressure threshold for inducing gastroesophageal junction (GEJ) opening in normal control subjects with and without hiatal hernia, and in patients with gastroesophageal reflux disease.Methods. This study was performed in 13 normal volunteers, 5 volunteers with hiatal hernia, and 3 patients with gastroesophageal reflux disease. During endoscopy a pressure transducer was used to measure baseline gastric pressures. The pressure in the stomach was measured while air was insufflated into the stomach until the gastroesophageal junction opened on endoscopic view.Results. There were two patterns of GEJ opening in normal volunteers. The mean opening pressure for Gastroesophageal junction in normal pattern-I, normal pattern-II, hiatal hernia, and Gastroesophageal reflux patients was 11.5, 12.6, 3.4, and 1.3 mmHg, respectively.Conclusions. GEJ opening is induced at a significantly lower pressure in subjects with hiatal hernia and in patients with gastroesophageal reflux disease than in normal volunteers.

Gastroesophageal Reflux Disease and Hiatal Hernia

2020 ◽  
Author(s):  
Kyle A. Perry ◽  
Vivian L. Wang
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Barrett’S Esophagus ◽  
Reflux Disease ◽  
Barrett's Esophagus ◽  
Paraesophageal Hernia ◽  
Nissen Fundoplication ◽  
Gastroesophageal Junction ◽  
Symptomatic Gerd

Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study

Gastroesophageal Reflux Disease and Hiatal Hernia

2020 ◽  
Author(s):  
Kyle A. Perry ◽  
Vivian L. Wang
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Barrett’S Esophagus ◽  
Reflux Disease ◽  
Barrett's Esophagus ◽  
Paraesophageal Hernia ◽  
Nissen Fundoplication ◽  
Gastroesophageal Junction ◽  
Symptomatic Gerd

Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study

scholarly journals Anatomical landmarks in laparoscopic surgical treatment of hiatal hernia

2016 ◽  
Vol 63 (4) ◽  
pp. 280-285
Author(s):  
Matei Răzvan Bratu ◽  
◽  
Bogdan I. Diaconescu ◽  
Alexandru Th. Ispas ◽  
Mircea Beuran ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Gastroesophageal Junction ◽  
Deep Understanding ◽  
Abdominal Hernia ◽  
Anatomical Landmarks ◽  
Regional Anatomy

Hiatal hernia of the adult is a benign pathology of the abdominal esophagus and has an increasing incidence because of the association with obesity. Hiatal hernia becomes clinical manifest when it presents gastroesophageal reflux disease, when it is voluminous or is incarcerated. If for gastroesophageal reflux disease there is an endoscopic treatment, for hiatal hernia the treatment is purely surgical. Open or laparoscopic, the objectives of the surgical treatment are the same as for any abdominal hernia. The local anatomy plays an important role for fulfilling the objectives. This study provides a detailed description of the regional anatomy of the gastroesophageal junction and of the esophageal hiatus of the diaphragm based on the laparoscopic procedures performed in the Emergency Clinical Hospital of Bucharest. There were evaluated the aspects and the relations of the anatomical structures and also the consistency (because the manipulation and traction is made with the help of the instruments). In conclusion, a deep understanding of the regional anatomy and variations facilitates a safe laparoscopic dissection of diaphragmatic hiatus and abdominal esophagus and helps the surgeon to avoid intraoperative accidents.

scholarly journals POSTOPERATIVE DYSPHAGIA AFTER LAPAROSCOPIC FUNDOPLICATION AS A TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
B Carrasco Aguilera ◽  
S Amoza Pais ◽  
T Diaz Vico ◽  
E O Turienzo Santos ◽  
M Moreno Gijon ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Surgical Technique ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Laparoscopic Fundoplication ◽  
Descriptive Study ◽  
Postoperative Dysphagia

Abstract INTRODUCTION Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center. MATERIAL AND METHODS Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019. RESULTS 248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively. CONCLUSION No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.

Minimally Invasive Esophageal Procedures

2020 ◽  
Author(s):  
Jon O. Wee
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Minimally Invasive ◽  
Reflux Disease ◽  
Paraesophageal Hernia ◽  
Nissen Fundoplication ◽  
Gastroesophageal Junction ◽  
Outcome Evaluation ◽  
Barrett Esophagus ◽  
Asymptomatic Patients

In most instances, laparoscopy has replaced open procedures as the standard of care. Nevertheless, equipoise remains in the literature regarding the benefits of surgery compared with alternative treatment strategies such as medications in the case of gastroesophageal reflux disease (GERD) or endoscopic procedures in the case of achalasia. According to Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guidelines published in 2010, indications for surgery include (1) failure of medical management, (2) patient preference, (3) complications of GERD (Barrett esophagus, peptic stricture), and (4) extraesophageal manifestations (asthma, hoarseness, cough, chest pain, aspiration). This chapter is organized by surgical procedure, all of which are derivatives of the laparoscopic Nissen fundoplication. In this chapter, the authors focus on minimally invasive surgical approaches to the treatment of the following benign esophageal disorders: GERD, achalasia, and paraesophageal hernias. New in this chapter is the in-depth coverage of laparoscopic paraesophageal hernia repair. The majority of patients with paraesophageal hernias are asymptomatic, and their hernias are found incidentally with a retrocardiac gastric bubble on an upright chest x-ray or herniated gastroesophageal junction seen on a chest or abdominal computed tomographic scan. For patients who are symptomatic, surgical repair is indicated as there is no medical treatment for this mechanical problem. For asymptomatic patients, clinical judgment needs to be used. All surgical procedures are covered by preoperative evaluation, operative planning, and operative technique, with a troubleshooting note for every step. Procedure complications, postoperative care, and outcome evaluation follow each procedure, listing the most current reports and data. This review contains 10 figures, 9 tables and 49 references Keywords: Minimally invasive surgery, esophagectomy, myotomy, gastroesophageal reflux disease, Barrett esophagus, Nissen fundoplication, fundoplication, paraesophageal hernia

