scholarly journals Causes of unsuccessful surgical treatment of hiatal hernia

2020 ◽  
Vol 11 (2) ◽  
pp. 67-72
Author(s):  
Georgy T. Bechvaya ◽  
Akhmat M. Ahmatov ◽  
Dmitry I. Vasilevsky ◽  
Vladislav V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Disease Recurrence ◽  
High Rate ◽  
Technical Errors ◽  
Large Size ◽  
Abdominal Organs ◽  
Life Threatening ◽  
Visceral Anatomy ◽  
The Relationship

Hiatal hernia is the most common type of visceral anatomy disorder, observed in people under 30 years of age in 10%, older than 50 years in 60%. Four types of hiatal hernias (IIV) are distinguished by the variant of the disturbances in the relationship between the esophagus, stomach, and diaphragm. Indications for surgical treatment of hiatal hernias are gastroesophageal reflux or anatomical disorders, which have a risk of developing life-threatening conditions (obstruction or necrosis of the stomach). An unresolved problem in this part of surgery is the high rate of disease recurrence, reaching 1015 4060%. The subjective reasons for the unsatisfactory results of surgical treatment of this pathology include technical errors in performing interventions (insufficient mobilization of the esophagus, stomach, legs of the diaphragm, incomplete excision of the hernial sac) and flaws in perioperative support (insufficient analgesia, vomiting, cough). The objective factors of the repeated displacement of the abdominal organs into the chest are the large size of the hiatal opening (more than 5 cm in maximum dimension), the insufficient mechanical strength of the legs of the diaphragm (hypotrophy, fibrosis) and the shortening of the esophagus (reduction of the abdominal part length less than 5 cm). Each of the noted factors plays a own role, together determining the success or failure of the surgical intervention. Understanding the basic principles and unresolved issues in this field of surgery is a prerequisite for its further development.

scholarly journals Poor results of surgical treatment of hiatal hernias. Is there a solution to the problem?

2020 ◽  
Vol 11 (4) ◽  
pp. 5-10
Author(s):  
Georgiy T. Bechvaya ◽  
Dmitriy I. Vasilevsky ◽  
Akhmat M. Akhmatov ◽  
Vladislav V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Perioperative Management ◽  
Recurrent Disease ◽  
Anterior Abdominal Wall ◽  
High Recurrence Rate ◽  
Anatomical Changes ◽  
Technical Errors ◽  
Large Size ◽  
Life Threatening ◽  
Visceral Anatomy

Hiatal hernias are the most common violation of visceral anatomy. Indications for surgical treatment of this pathology include refractory gastroesophageal reflux or anatomical changes, which carry a risk of developing life-threatening conditions. An unresolved problem in this area of surgery is the high recurrence rate of the disease, reaching 1040%. Subjective causes of unsatisfactory results are technical errors in performing interventions and violations of perioperative management. Compliance with the methodology of operations and the rules of patient management can minimize this group of factors. Large size of the hiatal opening, mechanical weakness of diaphragm crura and shortening of the esophagus are considered to be objective causes for the recurrent disease. An effective way to increase the reliability of the plastic esophageal opening of the diaphragm is the use of prosthetic materials. When the esophagus is shortened, it is possible to increase its length with the stomach (gastroplasty) or with the formation of a fundoplication wrap in the chest. Another option to increase the reliability of the operation may be fixing the stomach to the anterior abdominal wall (gastropexia) to prevent its redeployment to the chest. The use of this arsenal of techniques allows to reduce the frequency of unsatisfactory results after surgical treatment of hiatal hernias by up to 510%.

scholarly journals Principles of surgical treatment of recurrent hiatal hernias (review of literature)

2020 ◽  
Vol 26 (3) ◽  
pp. 20-24
Author(s):  
G. T. Bechvaya ◽  
D. I. Vasilevsky ◽  
A. M. Ahmatov ◽  
V. V. Kovalik
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux ◽  
Motor Skills ◽  
Surgical Interventions ◽  
Large Size ◽  
Abdominal Organs ◽  
Alternative Approach ◽  
Treatment Indications ◽  
Life Threatening ◽  
Recurrent Hiatal Hernia

