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Contrast-enhanced ultrasound using SonoVue mixed with oral gastrointestinal contrast agent to evaluate esophageal hiatal hernia: Report of three cases and a literature review

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World Journal of Clinical Cases 2021年第11期9卷 2679-2687页

作者： Jing-Yu Wang Yan Luo Wen-Ying Wang Shi-Cheng Zheng Lian He Chun-Yan Xie Li Peng Department of Ultrasound First People's Hospital of Longquanyi DistrictLongquan Hospital of West China Hospital of Sichuan UniversityChengdu 610100Sichuan ProvinceChina Department of Ultrasound West China Hospital of Sichuan UniversityChengdu 610041Sichuan ProvinceChina Department of Gastroenterology First People's Hospital of Longquanyi DistrictLongquan Hospital of West China Hospital of Sichuan UniversityChengdu 610100Sichuan ProvinceChina

BACKGROUND Due to a thicker abdominal wall in some patients,ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination,precluding its ability to display or clearly show the structure of a hernial sac(HS)and thereby diminishing diagnostic performance for esophageal hiatal hernia(EHH).Contrast-enhanced ultrasound(CEUS)imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal *** SUMMARY In this case series,we report three patients with clinically-suspected EHH,including two females and one male with an average age of 67.3±16.4 *** was administered with an oral agent mixture(microbubble-based SonoVue and gastrointestinal contrast agent)and identified a direct sign of supradiaphragmatic HS(containing the hyperechoic agent)and indirect signs[e.g.,widening of esophageal hiatus,hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS,and esophagus-gastric echo ring(i.e.,the“EG”ring)seen above the diaphragm].All three cases received a definitive diagnosis of EHH by esophageal manometry and *** lesions resolved upon drug treatment and one required *** recurrence rate in follow-up was 0%.The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of *** CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.

关键词： SonoVue Oral gastrointestinal contrast agent Contrast-enhanced ultrasound Gastrointestinal hiatal hernia Case report

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Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach

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World Journal of Gastroenterology 2011年第15期17卷 2054-2057页

作者： Kazuki Inaba Yoichi Sakurai Jun Isogaki Yoshiyuki Komori Ichiro Uyama Department of Surgery Fujita Health University School of Medicine 1-98 Dengakugakubo Kutsukake-cho Toyoake Aichi 470-1192 Japan

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.

关键词： Gastric volvulus Mesenterioaxial form hiatal hernia Mesh repair Laparoscopic procedure

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Preoperative calculation of angles of vision and working area in laparoscopic surgery to treat a giant hiatal hernia

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1638-1650页

作者： Francisco Javier Perez Lara Rogelio Zubizarreta Jimenez Francisco Javier Moya Donoso Jose Manuel Hernández Gonzalez Tatiana Prieto-Puga Arjona Arturo del Rey Moreno Maria Pitarch Martinez Surgery Service Antequera HospitalRincón de la Victoria 29730MálagaSpain DOXA Microfluidics Rincon de la Victoria 29738MálagaSpain

BACKGROUND Giant hiatal hernias still pose a major challenge to digestive surgeons,and their repair is sometimes a highly complex *** is usually performed by laparoscopy,while the role of the thoracoscopic approach has yet to be clearly *** To preoperatively detect patients with a giant hiatal hernia in whom it would not be safe to perform laparoscopic surgery and who,therefore,would be candidates for a thoracoscopic *** In the present study,using imaging test we preoperatively simulate the field of vision of the camera and the working area(instrumental access)that can be obtained in each patient when the laparoscopic approach is *** From data obtained,we can calculate the access angles that will be obtained in a preoperative computerised axial tomography coronal section,according to the location of the *** also provide the formula for performing the angle calculations If the trocars are placed in loss common situations,thus enabling us to determine the visibility and manoeuvrability for any position of the *** The working area determines the cases in which we can operate safely and those in which certain areas of the hernia cannot be accessed,which is when the thoracoscopic approach would be safer.

