Management of Paraesophageal Hernia in the Morbidly Obese Patient
Gastroesophageal reflux disease (GERD) is common in the morbidly obese population, and hiatal hernias are encountered in 20% to 52% of patients. Primary surgical repair of hiatal hernias, in particular the paraesophageal type, is associated with a higher recurrence rate in obese patients. Concomitant weight loss surgery may be advisable. Combined sleeve gastrectomy and paraesophageal hiatal hernia repair is feasible but can induce or worsen preexisting GERD. A Roux-en-Y gastric bypass offers advantages of more pronounced excess weight loss and better symptom control, albeit with a potentially higher rate of morbidity compared with paraesophageal hernia repair alone or sleeve gastrectomy.
Authors: Siamashvili M, Davis S Abstract INTRODUCTION: Bromocriptine mesylate quick release (QR) is a dopamine D2 receptor agonist and is the only oral, primarily centrally acting drug that can be used for the treatment of adults with type 2 diabetes. AREAS COVERED: The authors describe current recommendations on the use of bromocriptine mesylate QR. Major efficacy and safety parameters of the late phase trials, including The Cycloset Safety Trial, have been identified and presented. EXPERT OPINION: Efficacy of bromocriptine mesylate QR monotherapy appears to be low but is compensated by favorable safety pr...
Conclusions: The study ’s findings support the efficacy of tube weaning based on the published “Graz model of tube weaning” for children born with EA/TEF and indicate the necessity of specialized tube weaning programs for these patients.What is Known:• Children with esophageal atresia/tracheoesophageal fistula often suffer from feeding problems and tube dependency.• Different tube weaning programs and outcomes have been published, but not specifically for children with EA.What is New:• Evaluation of a large sample of children referred for tube weaning after EA repair.• Most children wi...
Publication date: Available online 9 October 2020Source: Nutrition, Metabolism and Cardiovascular DiseasesAuthor(s): Vanda Craveiro, Elisabete Ramos, Joana Araújo
Publication date: December 2020Source: Journal of Functional Foods, Volume 75Author(s): Jian Zhang, Xiaohang Fu, Wenhui Li, He Li, Zhiwei Ying, Xinqi Liu, Liduan Yin
In the paper by Angrisani et al. , the authors tackle an important question, namely, what are the long-term outcomes regarding gastroesophageal reflux disease (GERD) in patients undergoing sleeve gastrectomy (SG)? Many surgeons consider GERD to be the Achilles’ heel of the SG, and it is one of the main reasons for conver sion of the SG to other procedures, such as the gastric bypass . The last International Consensus Conference on SG demonstrated>50% of surgeons considered GERD to be a relative contraindication to the SG, and also hiatal hernias (HH) should be repaired when encountered .
In the paper by Angrisani et al, the authors tackle an important question, namely; what are the long term outcomes regarding gastroesophageal reflux disease (GERD) in patients undergoing sleeve gastrectomy (SG) ? Many surgeons consider GERD to be the Achilles heel of the SG, and it is one of the main reasons for conversion of the SG to other procedures such as the gastric bypass . The last International Consensus Conference on SG demonstrated that over 50% of surgeons considered GERD to be a relative contrindication to the SG, and also that hiatal hernias (HH) should be repaired when encountered .
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.
Obesity is known to be an independent risk factor for gastroesophageal reflux disease (GERD), as well as a contributing cause of hiatal hernias (HH). Laparoscopic sleeve gastrectomy (LSG) is considered a viable surgical option for weight loss; however, some surgeons suggest avoiding this procedure in patients with preexisting gastroesophageal reflux disease symptoms (GERDS) because of concern for worsening of these symptoms. The effect of LSG on GERDS is unclear, with studies reporting conflicting results.
Obesity is a major risk factor for hiatal hernias. High recurrence rates are reported following Nissen fundoplication in morbidly obese patients. Following a failed fundoplication, an acid diverting procedure (i.e. RYGB) is highly successful in reflux remission and weight loss.
We report mid-term results from a larger series with combining laparoscopic giant PEH repair with sleeve gastrectomy (SG). Methods We reviewed all combined cases of PEH repairs with SG done at a single institution from 2008 to 2013. The surgical technique was standardized and absorbable bio-prosthetic buttress crural closure reinforcement was used selectively. Yearly upper gastrointestinal radiographic (UGI) studies and postoperative Gastroesophageal Reflux Disease Health-Related Quality of Life questionnaires were completed. 33 patients were enrolled; 18 patients (55 %) com...