Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair.
Conclusion: Patients who had their hernias repaired emergently experienced complications at similar rates as those of elective patients with advanced age or comorbid conditions as demonstrated by the propensity analysis. The authors therefore recommend evaluation of all paraesophageal hernias for elective repair, especially in younger patients who are otherwise good operative candidates. PMID: 31285652 [PubMed - in process]
Conclusion: In this series of 32 cases, laparoscopic cruroplasty with UBM graft reinforcement has been effective and durable at 12 months of followup. This technique may offer one satisfactory solution for large hiatal hernia repair concomitant with laparoscopic sleeve gastrectomy that may achieve a durable repair with low GERD symptoms. PMID: 30880900 [PubMed - in process]
AbstractBackgroundControversy exists regarding the clinical utility of routine preoperative upper gastrointestinal (GI) fluoroscopy in morbid obese patients undergoing laparoscopic sleeve gastrectomy (LSG). The aim of our study was to determine the efficacy of these studies in detecting hiatal hernias (HH).MethodsThe institution ’s prospectively maintained, IRB-approved database was retrospectively queried to identify all consecutive patients who underwent LSG between 2011 and 2017. All patients underwent routine preoperative upper GI fluoroscopy. Reports from all imaging studies were retrospectively reviewed and com...
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
Background: The repair of a complex abdominal hernia has an important morbimortality. We propose laparoscopic sleeve gastrectomy as the first step in the treatment of hernias with loss of domain in patients with morbid obesity.
We present a case of 60-year-old man with a body mass index of 45.3 kg/m2 with a large recurrent ventral hernia. We performed a lap sleeve gastrectomy with laparoendoscopic anterior component separation with IPOM. The operative steps included hernia contents reduction, conventional sleeve gastrectomy, anterior component separation on either side, intra-corporeal closure of hernia defect and placement of a composite mesh. Patient recovery was uneventful. Concomitant bariatric surgery with laparoendoscopic component separation with IPOM may be safe, but more studies are required.
Morbidly obese patients are predisposed to developing ventral hernias. Although the optimal timing of ventral hernia repair (VHR) and bariatric surgery is unclear, concurrent management remains common. The aim of this study was to assess the incidence of wound site occurrence in the setting of VHR during bariatric surgery.
Both hiatal hernias (HH) and morbid obesity significantly contribute to gastroesophageal reflux disease which increases the risk for esophagitis and esophageal cancer. Therefore, concomitant HH repair is recommended during bariatric surgery procedures. Unfortunately, recurrence of HH following repair is not uncommon and the optimal surgical technique has yet to be established.
Morbid obesity and its associated comorbidities are risk factors for the development of abdominal hernias, add complexity to their repair, and increase the perioperative risk. The repair of hernias with loss of domain (LoD) is further complicated by the risk of abdominal compartment syndrome (ACS). A staged concept with an initial weight loss procedure might enable a reposition of the herniated viscera, improve comorbidities for and prohibit ACS in the subsequent repair.
Conclusion PODH is a common complication following hybrid esophagectomy and MIO. Given the high mortality from emergency repair, careful thought is needed to identify surgical techniques to prevent PODH forming when minimal access esophagectomy are performed. Upper GI surgeons need to have a low index of suspicion to investigate and treat patients for this complication.
We report the case of a 78-year-old man who underwent total gastrectomy with antecolic Roux-Y reconstruction for residual gastric cancer. He had alcoholic liver cirrhosis and received radical laparoscopic proximal gastrectomy for gastric cancer 3 years ago. Early gastric cancer in the remnant stomach was found by routine upper gastrointestinal endoscopy. We initially performed endoscopic submucosal dissection, but the vertical margin was positive in a pathological result. We performed total gastrectomy with antecolic Roux-Y reconstruction by laparotomy. For adhesion of the esophageal hiatus, the left chest was connected wi...