677 ROBOTIC-ASSISTED HIATAL HERNIA AND GASTROESOPHAGEAL REFLUX DISEASE RE-DO SURGERY: A SINGLE INSTITUTION EXPERIENCE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Arantxa Clavell Font ◽  
Sara Senti Farrarons ◽  
Marta Viciano Martin ◽  
Elisenda Garsot Savall
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Hernia Recurrence ◽  
Complication Rates ◽  
Robotic Approach ◽  
Clinical Recurrence ◽  
The Mean ◽  
Hiatal Hernia Recurrence

Abstract   Hiatal hernia recurrence (HHR) after surgical repair associated with dysphagia, gastroesophageal reflux disease or other symptoms represents a non-negligible disease that frequently needs a reoperative solution. The repair of a relapsed hiatal hernia represents a surgical challenge due to anatomic changes and fibrosis, and the robotic approach seems to provide benefits because offers enhanced visualization and dexterity. Methods Between June 2019 and February 2021, 7 patients (1 male, 6 female) underwent redo robotic approach surgery for hiatal hernia recurrence after being pre operative diagnosed. All surgeries were elective and all patients had both clinical and radiologic recurrence. Biosynthetic tissue absorbable mesh was applied in one patient with double time recurrence hernia. Four patients underwent total fundoplication (Nissen), 2 patients had Toupet fundoplication, and one patient had hiatus repair without fundoplication. Results The mean age of the patients was 62.7 years and the main expressed symptom for the patient was dysphagia. Time to clinical recurrence was 13 months. Biosynthetic mesh was used in one patient. The mean operative time was 143 minutes (80–240) and no intraoperative complications were described. There were no conversions to open or laparoscopic procedures. The early and 30 day mortality rate was 0% and mean hospital stay was 2.7 days. Conclusion Robotic support, when available, can be beneficial in redo surgery for GERD and hiatal hernia recurrence. Despite our short experience, we believe the robotic approach for redo hiatal surgery is safe and effective with low complication rates even in high-risk patients.

Hiatal Hernia and Gastroesophageal Reflux Disease

2012 ◽  
pp. 1067-1086
Author(s):  
Rebecca P. Petersen ◽  
Carlos A. Pellegrini ◽  
Brant K. Oelschlager
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease

scholarly journals A novel endoscopic assessment of the gastroesophageal junction for the prediction of gastroesophageal reflux disease: a pilot study

2019 ◽  
Vol 07 (11) ◽  
pp. E1468-E1473 ◽  
Author(s):  
Haruhiro Inoue ◽  
Yusuke Fujiyoshi ◽  
Mary Raina Angeli Abad ◽  
Enrique Rodriguez de Santiago ◽  
Kazuya Sumi ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Gastroesophageal Junction ◽  
Optimal Cutoff ◽  
Esophageal Ph ◽  
Impedance Monitoring ◽  
Acid Exposure Time ◽  
Sensitivity Specificity ◽  
Endoscopic Assessment

Abstract Background and aim Hiatal hernia and lower esophageal sphincter (LES) dysfunction play major roles in gastroesophageal reflux disease (GERD) pathogenesis. We developed a novel endoscopic assessment to evaluate the gastroesophageal junction (GEJ). This study aims to evaluate the feasibility of this method for the diagnostic prediction of GERD. Methods A retrospective analysis of patients with GERD symptoms who underwent gastroscopy and esophageal pH-impedance monitoring was conducted. The novel assessment evaluated the following in retroflex view: 1) Cardiac Opening (CO): diameter of the opening of the cardia, 2) Sliding Hernia (SH): length from the diaphragmatic crus to the squamocolumnar junction, 3) Scope Holding Time% (SHT%): the percentage of time that the Scope Holding Sign (SHS) was observed out of 30 seconds. The SHS is defined as the lower esophagus holding the endoscope under excessive insufflation. The results of this assessment and that of pH-impedance monitoring were compared. Results In total, 61 patients (mean age ± SD, 54.1 ± 16.4 years, 32 males) were enrolled. CO and SH were significantly correlated with acid exposure time (AET) (ρ = 0.36, P = 0.005, and ρ = 0.36, P = 0.004). The optimal cutoff of CO for AET > 6 % was 3 cm (Sensitivity = 72.4 %, Specificity = 46.9 %, AUC = 0.64) and that of SH was 2 cm (Sensitivity = 55.2 %, Specificity = 75.0 %, AUC = 0.70). When the population was stratified according to this cutoff, patients with CO > 3 cm and those with SH > 2 cm presented higher AET (15.1 vs 4.1 %, P = 0.037, and 23.0 vs 3.6 %, P = 0.026). Optimal cutoff of SHT% for the number of all reflux episodes > 80 was 75 % (Sensitivity = 81.8 %, Specificity = 54.6%, AUC = 0.67). Patients with SHT% < 75 % presented a higher number of all reflux episodes (88 vs 65, P = 0.014). Sensitivity, specificity, and accuracy of SHT% < 75 % for all reflux episodes > 80 were 81.8 % (95 %CI: 67.7 – 91.8), 54.5% (95 %CI: 40.4 – 64.5), and 68.2 % (95 %CI: 54.0 – 78.1). Conclusion This novel endoscopic assessment of GEJ significantly predicted the presence of GERD and merits further testing in future studies.

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