Posts Tagged ‘thoracic esophagus’
Surgical Procedure for Hiatal Hernia
There are two types: open and laparoscopic surgery, the latter being used more frequently, particularly if the patient has access to resources or health insurance with appropriate coverage.
The preferential path for the cases of esophagitis or uncomplicated hiatal hernias secondary to-and also for most traumatic recurrent hernias and hernias is the way old-abdominal incisional xifoumbilical median.
The technique, generally manages to get into the abdomen and with relative ease, not only to the stomach in hiatal hernias, but also to other organs that have migrated into the chest in hernias of the diaphragm.
To abdominal also allows you to treat other conditions often coexisting with hiatal hernias (peptic ulcer, gallstones, etc.). Stenosis in patients with long or very high indicating the opening of the chest cavity to be secure in the dissection and release of the thoracic esophagus, generally, is set firmly adherent to local structures.
The surgery is aimed more gastroesophageal reflux than the correction of hernias, so that all existing surgical techniques to treat hiatal hernias cause reflux, have as main fixing point 3 to 5 centimeters of the esophagus in the abdomen.
This is replenished in their normal lower esophageal sphincter, which antireflux action is facilitated by synergistic action of intra-abdominal pressure on the abdominal esophagus.
Thus, the gap widened to a diameter is reduced according to the dimensions of the esophagus, without pressing too much.
Experts cite a discussion about whether or not it is indispensable crurorrafia (when you leave a space equivalent to a pulp of finger between the esophagus and closure of the pillars) are in favor of it, therefore it is not yet major surgery, if well done helps to hinder the return of the stomach into the chest.
They consider it essential in this type of surgery, the reaction of an antireflux valve mechanism at the cardia. This can be achieved by single or double suture, between the fundus and the left side of the abdominal esophagus, or covering, like a necklace, the abdominal esophagus made by the fundus.
This coverage can be complete, as recommended by Nissen and Rossetti; or partial freeing of the anterior part of the esophagus and should have a length of 3 to 4 inches. “To not be too narrow the esophagus to the stomach, it is advisable to suture on a large-bore gastric tube or Foch, which may prevent this complication.
The antireflux mechanism can also be obtained by fixing the cardia to the arcuate ligament of the diaphragm. With these procedures are remakes the acute angle between the esophagus and stomach or ‘fistuliza’ penetration of the esophagus into the stomach. “Moreover, the volume created by the aforementioned Embracing esophagi difficult to return the abdomen to the thorax.
Laparoscopic intervention requires general anesthesia and takes between 3 to 4 hours. If developed without serious inconvenience, the patient can get up and go high even a day after surgery, returning relatively quickly to normal activities.