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Laparoscopic repair of paraesophageal hernia with organo-axial intrathoracic gastric volvulus

Siow SL, Chuah JS, Mahendran HA

Asian J Endosc Surg, 2020 Jul;13(3):437-440.
PMID: 31338969 DOI: 10.1111/ases.12740

Intrathoracic organo-axial gastric volvulus is a rare clinical entity associated with paraesophageal hernia. It is characterized by migration of the stomach into the thoracic cavity through an enlarged hiatal defect and rotation around its long axis connecting the cardia and the pylorus. A 72-year-old woman presented with epigastric pain that radiated to the left scapula for 1 week prior to presentation. Computed tomography scan of her thorax and abdomen demonstrated paraoesophageal hernia with organo-axial intrathoracic gastric volvulus. Laparoscopically, the stomach was returned to its abdominal position, the mediastinal sac was excised and after adequate intra-abdominal length of the esophagus was attained, the hiatal defect was closed primarily and reinforced with a composite mesh. An anterior 180° partial fundoplication was performed as both an anti-reflux procedure and also as a form of gastropexy. She had an uneventful recovery and remains well after 2 years.

Matched MeSH terms: Fundoplication
Fulltext Anterior dor or posterior toupet with Heller myotomy for achalasia cardia: a systematic review and meta-analysis

Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA

World J Surg, 2019 06;43(6):1563-1570.
PMID: 30756164 DOI: 10.1007/s00268-019-04945-9

BACKGROUND AND AIMS: Partial fundoplication is commonly performed in conjunction with Heller Myotomy. It is, however, controversial whether anterior Dor or posterior Toupet partial fundoplication is the antireflux procedure of choice. The aim was to perform a systematic review and meta-analysis of studies comparing these two procedures.

MATERIAL AND METHODS: A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, Google scholar and current contents for English language articles comparing Dor and Toupet fundoplication following HM between 1991 and 2018 was performed. The outcome variables analyzed included operating time, length of hospital stay (LOHS), overall complication rate, quality of life (QOL), postoperative reflux, residual postoperative dysphagia, treatment failure and reoperations. The meta-analysis was prepared in accordance with the PRISMA-P statement.

RESULTS: Seven studies totaling 486 patients (Dor = 245, Toupet = 241) were analyzed. LOHS was significantly shorter for Toupet repair compared to Dor procedure (WMD 0.73, 95% CI 0.47 to 0.99; P

Matched MeSH terms: Fundoplication/methods*
Epiphrenic oesophageal diverticulum managed via laparoscopic transhiatal approach

Soo WT, Ling JSW, Chuah JS, Siow SL

Med J Malaysia, 2019 Jun;74(3):243-245.
PMID: 31256184

Epiphrenic oesophageal diverticulum is a rare disorder affecting the distal oesophagus. Surgical techniques for this condition evolve over time from open transthoracic and trans-abdominal approaches to minimally invasive surgery. We report a case of an 82-year-old male who presented with symptomatic epiphrenic oesophageal diverticulum over the last 1 year. He underwent laparoscopic transhiatal diverticulectomy, myotomy and anterior partial fundoplication and was discharged well. He remains asymptomatic after a follow-up of 6 months.

Matched MeSH terms: Fundoplication
Fulltext Does mesh augmentation of the hiatal repair with gore bio-A® improve symptomatic outcomes in laparoscopic fundoplication?

Christodoulidou, M., Kosai, N.R., Rajan, R., Hassan, S., Dac, S., Sutton, P.A., et al.

International Medical Journal Malaysia, 2015;14(1):43-48.
MyJurnal

Introduction: Laparoscopic fundoplication is performed for the management of symptomatic hiatus hernias and gastro-oesophageal reflux disease (GORD) refractory to medical therapy. We adopted the use of Gore Bio-A® for selected laparoscopic hiatus hernia repairs in 2011 and with this case series aimed to establish whether mesh augmentation affects symptomatic outcomes. Methods: A retrospective review of prospectively collected data from all laparoscopic fundoplications performed by a single surgeon between October 2011 and January 2013 was performed. Patient specific data were entered into a proforma and analysed using Microsoft ExcelTM. Patient reported outcomes were assessed with a system specific quality of life questionnaire (GORD-HRQL) both pre and post-operatively. Results: Twenty-three patients underwent laparoscopic fundoplication during the study period. Gore Bio-A® re-enforcement of the hiatal repair was used in 14 patients and was the preferred option for those with pre-operative evidence of a large hiatus hernia. Whilst overall there was a statistically significant difference between pre and post-operative scores (21 vs 0, p=

