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Corbett JM, Eriksson SE, Sarici IS, Jobe BA, Ayazi S. Complications After Paraesophageal Hernia Repair. Thorac Surg Clin 2024; 34:355-369. [PMID: 39332860 DOI: 10.1016/j.thorsurg.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Paraesophageal hernia repair (PEHR) is a challenging operation both technically and because the affected patient population is typically older with more comorbidities. As a result, PEHR is associated with substantial morbidity. Morbidity and mortality following PEHR vary significantly depending on the acuity of the operation and size of the hernia. In addition to a higher risk for general peri- and postoperative complications there are a variety of other foregut specific complications to consider including, acute perioperative, early, and late reherniation, mesh-related complications, perforation, gastroparesis, pulmonary and insufflation-related complications, among others. This review focuses on the complication-specific data on incidence, recognition etiology and management.
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Affiliation(s)
- Julie M Corbett
- Foregut Division, Surgical Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA
| | - Sven E Eriksson
- Foregut Division, Surgical Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA; Chevalier Jackson Research Foundation, Esophageal Institute, Western Pennsylvania Hospital, Pittsburgh, PA, USA
| | - Inanc Samil Sarici
- Foregut Division, Surgical Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA; Chevalier Jackson Research Foundation, Esophageal Institute, Western Pennsylvania Hospital, Pittsburgh, PA, USA
| | - Blair A Jobe
- Foregut Division, Surgical Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA; Chevalier Jackson Research Foundation, Esophageal Institute, Western Pennsylvania Hospital, Pittsburgh, PA, USA; Department of Surgery, Drexel University, Philadelphia, PA, USA
| | - Shahin Ayazi
- Foregut Division, Surgical Institute, Allegheny Health Network, 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA; Chevalier Jackson Research Foundation, Esophageal Institute, Western Pennsylvania Hospital, Pittsburgh, PA, USA; Department of Surgery, Drexel University, Philadelphia, PA, USA; 4815 Liberty Avenue, Suite 454, Pittsburgh, PA 15224, USA.
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da Cunha ST, Vergos G, Pfefferkorn U. Gallstone in the gastric remnant after bariatric surgery. J Surg Case Rep 2024; 2024:rjae524. [PMID: 39211374 PMCID: PMC11358047 DOI: 10.1093/jscr/rjae524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
In the last decades, bariatric surgery has been widely performed to treat obesity and its co-morbidities, with the laparoscopic Roux-en-Y gastric bypass (LRYGB) being the second most commonly performed procedure. Abdominal pain after LRYGB is a common symptom. This report concerns a case of a rare cause of chronic abdominal pain after LRYGB and cholecystectomy in a 48-year-old woman due to a cholesterol stone within the gastric remnant that was removed via open gastrectomy. This is the first documented case of cholesterol stone formation in the gastric remnant and underscores the importance of vigilance for atypical complications in patients undergoing bariatric procedures.
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Affiliation(s)
- Sofia Teixeira da Cunha
- Clinic for Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, 4600 Olten, Switzerland
| | - Georgios Vergos
- Clinic for Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, 4600 Olten, Switzerland
| | - Urs Pfefferkorn
- Clinic for Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten, 4600 Olten, Switzerland
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He S, Jia Y, Xu F, Li Q, Xiong X, Wang H, Jing X, Yang X, He L, Wang H, Tao X. Transient delayed gastric emptying following laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Langenbecks Arch Surg 2021; 406:1397-1405. [PMID: 33825044 DOI: 10.1007/s00423-021-02156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Although laparoscopic Nissen fundoplication (LNF) is a kind of minimally invasive surgery, some transition time may still be required to allow the fundoplicated stomach to adapt to the new anatomical position. We observed transient delayed gastric emptying (DGE) post-LNF in our preliminary study. This study aimed to investigate the occurrence rate and development of transient DGE post-LNF. METHODS Patients who underwent LNF for gastroesophageal reflux disease (GERD) at our institution were recruited consecutively. They were treated with standardized LNF and prospectively followed up for 2 months. Proper diet guidance and/or pharmacologic therapy were given during these 2 months. GERD Health-Related Quality of Life (GERD-HRQL), DGE symptoms, and DGE status were evaluated preoperatively and postoperatively. RESULTS Fifty-one patients underwent LNF and completed a 2-month follow-up. LNF succeeded in all patients. Prior to LNF, no DGE was identified. At the 1-month follow-up, LNF led to a significant reduction in the GERD-HRQL total score but a significantly increased DGE score. Endoscopically, DGE was identified in forty-seven (n = 47, 92.2%) patients. At the 2-month follow-up, the GERD-HRQL scores continued to show decreases compared to the 1 month. The DGE score returned to the baseline value. Endoscopically, no DGE was identified in any patients (n = 0, 0.0%). CONCLUSIONS Transient DGE is a very common one-month post-LNF but can recover quickly in the second month following LNF.
