Purpose
Thanks to the improvement of laparoscopic surgical techniques, from the early 1990s we have been witnessing a shift in surgical approach, with reference to many pathologies, such as gallbladder calcolosis, hiatal and, by all means, paraesophageal hernia.In particular, the advantages of laparoscopy, including the reduction of post operative pain and rapid convalescence, convinced surgeons to apply the laparoscopic approach in the treatment of giant paraesophageal hiatal hernias. Many studies were being done since that time, to evaluate the usefulness and feasibility of laparoscopy: in 2000...
Methods and Materials
From January 2000 to March 2008, 34 patients affected by type III and IV paraesophageal hiatal hernia were treated: 24 type III (70.6%) and 10 type IV (29.4%). They were 8 males and 26 females, between 36 and 83 years old (average age 62). A 360-degree Nissen fundoplication was performed in 19 patients and a 270-degree Toupet fundoplication in 15 patients. DF swallow examination was carried out in all of the patients, both in the early post-operative period within 3 days from surgery, and in...
Results
In the early post-operative period, complications occurred in three patients: a hemoperitoneum, a pulmonary embolism and an early recurrence on the first postoperative day, due to strong vomiting, which was highlighted by an urgent DF swallow study, and required immediate laparoscopic operation. In the late period further fluoroscopic controls pointed out a recurrence rate by 14.7% (5/34). DF swallow study permitted to rule out a recurrence of pathologic hernia in 5 patients (14.7%): three (8.8%) were fully asymptomatic, whereas two (5.9%) underwent an operation again.
Conclusion
Digital fluoroscopy swallow study is a fast, well tolerated and reliable diagnostic procedure which plays a foundamental role in post surgical follow up of patients treated for numerous gastro-esophageal diseases, such as giant paraesophageal hiatal hernias. Obviously the radiologist must be aware of the surgical tecniques in order to evaluate the images correctly. In Nissen fundoplication, the fundus is wrapped posteriorly around the distal esophagus and the lower esophageal sphincter, then sutured anteriorly thus making a complete 360° wrap. Digital fluoroscopy reveals a typical subdiaphragmatic...
References
1- Majid Hashemi, Jeffrey H. Peters, Tom R. DeMeester, James E. Huprich, Marcus Quek, Jeffrey A. Hagen, Peter F. Crookes, Jorg Theisen, Steven R. DeMeester, Lelan F. Sillin, and Cedric G. Bremner. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. Journal of the American College of Surgeons. Volume 190, Issue 5, 1 May 2000, Pages 553-5602-Andujar JJ, Papasavas PK, Birdas T, Robke J, Raftopoulos Y, Gagné DJ, Caushaj PF, Landreneau RJ, Keenan RJ. Laparoscopic repair of large paraesophageal hernia...