Recurrent hiatal hernia is the re-displacement of the abdominal organs into the chest after surgical treatment. Indications for repeated surgical interventions for this pathology are resistant to medical correction gastroesophageal reflux or anatomical disorders, bearing the risk of developing life-threatening conditions. The key task of revision interventions is to identify and address the causes of the failure of the primary operation. The main factors of the recurrence of hernias of this localization are the large size of the hiatal opening, the mechanical weakness of the legs of the diaphragm and the shortening of the esophagus. To increase the reliability of the esophageal aperture plasty in the surgical treatment of recurrent hiatal hernias, prosthetic materials are widely used. When the esophagus is shortened, it is possible to increase its length by creating a gastric stalk (gastroplasty) or fixing the stomach to the anterior abdominal wall (gastropexy). The disadvantage of both methods is the occurring functional impairment. An alternative approach is the formation of a fundoplication wrap in the chest with the closure of the esophageal opening only with its own tissues. To eliminate or prevent the development of gastroesophageal reflux, antireflux reconstruction is an essential component of operations for recurrent hiatal hernias. The option of fundoplication is selected in accordance with the contractility of the esophagus. With normokinesia, circular fundoplication was preferred, with impaired motor skills – free reconstructions.

Recurring Desmoid Tumor of the Foot: A Case Study

1996 ◽  
Vol 17 (4) ◽  
pp. 221-225 ◽  
Author(s):  
Ronald Barbella ◽  
Ira M. Fox
Keyword(s):  
Surgical Treatment ◽  
Desmoid Tumor ◽  
Clinical Characteristics ◽  
Functional Limitation ◽  
Wide Excision ◽  
High Rate ◽  
Diagnosis And Treatment ◽  
Large Size

The desmoid tumor is benign, uncommon, and frequently recurs after excision. It can be confusing in terms of diagnosis and treatment due to its ability to achieve large size, causing functional limitation and/or pain. Its overall clinical characteristics can mimic those of its malignant counterparts. Because of its high rate of recurrence, surgical treatment should include a wide excision around the margins.

Histological Staging and Dupuytren’s Disease Recurrence or Extension after Surgical Treatment: A Retrospective Study of 124 Patients

2009 ◽  
Vol 34 (4) ◽  
pp. 493-496 ◽  
Author(s):  
T. BALAGUER ◽  
S. DAVID ◽  
T. IHRAI ◽  
N. CARDOT ◽  
G. DAIDERI ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Reliable Method ◽  
Disease Recurrence ◽  
High Rate ◽  
Dupuytren’S Disease ◽  
Dupuytren's Disease ◽  
Significant Difference ◽  
Caucasian Patients ◽  
Histological Staging

Dupuytren’s disease has a high rate of recurrence after treatment. In this study we have assessed the usefulness of histological staging in the prediction of recurrence. We have also verified whether there is a correlation between histological staging and features of Dupuytren’s diathesis. We studied 139 hands in 124 Caucasian patients treated between 1997 and 2004. There was a significant difference in the recurrence rate between the three histological types ( P = 0.04). Histological staging was independent of features of Dupuytren’s diathesis. This study confirms that histological staging is a reliable method for predicting recurrence. However, it should be used in association with clinical data to determine precisely the prognosis of patients suffering from Dupuytren’s contracture.

scholarly journals Recurrent hiatal hernias. To operate or not?

2020 ◽  
Vol 11 (5) ◽  
pp. 31-35
Author(s):  
Dmitry I. Vasilevsky ◽  
Georgy T. Bechvaya ◽  
Akhmat M. Ahmatov ◽  
Andrey Yu. Korolkov ◽  
Alexander A. Smirnov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
Recurrent Hernia ◽  
Initial Position ◽  
Long Term Results ◽  
Prosthetic Material ◽  
Scientific Discussion ◽  
Abdominal Organs ◽  
Treatment Indications ◽  
Functional Factors

