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The authors evaluate the results of mini-invasive therapy in patients diagnosed with upside-down stomach.
From 1998 to 2008, a total of 27 patients diagnosed with upside-down stomach were surgically treated at the 1st Department of Surgery, University Hospital Olomouc. Before the operation, patients were examined endoscopically and a barium swallow...
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Background: Resistant benign esophageal strictures (E.S) are likely to end up to esophageal replacement. Colon patch esophagoplasty (C.P.E) although originally described for correction of long segment esophageal stenosis; it was though that the length of the stricture may limit the use of the patch technique. We performed C.P.E on three to four inc...
Citations
... Upside-down stomach (UDS) is a type of torsion where there is an extreme hiatal hernia formed with organoaxial torsion of the stomach and its localization in the thoracic cavity [55]. Other abdominal organs, mainly the spleen and large intestine, can also be in the hernial sac when this occurs [55][56][57]. ...
... Upside-down stomach (UDS) is a type of torsion where there is an extreme hiatal hernia formed with organoaxial torsion of the stomach and its localization in the thoracic cavity [55]. Other abdominal organs, mainly the spleen and large intestine, can also be in the hernial sac when this occurs [55][56][57]. The entire stomach is dislocated to the thoracic cavity in UDS and surgery is the only possible treatment [55,58]. ...
... Other abdominal organs, mainly the spleen and large intestine, can also be in the hernial sac when this occurs [55][56][57]. The entire stomach is dislocated to the thoracic cavity in UDS and surgery is the only possible treatment [55,58]. Laparoscopic surgery has been shown to be the most successful, with a study of 27 patients showing the average operation time to be 135 minutes [55]. ...
Background
Torsion is a rare manifestation of organs of the abdomen and pelvis. It is imperative to address this medical emergency urgently to prevent poor prognosis.
Methods
A MEDLINE® database search of case report literature was piloted to obtain current information using the query “torsion” and “cotorsion” combined with organs of the abdomen and pelvis.
Findings
Common diagnostic modalities across all types of organ torsion include ultrasound, explorative laparotomy, and computed tomography. Common surgical techniques for treatment include resection, laparotomy, and detorsion. Understanding the clinical features, diagnosis, and treatment of torsion in the spleen, bladder, gallbladder, liver and accessory liver lobe, omentum, ovaries, stomach, large and small bowel, fallopian tubes, appendix, transplanted kidney, testicles and appendix testis, and uterus is essential for the clinician to develop their differential diagnosis in the event they must act appropriately.
Conclusion
Prompt evaluation of abdominal or pelvic torsion is critical as it may present as a medical emergency requiring urgent surgical intervention to ischemic changes from progressing to gangrene.
... UDS comes with complications such as strangulation, stomach obstruction, acute bleeding from ulceration, leading to stomach necrosis, perforations and mediastinitis. 16 Fifty percent or more of these patients have GERD symptoms. 17 Going forward, further examination is necessary of the degree and frequency of symptoms. ...
... 38 Several reports have recommended anterior hemifundoplication for UDS. 17,39 For UDS, Vrba et al carried outNissen fundoplication on patients with preoperative reflux symptoms or reflux esophagitis while conducting fundopexy on the remaining cases, which resulted in good outcomes.16 Based on the above, keeping in mind that fundoplication should be carried out in general, decisions should be made by comprehensively taking into consideration the esophageal motility of each patent, the severity of GERD, age, and complications. ...
The majority of large hiatal hernias are paraesophageal hiatal hernias (PEH). Once prolapse of the stomach to the chest cavity reaches a high degree, it is called an intrathoracic stomach. More than 25 years have elapsed since laparoscopic surgery was carried out as minimally invasive surgery for PEH. The feasibility and safety thereof has nearly been established. PEH may cause serious complications such as strangulation and perforation. The outcome of elective repair of PEH is better than emergent repair, so we should carry out elective repair as much as possible. Although not a major clinical problem, following PEH repair the rate of anatomical recurrence increases with age. In order to reduce the recurrence rate, mesh reinforcement by crural repair has been widely performed. Although this improves the short‐term outcomes, the long‐term outcomes are unclear. For PEH repair, fundoplication and gastropexy are believed desirable. We should select the procedure associated with a lower incidence of dysphagia and so on following surgery. While relaxing incision is useful for primary tension‐free closure, it has not contributed to improvement in the recurrence rate. This work describes several recent topics about minimally invasive surgery for paraesophageal hiatal hernia, especially, large hiatal hernia and intrathoracic stomach.
... Reconstruction of the upper portion of the gastrointestinal tract is completed classically by an open procedure from a minilaparotomy and in most cases using a left-sided cervical approach. Minimally invasive transhiatal laparoscopic esophagectomy was first performed at our department in 2003, based on years of experience with minimally invasive operations of hiatal hernias [10]. Currently, minimally invasive transhiatal laparoscopic esophagectomy is the predominant surgical procedure at our department for all tumors of the distal esophagus and has practically replaced the previously indicated esophagectomy from laparotomy according to Orringer. ...
