Hiatus hernia and recurrence

Pointner, Rudolph; Granderath, Frank A.

doi:10.1007/s00104-008-1496-8

Cited by 17 publications

(1 citation statement)

References 39 publications

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“…In some patients, failure means resumption of drug therapy. Others may benefit only from surgical revision [2], because the majority of cases are subject to morphological changes either attributable to the fundoplication wrap or the hiatal closure [5]. While different diagnostic follow-up options, such as manometry studies and endoscopy, exist, dynamic MR imaging was recently introduced as a promising non-invasive method for evaluating the gastroesophageal junction after Nissen fundoplication [6].…”

Section: Introductionmentioning

confidence: 99%

Swallowing MRI—a reliable method for the evaluation of the postoperative gastroesophageal situs after Nissen fundoplication

et al. 2018

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Purpose To evaluate the diagnostic performance of swallowing MRI of the gastroesophageal junction (GEJ) in the postoperative care of patients after laparoscopic antireflux surgery (LARS) Material and methods In this institutional review board-approved prospective study, 79 symptomatic patients (mean age, 52.3 years; range, 26–80 years) were evaluated after laparoscopic Nissen fundoplication. MRI findings were correlated with revision surgery, endoscopy, and high-resolution manometry (HRM) as standard of reference. MRI was performed on a 3.0-T unit using T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequences for anatomical assessment of the GEJ followed by dynamic MR swallowing (fast low-angle shot sequences). Four independent readers (two radiologists, two surgeons) rated 83 MR scans according to defined criteria, such as wrap disruption, slipping, recurrent hiatal hernia, and esophageal motility disorder. Results Wrap disruption was correctly diagnosed concordantly with the standard of reference in 87.8%, slipping in 81.5%, and recurrent hiatal hernia in 84.9% of the cases. For esophageal motility disorder, MRI interpretation was consistent with manometry in 66.2% of the subjects. Interobserver analysis showed substantial agreement for recurrent hiatal hernia ( k = 0.703), moderate agreement for wrap disruption ( k = 0.585), and fair agreement for motility disorder and slipping ( k = 0.234 and k = 0.200, respectively). Conclusion MR swallowing readily depicts the major failure mechanisms of LARS and has good reliability even in non-experienced readers. Key Points • MR swallowing accurately readily depicts the major failure mechanisms of laparoscopic antireflux surgery and has good reliability even in non-experienced readers. • It should be included in the preoperative workup for revision surgery after fundoplication. • It will be of great benefit to surgeons in considering and planning a reoperation.

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Section: Introductionmentioning

confidence: 99%

Swallowing MRI—a reliable method for the evaluation of the postoperative gastroesophageal situs after Nissen fundoplication

et al. 2018

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Biomechanical analyses of prosthetic mesh repair in a hiatal hernia model

et al. 2014

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Recurrence rate of hiatal hernia can be reduced with prosthetic mesh repair; however, type and shape of the mesh are still a matter of controversy. The purpose of this study was to investigate the biomechanical properties of four conventional meshes: pure polypropylene mesh (PP-P), polypropylene/poliglecaprone mesh (PP-U), polyvinylidenefluoride/polypropylene mesh (PVDF-I), and pure polyvinylidenefluoride mesh (PVDF-S). Meshes were tested either in warp direction (parallel to production direction) or perpendicular to the warp direction. A Zwick testing machine was used to measure elasticity and effective porosity of the textile probes. Stretching of the meshes in warp direction required forces that were up to 85-fold higher than the same elongation in perpendicular direction. Stretch stress led to loss of effective porosity in most meshes, except for PVDF-S. Biomechanical impact of the mesh was additionally evaluated in a hiatal hernia model. The different meshes were used either as rectangular patches or as circular meshes. Circular meshes led to a significant reinforcement of the hiatus, largely unaffected by the orientation of the warp fibers. In contrast, rectangular meshes provided a significant reinforcement only when warp fibers ran perpendicular to the crura. Anisotropic elasticity of prosthetic meshes should therefore be considered in hiatal closure with rectangular patches.

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Dehnverschluss der Speiseröhre

Stelzner¹

2014

Chirurg

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The investigations described in this article clearly show that the lower esophageal sphincter (LES) represents a variation of circular muscular occlusive mechanisms found elsewhere in the gastrointestinal tract. The LES is a double layer stretch sphincter that operates in an apparently paradoxical manner: it closes when under stretch but opens when the muscle fibers contract. Impedance manometry studies demonstrate that the entire esophagus is involved in the normal functioning of the esophagus as well as in esophageal disorders. The pronounced elasticity of esophageal tissue is a functional feature that has its basis in the singular architecture of elastic fibers located between the muscle layers. All traditional forms of operative treatment of gastroesophageal reflux disease (GERD) impede the natural functioning of the stretch sphincter to a greater or lesser degree by locking it up. The cause of GERD is mainly by contraction of the esophagus brought about by the cephalad transposition of the stretch sphincter segment into the chest. In a sense this is an incipient axial hernia that frequently remains undiagnosed in the early stages. The operative repositioning of the stretch sphincter segment into the abdominal cavity provides sufficient restoration of the natural topographic relationships to achieve a cure of GERD. Whether this straightforward repair restores the function of the entire esophagus remains to be elucidated. The concept of the stretch provides a good explanation of the pathophysiology of achalasia, a condition in which a paralyzed paradoxical ring sphincter remains occluded. Successful myotomy approaches only split the muscularis propria layer of the stretch sphincter while leaving subepithelial muscle fibers intact that remain paralyzed. This limited intervention provides a good relief of symptoms.

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Hiatus hernia and recurrence

Cited by 17 publications

References 39 publications

Swallowing MRI—a reliable method for the evaluation of the postoperative gastroesophageal situs after Nissen fundoplication

Swallowing MRI—a reliable method for the evaluation of the postoperative gastroesophageal situs after Nissen fundoplication

Biomechanical analyses of prosthetic mesh repair in a hiatal hernia model

Dehnverschluss der Speiseröhre

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