关键词： hiatal hernia Angles Approach Laparoscopy Thoracoscopy

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Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor

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World Journal of Gastrointestinal Surgery 2023年第12期15卷 2739-2746页

作者： Francisco Javier Pérez Lara Rogelio Zubizarreta Jimenez Tatiana Prieto-Puga Arjona Pilar Gutierrez Delgado Juan Manuel Hernández Carmona Jose Manuel Hernández Gonzalez Maria Pitarch Martinez Department of Surgery Hopital de AntequeraAntequera 29200Spain DOXA MicrofluidicsRincon de la Victoria 29730Spain Department of Surgery HRU Carlos HayaUnidad Cirugia Hepatobiliopancreat&TrasplantesMalaga 29200Spain

BACKGROUND Giant hernias present a significant challenge for digestive *** approach taken(laparoscopic vs thoracoscopic)depends largely on the preferences and skills of each surgeon,although in most cases today the laparoscopic approach is *** To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem,in order to assess the need for a thoracoscopic *** For the retrospective series of patients treated in our hospital for hiatal hernia(n=112),we calculated the laparoscopic field of view and the working area accessible to surgical instruments,by means of preoperative imaging tests,to assess the likely outcome for cases inaccessible to *** Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was *** difference was statistically ***,the insertion of mesh did not improve results for the non-accessible *** For patients with giant hiatal hernias,it is essential to conduct a preoperative evaluation of the angle of vision and the working area for *** parts of the intrathoracic sac are inaccessible laparoscopically,the thoracoscopic approach should be considered.

关键词： hiatal hernia Abdominal surgery Laparoscopy Thoracoscopy surgery

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hiatal hernia by Rolling Revealed by Respiratory Symptoms: A Rare Condition and Atypical Presentation

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Case Reports in Clinical Medicine 2016年第9期5卷 330-334页

作者： Hind Serhane Othmane Ouardi Hafsa Sajiai Selma Aitbatahar Lamyae Amro Department of Respiratory Medicine Laboratory PCIM Faculty of Medicine and Pharmacy Cadi Ayyad University Marrakesh Morocco

hiatal hernia by rolling is a rare pathology estimated at 5% of all diaphragmatic hernias. It is usually asymptomatic. Sometimes, it can be accompanied by different symptoms, such as post prandial bloating, dysphagia, regurgitation, retro sternal pain, even respiratory symptoms. The aim of this article is to show that a hiatus hernia by rolling can cause a misleading clinical picture that may be taken wrongly for a heart or respiratory disease. We report the case of an 80-year-old patient whose presentation was suggestive of an acute heart condition, but the scan confirmed a rolling diaphragmatic hernia. Because of the rarity and the atypical presentation of this case, we have found it desirable to bring this new observation.

关键词： hiatal hernia Diaphragmatic hernia Rolling hernia Retrosternal Pain Respiratory Symptoms

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Robotic-assisted versus laparoscopic repair of type II, III and IV hiatal hernias: A retrospective study comparing adverse outcomes

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Laparoscopic, Endoscopic and Robotic Surgery 2024年第1期7卷 11-15页

作者： Payton Kooiker Shane Monnett Stephanie Thompson Bryan Richmond West Virginia School of Osteopathic Medicine LewisburgWV24901United States Department of Surgery Charleston Area Medical CenterCharlestonWV25304United States