The recurrence of a hiatal hernia after surgical treatment is the most serious and far from resolved problem in this area of surgery. The validity and effectiveness of surgical treatment of recurrent hiatal hernia of the diaphragm remains the subject of clinical research and scientific discussion. The main problems of such interventions are the difficulty of eliminating the anatomical or functional factors that underlie the failure of the primary operation. The stated provisions determine the need for further searches for a solution of this problem. In the period from 2015 to 2020, 61 patients with recurrent hernia of the gastrointestinal orifice of the diaphragm underwent surgical treatment. Indications for the operation were gastroesophageal reflux refractory to drug therapy or anatomical changes that carry the risk of developing life-threatening conditions. In 58 (95.1%) cases, surgery was performed laparoscopically, in 3 (4.9%) through left-side thoracotomy. In 54 (88.5%) cases, complete restoration of normal anatomy with closure of the hiatal opening with prosthetic material is performed. In 7 (11.5%) cases, when the esophagus was shortened, the fundoplication cuff was created in the chest cavity, and the hiatal opening was performed only with its own tissues. Complications occurred in 11 (18.0%) cases (7 pneumothorax, 2 bleeding, 2 perforation of a hollow organ). Long-term results (12-48 months) were evaluated in 57 (93.4% of operated) people. Repeated recurrence of hiatal hernia of the diaphragm was detected in 6 (10.5%) cases. In 44 (77.2%) cases, the natural anatomical position of the abdominal organs was documented. In 7 (12.3%) patients, with a fundoplication cuff formed in the chest, its initial position was ascertained.

scholarly journals SURGICAL TREATMENT OF RECURRENT HIATAL HERNIAS

2019 ◽  
Vol 178 (5) ◽  
pp. 69-73
Author(s):  
D. I. Vasilevsky ◽  
G. T. Bechvaya ◽  
A. M. Ahmatov
Keyword(s):  
Surgical Treatment ◽  
Hiatal Hernia ◽  
High Frequency ◽  
Common Type ◽  
Long Term Results ◽  
Revision Operation ◽  
Surgical Interventions ◽  
The People ◽  
Visceral Anatomy

OBJECTIVE. Hiatal hernias are the most common type of visceral anatomy disorder. The unresolved problem of surgical treatment of this pathology remains the high frequency of its relapse. Currently, it is believed that repeated surgical interventions for hiatal hernia are technically difficult, carry a high risk of complications and have unsatisfactory long-term results.MATERIAL AND METHODS. In the period from 2015 to 2019, 55 patients with this pathology were operated. In 52 (94.5 %) cases, the revision operation was performed laparoscopically, in 3 (5.5 %) – through left-side thoracotomy. The technique of the operation implied the removal of hiatal hernia and the implementation of antireflux reconstruction. In five (9.9 %) patients with a shortened esophagus, the fundoplication wrap was originally created in the chest; in 50 (90.1 %), normal anatomy was restored.RESULTS. Long-term results ranging from 12 to 48 months were evaluated in 53 (96.4 %) cases. The natural position of the esophagus and stomach in relation to the diaphragm was detected in 43 (81.1 %) patients, relapse of hiatal hernia – in 5 (9.4 %). In 5 patients, the fundoplication wrap formed in the chest was functional. The absence of gastroesophageal reflux was observed in 41 (91.8 % of patients who had GERD before surgery). In 4 (8.8 %) cases, including one patient with antireflux reconstruction in the chest, a relapse of the disease occurred.CONCLUSION. The presented results allowed the surgical treatment of recurrent hiatal hernias reasonable and effective.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

scholarly journals Laparoscopic Treatment of the Largest Mesothelial Adrenal Cyst in Literature

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Surgical Treatment ◽  
Laparoscopic Approach ◽  
Laparoscopic Treatment ◽  
Adrenal Cyst ◽  
Large Size ◽  
Abdominal Organs ◽  
Radical Therapy ◽  
Recovery Times ◽  
Flanking Region ◽  
The Right

