Introduction: The identification of sliding hiatal hernia (SHH) less than 3 cm in size using barium swallow fluoroscopy (BSF) and oesophagogastroduodenoscopy (OGD) was recently noted as a non-reliable method, allowing for approximately 2 cm of inherent error in its size estimate. Aim of the research: We aimed to develop a reliable method, which could be used for preoperative visualisation and accurate anatomic depiction of any hiatal hernia and anatomical abnormalities in patients with incomplete gastro-oesophageal reflux disease (GORD) symptom remission after appropriate medical therapy. Material and methods: Within the period 2015-2017, 29 GORD patients (15 women, mean age 51 years) with incomplete symptom resolution on acid inhibition and equivocal findings as for SHH after endoscopy and/or BSF, were evaluated before laparoscopic anti-reflux surgery (LARS) using a computed tomography scan with a Sengstaken-Blakemore tube (CTSBT) provocation probe to confirm hernia existence. We calculated the sensitivity of each of these diagnostic tests. Results: SHH was diagnosed in 21 patients by OGD and/or BSF, but during the surgery this diagnosis was confirmed in 18 patients. The sensitivity was found to be significantly higher in CTSBT modality, comparing with each of the other diagnostic tests and even higher than in OGD and BSF together. Conclusions: CTSBT has been verified as the most efficient method to confirm or rule out SHH diagnosis or other anatomical abnormalities, which could be used to provide a surgeon with detailed information while making a decision about the advisability of LARS. Streszczenie Wprowadzenie: Rozpoznawanie wślizgowej przepukliny rozworu przełykowego (SHH) o rozmiarze mniejszym niż 3 cm z zastosowaniem fluoroskopii z barytem (BSF) i ezofagoduodendoskopii (OGD) zostało ostatnio uznane za mało wiarygodną metodę, pozwalającą na ok. 2 cm błędu w oszacowaniu jej wielkości. Cel pracy: Opracowanie metody, która może być wykorzystana do przedoperacyjnej wizualizacji i dokładnego anatomicznego obrazowania SHH i innych nieprawidłowości anatomicznych u pacjentów z chorobą refluksową przełyku (GORD). Materiał i metody: W latach 2015-2017 u 29 pacjentów (15 kobiet, średni wiek: 51 lat) z niepełną remisją GORD po odpowiedniej terapii lekowej, u których wcześniej zdiagnozowano GORD i podejrzewano SHH na podstawie wyników endoskopii i/lub BSF, wykonano tomografię komputerową z zastosowaniem sondy Sengstaken-Blakemore (CTSBT) przed laparoskopową operacją antyrefluksową (LARS) w celu potwierdzenia obecności przepukliny. Różnicę czułości testów diagnostycznych obliczono za pomocą testu McNemar's Chi-square. Wyniki: Przepuklinę rozpoznano u 21 pacjentów za pomocą OGD i/lub BSF, chociaż w trakcie operacji rozpoznanie potwierdzono tylko u 18 pacjentów. Czułość diagnostyczna była znacznie wyższa w zakresie modalności CTSBT, gdy porównano ją z każdym z pozostałych testów diagnostycznych, a nawet wyższa niż w OGD i BSF razem. New method of preoperative selection of patients with gastro-oesophageal reflux disease Med...

Introduction: Iatrogenic injuries to the trachea and main bronchi present one of the most dramatic complications traditionally treated by thoracotomy and transcervical-transtracheal approaches but almost never by video-assisted thoracic surgery.Aim: To evaluate our experience in a video-assisted thoracic surgery repair of iatrogenic tracheal lacerations. Material and methods: The group under analysis consisted of 5 consecutive patients (1 male, mean age: 52 years, range: 32-56 years) who were treated for postintubation and intraoperative damage to the tracheobronchial tree using video-assisted thoracic surgery within the period 2015-2018. Thoracic computed tomography and fibreoptic tracheobronchoscopy were used to confirm iatrogenic tracheal ruptures before surgery. The membranous rupture of the trachea was closed with interrupted absorbable sutures, which were additionally sutured through the oesophageal wall or the wall of the gastric conduit to strengthen the suture line. Postoperative treatment included broad-spectrum antibiotic therapy and control tracheobronchoscopy. Results: The average duration of thoracoscopic tracheal rupture repair with suture line reinforcement was 103 min (range: 60-180 min). All patients were treated thoracoscopically without resorting to open surgery and were discharged without any postoperative complications within 16 days (range: 8-22 days). Conclusions: The minimally invasive thoracoscopic approach may be the method of choice for the treatment of intraoperative and post-intubation injuries of the tracheobronchial tree.