scholarly journals Hiatus hernia as a cause of gastroesophageal reflux. Case report

2019 ◽  
Vol 104 (807) ◽  
pp. 121-123
Author(s):  
Mª José Luesma-Bartolomé ◽  
◽  
Irene Cantarero-Carmona ◽  
Juan Luís Blas-Laína ◽  
Irene Morales- Hernández ◽  
...  
Keyword(s):  
Case Report ◽  
Gastroesophageal Reflux ◽  
Hiatus Hernia

Excess gastroesophageal reflux in patients with hiatus hernia is caused by mechanisms other than transient LES relaxations

2000 ◽  
Vol 118 (4) ◽  
pp. A490
Author(s):  
Margot A. van Herwaarden ◽  
Melvin Samsom ◽  
Andre J. Smout
Keyword(s):  
Gastroesophageal Reflux ◽  
Hiatus Hernia

PS01.065: MAGNETIC SPHINCTER AUGMENTATION AS AN EFFECTIVE ALTERNATIVE TO ROUX-EN-Y CONVERSION AFTER BILLROTH II GASTRECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 68-68
Author(s):  
Veronica Lazzari ◽  
Emanuele Asti ◽  
Andrea Sironi ◽  
Matteo Melloni ◽  
Luigi Bonavina
Keyword(s):  
Gastroesophageal Reflux ◽  
Hiatus Hernia ◽  
Acid Reflux ◽  
Jejunal Loop ◽  
Esophageal Wall ◽  
Magnetic Sphincter Augmentation ◽  
Billroth Ii ◽  
Biliary Reflux ◽  
Billroth Ii Gastrectomy ◽  
Billroth Ii Reconstruction

Abstract Background Background and hypothesis Conversion into a 60 cm Roux-en-Y jejunal loop is the most common remedial procedure in patients with gastroesophageal reflux after Billroth II gastrectomy. While this allows diversion of bilio-pancreatic secretions, symptomatic acid reflux may persist in the presence of a mechanically incompetent lower esophageal sphincter. We hypothesized that magnetic sphincter augmentation (MSA) may relieve symptoms and control esophagitis by reducing both acid and biliary reflux. Methods Methods A 70 year-old male patient presented with intractable reflux symptoms and grade B esophagitis 46 years after partial gastrectomy and Billroth II reconstruction for perforated gastric ulcer. The patient underwent extensive diagnostic evaluation. There was a 3 cm hiatus hernia, grade B esophagitis, and hyperemia of the gastrojejunal anastomosis. Biopsies were negative for malignancy and Helicobacter Pylori. pH-impedance testing showed combined acid and non-acid reflux; esophageal peristalsis was normal on high-resolution manometry. After informed consent, the patient preferred the option of laparoscopic MSA versus open laparotomy and Roux-en-Y conversion. Pneumoperitoneum was established with a Hasson trocar. After adhesiolysis, a hiatus hernia with retroesophageal lipoma was identified. The gastroesophageal junction was completely reduced in the abdominal cavity and a posterior crural repair was performed. A tunnel was made between the esophageal wall and the posterior vagus nerve and a no. 16 MSA (Linx®) device was applied. Results Results The postoperative course was uneventful and the patient was discharged home on postoperative day one. At 1- and 6-month follow-up visit the patient was off-medication, tolerated a free diet, and did not complain of any reflux symptom. The mean GERD-HRQL score decreased from 26 to 2 compared to baseline. A barium swallow confirmed the complete reduction of the hiatal hernia and the absence of reflux in the Trendelenburg position. Esophagitis was completely healed. Conclusion Conclusions To the best of our knowledge, this is the first case of MSA implant for refractory gastroesophageal reflux disease after Billroth II gastrectomy. This simple laparoscopic procedure allowed correction of both acid and biliary reflux. Disclosure All authors have declared no conflicts of interest.

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