... To achieve the best perioperative and postoperative results, it is necessary to perform such operations in specialized centers (high volume centers) with personnel experienced in the treatment of esophageal cancer [24,25]. From a surgical standpoint, long-term experience of the surgical team with minimally invasive surgical techniques, especially in the area of the gastroesophageal junction and experience with thoracoscopic surgery, is imperative [10,26,27]. It is necessary, of course, to have a perfect understanding of classical operation techniques for esophageal cancer with the possibility of conversion and completion by an open procedure. ...
The indication for minimally invasive esophagectomy (MIE) in esophageal cancer has an increasing tendency.
To present our cohort of patients operated on between 2006 and 2012. Material and methods: A single centre study of 106 consecutive esophagectomies performed for esophageal cancer by a minimally invasive approach in 79 patients was performed. Transhiatal laparoscopic esophagectomy (THLE) was performed in 66 patients, transthoracic esophagectomy (TTE) in 13 patients, with histological findings of squamous cell carcinoma in 28 and adenocarcinoma in 51 patients.
The MIE was completed in 76 (96.2%) patients. In cases of TTE, the operation was converted to an open procedure in 3 cases. Operation time ranged from 225 to 370 min (average 256 min). The number of lymph nodes removed was 7-16 (11 on average). The postoperative course was without any complications in 54 (68.3%) patients. Respiratory complications were observed in 14 (17.7%) patients (9 following THLE, 5 following TTE). Other serious complications included acute myocardial infarction (1 patient) and necrosis of the gastroplasty (1 patient). Anastomotic dehiscence was observed in 8 patients, left recurrent laryngeal nerve paralysis in 8 patients, intra-abdominal abscesses in 2 patients, and pleural empyema in 1 case. The overall morbidity of patients operated on by MIE was 31.6%. Thirty-day mortality was 10.1%.
The MIE belongs to the therapeutic portfolio of surgical procedures performed for esophageal cancer. Successful performance requires erudition of the surgical team in both minimally invasive procedures as well as in classical surgical treatment of esophageal cancer; therefore centralization of patients is imperative.
... Once the endoscopic treatment was completed patients were qualified for laparoscopic antireflux surgery. Four of them (4/11) expressed consent and were subjected to laparoscopic fundoplication with Nissen's method [10,11]. After the treatment course all patients were subjected to annual endoscopic and histopathological follow-up. ...
Barrett's esophagus develops as a result of chronic injury of esophagus epithelium from gastroesophageal reflux disease. It is defined when metaplastic columnar epithelium replaces the stratified squamous epithelium which normally lies in the distal esophagus. The condition represents a risk factor for esophageal adenocarcinoma. The aim of the radiofrequency ablation (RFA) method is to destroy metaplastic epithelium with radiofrequency electric current and to stimulate reappearance of the flat multilayer epithelium in the distal esophagus.
To evaluate the efficiency and safety of the RFA technique, newly introduced in Poland, in the management of Barrett's esophagus.
Twelve patients were treated with the RFA method. Patients with Barrett's esophagus confirmed in the histopathological report were qualified for treatment. Two RFA techniques were applied using a BARRX(®) device: circular based on the balloon HALO(360) system or focal based on the HALO(90) system mounted to the endoscopic ending. The procedures were performed at 2-month intervals. The macroscopic and microscopic effects of RFA therapy, the patients' treatment tolerance as well as potential complications were evaluated.
In the group of 12 patients subjected to RFA therapy, 10 completed the therapeutic cycle. A total of 37 procedures were performed: 5 HALO(360) and 32 HALO(90). In all patients eradication of the abnormal metaplastic esophageal epithelium was achieved, as confirmed in both endoscopic and histopathological evaluation. In 2 patients with ongoing therapy progressive eradication of metaplastic epithelium was observed. No significant RFA-related complications were reported.
Based on our preliminary results we consider this method to be promising, free of significant complications and well tolerated by patients. In most patients it results in successful eradication of metaplastic epithelium in the distal esophagus.
... This way the angle of His is recreated. Another way is to suture the stomach to the anterior abdominal wall using the Boerem technique [11,12]. ...
The authors present a 32-year-old male patient with incarceration of a recurrent esophageal hiatal hernia after laparoscopic repair. A life-threatening strangulation of the stomach and the transverse colon occurred within a few days after the operation. Relapse of hiatal hernias amounts to almost half of early complications characteristic for the laparoscopic approach. General recommendations regarding surgical technique as well as perioperative care have been proposed in order to decrease the risk of relapse. Also, routine contrast radiology on the first or second day following the laparoscopic operation facilitates early diagnosis of relapse of hiatal hernia with emergent reoperation. This may result in decreased morbidity and improved overall outcome of the treatment.
