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A Mastery Approach to Complex Esophageal DiseasesParaesophageal Hernia

A Mastery Approach to Complex Esophageal Diseases: Paraesophageal Hernia [Paraesophageal hernias (PEH) are commonly diagnosed in the Western population, and typically occur in elderly females. These patients usually present with vague symptoms, including postprandial fullness and epigastric pain. There are four different types of PEHs, and surgical repair is generally recommended as treatment for the repair of any symptomatic hiatal hernia. Although PEH repair was traditionally performed primarily using an open surgical approach, with the increased acceptance and practice of minimally invasive surgery, the laparoscopic approach is rapidly becoming the new standard of care for the repair of these hernias. Steps involved in the laparoscopic PEH repair include the complete reduction of the hernia sac, identification of the gastroesophageal junction and the crura, mobilizing a minimum of 3 cm of esophagus intra-abdominally, re-approximation of the crura and maintaining it tension-free using an absorbable mesh onlay, creation of an anti-reflux procedure, and diagnostic endoscopy at the end of the procedure. This chapter reviews various aspects of managing a patient who presents with a paraesophageal hernia, including the preoperative evaluation of patients with a PEH, laparoscopic surgical approach to PEH repair, and current controversies in surgical technique in regards to laparoscopic repair of PEH.] http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

A Mastery Approach to Complex Esophageal DiseasesParaesophageal Hernia

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Publisher
Springer International Publishing
Copyright
© Springer International Publishing AG, part of Springer Nature 2018
ISBN
978-3-319-75794-0
Pages
89 –101
DOI
10.1007/978-3-319-75795-7_7
Publisher site
See Chapter on Publisher Site

Abstract

[Paraesophageal hernias (PEH) are commonly diagnosed in the Western population, and typically occur in elderly females. These patients usually present with vague symptoms, including postprandial fullness and epigastric pain. There are four different types of PEHs, and surgical repair is generally recommended as treatment for the repair of any symptomatic hiatal hernia. Although PEH repair was traditionally performed primarily using an open surgical approach, with the increased acceptance and practice of minimally invasive surgery, the laparoscopic approach is rapidly becoming the new standard of care for the repair of these hernias. Steps involved in the laparoscopic PEH repair include the complete reduction of the hernia sac, identification of the gastroesophageal junction and the crura, mobilizing a minimum of 3 cm of esophagus intra-abdominally, re-approximation of the crura and maintaining it tension-free using an absorbable mesh onlay, creation of an anti-reflux procedure, and diagnostic endoscopy at the end of the procedure. This chapter reviews various aspects of managing a patient who presents with a paraesophageal hernia, including the preoperative evaluation of patients with a PEH, laparoscopic surgical approach to PEH repair, and current controversies in surgical technique in regards to laparoscopic repair of PEH.]

Published: Apr 21, 2018

Keywords: Paraesophageal hernia; Hiatal hernia; Laparoscopy; Hernia repair; Gastroesophageal reflux disease; Gastropexy

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