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Affiliation(s)
- Suyu He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China.
| | - Yingdong Jia
- The First Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Fei Xu
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Qianlong Li
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Xin Xiong
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Hui Wang
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Xiaojuan Jing
- The Endoscopy Center, Suining Central Hospital, Sichuan, China
| | - Xuejun Yang
- The First Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, China
| | - Lianfen He
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Hanmei Wang
- The Fourth Department of the Digestive Disease Center, Suining Central Hospital, Sichuan, 629000, China
| | - Xin Tao
- The Nutrition Department, Suining Central Hospital, Sichuan, China
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Differential gastric emptiness according to preoperative stomach position in neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy. Surg Today 2021; 51:1918-1923. [PMID: 33786644 DOI: 10.1007/s00595-021-02274-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We sometimes experienced prolonged delayed gastric emptying (DGE) in neurologically impaired patients undergoing laparoscopic fundoplication and gastrostomy. We explored the difference in the DGE rate according to the preoperative stomach position. METHODS Thirty-two neurological impaired patients who underwent laparoscopic fundoplication and gastrostomy between 2015 and 2019 were classified into two groups based on stomach position: non-elevated stomach position (NESP) and elevated stomach position (ESP). Patients' characteristics, operative result and postoperative gastric emptying were reviewed. RESULTS The 11 ESP patients were significantly older than the 21 NESP patients (p < 0.05). The ESP patients had a significantly heavier body weight (BW) than the NESP patients (p < 0.05). The time taken (days) to reduce gastric drainage (days, below BW × 10 ml) in the NESP (4.3 ± 3.6) was significantly longer than that of ESP (1.3 ± 1.6) (p < 0.05). The time taken (days) to achieve full enteral nutrition in the NESP (14.1 ± 8.9) was significantly longer than that of the ESP patients (8.8 ± 3.1) (p < 0.05). CONCLUSION Elevated stomach position (ESP) patients archived full enteral nutrition earlier than NESP patients after laparoscopic fundoplication and gastrostomy. Stomach position correction might, therefore, be involved in the incidence of DGE.
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Liu DS, Bright T, Thompson SK, Irvine T, Watson DI, Aly A. Patients with Delayed Gastric Emptying Following Laparoscopic Repair of Large Hiatus Hernias Regain Long-Term Quality of Life. J Gastrointest Surg 2020; 24:2654-2657. [PMID: 32671804 DOI: 10.1007/s11605-020-04733-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- David S Liu
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia. .,Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.
| | - Tim Bright
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Sarah K Thompson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Tanya Irvine
- Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - David I Watson
- Oesophagogastric Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5042, Australia.,Flinders University Discipline of Surgery, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia
| | - Ahmad Aly
- Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia.,University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria, 3084, Australia
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Wee M, Liu DS, Thompson SK. Acute gastric dilatation: a life-threatening early complication following laparoscopic hiatus hernia repair. ANZ J Surg 2020; 91:755-757. [PMID: 32820843 DOI: 10.1111/ans.16267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Melissa Wee
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David S Liu
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Oesophago-Gastric Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia
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Shea B, Boyan W, Decker J, Almagno V, Binenbaum S, Matharoo G, Squillaro A, Borao F. Emergent Repair of Paraesophageal Hernias and the Argument for Elective Repair. JSLS 2019; 23:JSLS.2019.00015. [PMID: 31285652 PMCID: PMC6600053 DOI: 10.4293/jsls.2019.00015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives: A feared complication of large paraesophageal hernias is incarceration necessitating emergent repair. According to previous studies, patients who require an emergent operation are subject to increased morbidity compared with patients undergoing elective operations. In this study, we detail patients who underwent hernia repair emergently and compare their outcomes with elective patients. Methods: A retrospective analysis was performed of the paraesophageal hernia repair operations between 2010 and 2016. Patients were divided into 2 groups: patients with hernias that were repaired electively and patients with hernias that were repaired emergently. Perioperative complications and follow-up data regarding morbidity, mortality, and recurrence were also recorded. A propensity analysis was used to compare emergent and elective groups. Results: Thirty patients had hernias repaired emergently, and 199 patients underwent elective procedures. Patients undergoing emergent repair were more likely to have a type IV hernia, have a partial gastrectomy or gastrostomy tube insertion as part of their procedure, have a postoperative complication, and have a longer hospital stay. However, propensity analysis was used to demonstrate that when characteristics of the emergent and elective groups were matched, differences in these factors were no longer significant. Having an emergent operation did not increase a patient's risk for recurrence. Conclusion: Patients who had their hernias repaired emergently experienced complications at similar rates as those of elective patients with advanced age or comorbid conditions as demonstrated by the propensity analysis. The authors therefore recommend evaluation of all paraesophageal hernias for elective repair, especially in younger patients who are otherwise good operative candidates.