Introduction: Adrenal cyst lesions are rare, with varying etiology, with unspecified symptomatic kit and instrumental diagnosis not simple if of large size. The directions for surgical treatment are well defined. Clinical Case: A 28-year-old patient complained of abdominal swelling, slight dyspnea, pain in the right flanking region associated with a lack of weight loss despite voluntary diet. He practices a TC and RM abdomen. That point out a cystic lesion of 30x21x38 cm but do not clarify the origin. He is subjected to laparoscopic surgical treatment which allows to clarify the peritoneal background of cysts, its drainage and removal. Histological examination confirms the mesothelial nature of cysts. The TC abdominal control at a distance of six months points out the correct localization of the abdominal organs, previously moved to the left, and the right surreal leftover. Conclusions: Surgical treatment allows to clarify diagnostic doubts in case of large cystic lesions and to carry out a radical therapy. The removal of only cysts or the entire adrenal gland is controversial. The laparoscopic approach, if possible, is preferable as it guarantees the same result with faster recovery times and less risk of site infection or surgical wound.

scholarly journals Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy

2014 ◽  
Vol 60 (6) ◽  
pp. 571-576 ◽  
Author(s):  
Artur Lício Rocha Bezerra ◽  
Thales Paulo Batista ◽  
Mário Rino Martins ◽  
Vandré Cabral Gomes Carneiro
Keyword(s):  
Surgical Treatment ◽  
Endometrial Carcinoma ◽  
Early Stage ◽  
Disease Recurrence ◽  
Sampling Procedure ◽  
High Rate ◽  
Surgical Morbidity ◽  
Systematic Lymphadenectomy ◽  
Kaplan Meier ◽  
Lymph Nodes Dissection

Objective: the main aim of this study was to describe the authors’ experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. Methods: a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan–Meier method was applied for survival estimation. Results: eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 – Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. Conclusion: on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy.

Surgical treatment of transmissible venereal tumor (sticker sarcoma)

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Bougherara Hithem ◽  
Boukhechem Saïd ◽  
Aguezlane Abdelaziz ◽  
Benelhadj Khouloud ◽  
Aissi Adel
Keyword(s):  
Surgical Treatment ◽  
Cancer Cells ◽  
Treatment Method ◽  
High Rate ◽  
Surgical Removal ◽  
Characteristic Appearance ◽  
Recurrent Tumors ◽  
External Genital Organs

Background: Sticker sarcoma, also called venereal sarcoma or venereal lymphosarcomatosis, is a tumor of the external genital organs in females and males. In male animals the penis and foreskin (prepuce) are affected, in the female, it happens in vagina (vagina) and labia (vulva). The diagnosis of sticker sarcoma is based on the chronic discharge, the typical locations and the characteristic appearance of the tumor. Methods: We have relied on the treatment method on the complete surgical removal of all cancer cells that we can access. Results: After surgery, we notice recurrent tumors about six months after surgical treatment, indicating the need for other treatments in addition to surgery. Conclusion: Although spontaneous regressions of sticker sarcoma are documented (with permanent immunity), chemotherapy is the treatment of choice today. Irradiation should also be effective. If the tumor is only removed surgically, there is a high rate of recurrence, and this is what happened with the case that we treated, as the tumor reappeared after less than six months.

Ion Channel Remodelling in Atrial Fibrillation

2011 ◽  
Vol 7 (2) ◽  
pp. 97 ◽  
Author(s):  
Niels Voigt ◽  
Dobromir Dobrev ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ion Channel ◽  
Antiarrhythmic Drugs ◽  
Current Knowledge ◽  
Bleeding Complications ◽  
Large Size ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
Life Threatening ◽  
Underlying Mechanisms

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial cardiovascular morbidity and mortality, with stroke being the most critical complication. Present drugs used for the therapy of AF (antiarrhythmics and anticoagulants) have major limitations, including incomplete efficacy, risks of life-threatening proarrhythmic events and bleeding complications. Non-pharmacological ablation procedures are efficient and apparently safe, but the very large size of the patient population allows ablation treatment of only a small number of patients. These limitations largely result from limited knowledge about the underlying mechanisms of AF and there is a hope that a better understanding of the molecular basis of AF may lead to the discovery of safer and more effective therapeutic targets. This article reviews the current knowledge about AF-related ion-channel remodelling and discusses how these alterations might affect the efficacy of antiarrhythmic drugs.

Sign in / Sign up

Export Citation Format

Share Document