Objective:Robotic-assisted surgery(RAS)is continuing to expand in use in surgical specialties,including foregut *** available data on its use in large hiatal hernia(HH)repair are limited and *** study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs.a laparoscopic *** study was limited to outcomes in patients with type II,III,and IV HHs,as these hernias are typically more challenging to ***:A retrospective analysis was performed from data obtained from TriNetX,a large deidentified clinical database,over a 10-year *** patients who underwent type II,III,or IV HH repair were included in the *** with robotic repair was compared to laparoscopic *** were propensity score matched for demographic information and *** ratios,risk differences(RDs)with 95%confidence intervals(CIs),and t test for each examined adverse outcome were used to estimate the effects of robotic repair *** ***:In total,20,016 patients who met the inclusion criteria were identified;1,515 patients utilized RAS,and 18,501 used *** to matching,there were significant differences in age,sex,comorbidity,and BMI between the two *** 1:1 propensity score matching,analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or *** who underwent robotic repair were more likely to experience major complications,including venous thromboembolism(RD:0.007,95%CI:0.003,0.011;p?0.002),critical care(RD:0.023,95%CI:0.007,0.039;p?0.004),urinary/renal complications(RD:0.027,95%CI:0.014,0.041;p<0.001),and respiratory complications(RD:0.046,95%CI:0.028,0.064;p<0.001).RAS was associated with a significantly shorter length of stay(32.4±27.5 h vs.35.7±50.1 h,p?0.031),although this finding indicated a reduction in the length of stay of less than 4 *** statist

关键词： hiatal hernia Robotic-assisted surgery Laparoscopic surgery Adverse outcomes

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Robotic Laparoscopic Transdiaphragmatic Repair of Large hiatal hernias

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World Journal of Cardiovascular Surgery 2022年第4期12卷 85-104页

作者： Farid Gharagozloo Mark Meyer University of Central Florida Orlando USA

Introduction: Although laparoscopic Nissen fundoplication is the most common procedure for the repair for hiatal hernia (HH) repair, HH recurrence due to breakdown of the hiatoplasty has been reported as a common mechanism of failure after primary repair. Left transthoracic anatomic and physiologic repair (AFR) of HH is associated with lower incidence of leak and reoperation but greater morbidity. Adopting the transthoracic approach to a robotic laparoscopic platform may represent the ideal approach to the repair of HH. This study reviews the results of this technique. Methods: A retrospective review was performed on patients who had robotic AFR (RAFR) of large HH. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and postoperatively. Objectively, symptoms were graded using the Visick Scale. Recurrence was defined as greater than 2 cm or 10% of the stomach above the diaphragm detected by either CT, esophagogram or endoscopy. The preoperative data was compared to the results at 2 years. Results: 396 patients underwent RAPR. The Median GERD-HRQL score was 42 (range 38 - 45) preoperatively and 6 (range 0 - 14) at two years (p hiatal hernias.

关键词： Robotic hiatal hernia Recurrence

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Cardiovascular Complications of Large hiatal hernias: Expanding the Indications for Robotic Surgical Anatomic and Physiologic Repair: A Review

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World Journal of Cardiovascular Surgery 2022年第3期12卷 39-69页

作者： Farid Gharagozloo Mark Meyer Robert Poston Center for Advanced Thoracic Surgery Global Robotics Institute Advent Health Celebration University of Central Florida Orlando USA

Background: Historically, the pathophysiology of hiatal hernias (HH) has not been fully understood. As a result, the surgical therapy of HH has focused primarily on gastrointestinal symptoms and Gastroesophageal Reflux (GERD). This treatment strategy has been associated with poor relief of symptoms and poor long-term outcomes. In fact, until recently, most patients with HH have been watched and referred for surgery as a last resort. Recent experience has shown that a large (giant) hiatal hernia (GHH) is a common problem known to impact adjacent organs such as the hearts and lungs. Those referred for surgical repair often complain of dyspnea, which is erroneously attributed to pulmonary compression or aspiration, but has been shown to be from tamponade caused from compression of the heart by herniated abdominal contents. This article reviews the present understanding of GHH, the cardiac complications which result from GHH, and the most advanced robotic minimally invasive surgical approach to the anatomic and physiologic repair of GHH. Methods: In a prospective cohort study, we evaluated patients undergoing RRHH with at least a 2-year follow-up. All patients undergoing elective (RRHH) were identified preoperatively and enrolled prospectively in this study. Preoperative characteristics, medical comorbidities, and clinical information were all recorded prospectively and recorded into a secure surgical outcomes database. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and at postoperative time points of 1 month, 1 year, and 2 years. Patients routinely had a barium swallow postoperatively before discharge but did not undergo a barium swallow, an endoscopy, or a CT scan study at the 1-month time point unless indicated by symptoms. At 6 months, 1 year, and yearly intervals thereafter, all patients received an endoscopy study to ascertain the presence of a recurrence, regar