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Affiliation(s)
- Brian Shea
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - William Boyan
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Jonathan Decker
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Vincent Almagno
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Steven Binenbaum
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Gurdeep Matharoo
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Anthony Squillaro
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
| | - Frank Borao
- Monmouth Medical Center, Department of Surgery, Long Branch, New Jersey
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Park JM, Kim JW, Chi KC. Long-limb Roux-en-Y Reconstruction after Subtotal Gastrectomy to Treat Severe Diabetic Gastroparesis. J Gastric Cancer 2019; 19:365-371. [PMID: 31598378 PMCID: PMC6769369 DOI: 10.5230/jgc.2019.19.e23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/16/2019] [Accepted: 06/22/2019] [Indexed: 11/20/2022] Open
Abstract
The role of surgical intervention in patients with diabetic gastroparesis is unclear. We report a case of a 37-year-old man with a history of recurrent episodes of vomiting and long-standing type 2 diabetes mellitus. Esophagogastroduodenoscopy did not reveal any findings of reflux esophagitis or obstructive lesions. A gastric emptying time scan showed prolonged gastric emptying half-time (344 minutes) indicating delayed gastric emptying. Laboratory tests revealed elevated fasting serum glucose and glycosylated hemoglobin (HbA1c, 12.9%) and normal fasting C-peptide and insulin levels. We performed Roux-en-Y reconstruction after subtotal gastrectomy to treat gastroparesis and improve glycemic control, and the patient showed complete resolution of gastrointestinal symptoms postoperatively. Barium swallow test and gastric emptying time scan performed at follow-up revealed regular progression of barium and normal gastric emptying. Three months postoperatively, his fasting serum glucose level was within normal limits without the administration of insulin or oral antidiabetic drugs with a reduced HbA1c level (6.9%). Long-limb Roux-en-Y reconstruction after subtotal gastrectomy may be useful to treat severe diabetic gastroparesis by improving gastric emptying and glycemic control.
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Affiliation(s)
- Joong-Min Park
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Won Kim
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyong-Choun Chi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Delayed Gastric Emptying Following Laparoscopic Repair of Very Large Hiatus Hernias Impairs Quality of Life. World J Surg 2018; 42:1833-1840. [PMID: 29159599 DOI: 10.1007/s00268-017-4362-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Delayed gastric emptying (DGE) following hiatus hernia surgery may affect a substantial number of patients with adverse clinical consequences. Here, we aim to evaluate the impact of DGE following laparoscopic repair of very large hiatus hernias on patients' quality of life, gastrointestinal symptomatology, and daily function. METHODS Analysis of data collected from a multicenter prospective randomised trial of patients who underwent laparoscopic mesh versus sutured repair of very large hiatus hernias (>50% of stomach in chest). DGE was defined as gastric food retention visualised at endoscopy after 6 h of fasting at 6 months post-surgery. Quality of life (QOL), gastrointestinal symptomatology, and daily function were assessed with the SF-36 questionnaire, Visick scoring and structured surveys administered prior to surgery and at 1, 3, 6 and 12 months after surgery. RESULTS Nineteen of 102 (18.6%) patients had DGE 6 months after surgery. QOL questionnaires were completed in at least 80% of patients across all time points. Compared with controls, the DGE group demonstrated significantly lower SF-36 physical component scores, delayed improvement in health transition, more adverse gastrointestinal symptoms, higher Visick scores and a slower rate of return to normal daily activities. These differences were still present 12 months after surgery. CONCLUSIONS DGE following large hiatus hernia repair is associated with a negative impact on quality of life at follow-up to 12 months after surgery.
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