关键词： hiatal hernia GERD Paraesophageal hernia Robotic Surgery Laparoscopic Repair Nissen Belsey Gastroesophageal Valvuloplasty

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Influence of age on outcome of total laparoscopic fundoplication for gastroesophageal reflux disease

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World Journal of Gastroenterology 2007年第5期13卷 740-747页

作者： F Pizza G Rossetti P Limongelli G Del Genio V Maffettone V Napolitano L Brusciano G Russo S Tolone M Di Martino A Del Genio 1st Division of General and Gastrointestinal Sur-gery Second University of Naples Via Pansini 5 Naples 80131 Italy

AIM: To demonstrate that age does not influence the choice of treatment for gastroesophageal reflux disease (GERD). We hypothesized that the outcome of total fun-doplication in patients > 65 years is similar to that of patients aged ≤ 65 ***: Four hundred and twenty consecu-tive patients underwent total laparoscopic fun-doplication for GERD. Three hundred and fifty-five patients were younger than 65 years (group Y), and 65 patients were 65 years or older (group E). The following elements were considered: pres-ence, duration, and severity of GERD symptoms; presence of a hiatal hernia; manometric evalu- ation, 24 h pH-monitoring data, duration of operation; incidence of complications; and length of hospital stay. RESULTS: Elderly patients more often had atypical symptoms of GERD and at manometric evaluation had a higher rate of impaired esophageal peristalsis in compari-son with younger patients. A mild intensity of heartburn often leads physicians to underestimate the severity of erosive esophagitis. The duration of the operation was similar between the two groups. The incidence of intra-operative and postoperative complications was low and the difference was not statistically significant between the two groups. An excellent outcome was observed in 92.9% young patients and 91.9% elderly patients. CONCLUSION: Laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly pa-tients, warranting low morbidity and mortality rates and a significant improvement of symptoms comparable to younger patients.

关键词： Gastroesophageal reflux disease Esophagitis Impaired peristalsis hiatal hernia Laparoscopic totalfundoplication

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Comparison of reflux esophagitis and its complications between African Americans and non-Hispanic whites

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World Journal of Gastroenterology 2009年第23期15卷 2878-2881页

作者： Kenneth J Vega Sian Chisholm M Mazen Jamal Divisions of Gastroenterology and General Internal Medicine University of Florida Health Sciences Center Jacksonville Florida 32207 United States Gastroenterology Section Veterans Affairs Medical Center 5901 E. 7th St. Long Beach CA 90822 United States

AIM: To determine the effect of ethnicity on the severity of reflux esophagitis (RE) and its complications. METHODS: A retrospective search of the endoscopy database at the University of Florida Health Science Center/Jacksonville for all cases of reflux esophagitis and its complications from January 1 to March 31, 2001 was performed. Inclusion criteria were endoscopic evidence of esophagitis using the LA classif ication, reflux related complications and self-reported ethnicity. The data obtained included esophagitis grade, presence of a hiatal hernia, esophageal ulcer, stricture and Barrett's esophagus, and endoscopy indication. RESULTS: The search identified 259 patients with RE or its complications, of which 171 were non-Hispanic whites and 88 were African Americans. The mean ages and male/female ratios were similar in the two groups. RE grade, esophageal ulcer, stricture and hiatal hernia frequency were likewise similar in the groups. Barrett's esophagus was present more often in non-Hispanic whites than in African Americans (15.8% vs 4.5%; P hiatal hernia are similar in non-Hispanic whites and African Americans. Heartburn was more frequently and nausea/vomiting less frequently reported as the primary endoscopic indication in non-Hispanic whites compared with African Americans with erosive esophagitis or its complications. African Americans have a decreased prevalence of Barrett's esophagus compared with non-Hispanic whites.

关键词： Reflux esophagitis African American hiatal hernia Barrett's esophagus

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