Matched MeSH terms: Fundoplication
Fulltext Successful laparoscopic management of paraesophageal hiatal hernia with upside-down intrathoracic stomach: a case report

Siow SL, Tee SC, Wong CM

J Med Case Rep, 2015;9:49.
PMID: 25890166 DOI: 10.1186/s13256-015-0519-6

Paraesophageal hernia with intrathoracic mesentericoaxial type of gastric volvulus is a rare clinical entity. The rotation occurs because of the idiopathic relaxation of the gastric ligaments and ascent of the stomach adjacent to the oesophagus through the hiatus defect, while the gastroesophageal junction remains in the abdomen. The open approach remains the gold standard therapy for most patients. Here we report the case of a patient with such a condition who underwent a successful laparoscopic surgery. A literature search revealed that this is the first case report from Southeast Asia.

Matched MeSH terms: Fundoplication
Fulltext Gastro-oesophageal reflux in children with severe respiratory symptoms--clinical spectrum and management

Norzila MZ, Azizi BH, Deng CT, Zulfikar A, Devadass P, Tai A

Med J Malaysia, 1996 Mar;51(1):93-8.
PMID: 10967986

Respiratory symptoms in children may be associated with underlying gastro-oesophageal reflux (GOR). We reviewed the case notes of 20 children who presented to us from June 1993 to June 1994 with respiratory symptoms and GOR. The patients consisted of 16 Malays, two Chinese and two Indians with equal number of males and females. Their age at diagnosis was less than one year in 17 patients. The earliest age at presentation was at the third day of life. All patients had major respiratory manifestations i.e. recurrent wheezing, recurrent cough and pneumonia. In addition, three patients had stridor and six patients had apparent life threatening episodes (ALTE). Fourteen patients required ventilation because of respiratory failure. Diagnosis of GOR was based on clinical grounds supported by barium oesophagogram in seven patients and ultrasound examination in 11 patients. Eight patients were fundoplicated because of ALTE and recurrent severe bronchospasm. On follow up, 14 patients had hyperactive airways requiring inhaled bronchodilator and steroid therapy.

Matched MeSH terms: Fundoplication
Changes in the disease-specific quality of life following Dor fundoplication. A multicentre cross-sectional study

Loo GH, Rajan R, Deva Tata M, Ritza Kosai N

Ann Med Surg (Lond), 2020 Jul;55:252-255.
PMID: 32528674 DOI: 10.1016/j.amsu.2020.05.018

Background: Gastrooesophageal reflux disease (GERD) is a spectrum of symptoms arising from the laxity of the cardio-oesophageal junction. Anti-reflux surgery is reserved for patients with refractory GERD. Anterior partial fundoplication (Dor) is a regularly performed anti-reflux surgery in Malaysia. We intend to determine the improvement in disease-specific quality of life in our patients after surgery.
Methods: A multicentre cross-sectional study was conducted to assess patients' improvement in disease-specific quality of life after Dor fundoplication. Ethics approval was obtained from our institutional review board. Patients between the ages of 18 and 65 years who underwent Dor fundoplication within the past five years were assessed using the GERD HRQL as well as the VISICK score via telephone interview. We excluded cases of revision surgery.
Results: Out of 129 patients screened, 55 patients were included. We found a significant improvement in patients' GERD HRQL score with the pre-operative mean score of 28.3 ± 9.39 and 6.55 ± 8.52 post-operatively, p

Matched MeSH terms: Fundoplication
Gastro-oesophageal reflux: clinical profiles and outcome

Lee WS, Beattie RM, Meadows N, Walker-Smith JA

J Paediatr Child Health, 1999 Dec;35(6):568-71.
PMID: 10634985

OBJECTIVES: To assess the clinical features, investigations and outcome of 69 children (40 males, 29 females) with gastro-oesophageal reflux (GOER) referred to a tertiary referral centre in paediatric gastroenterology.
METHODS: A study of all patients with significant GOER seen at the Paediatric Gastroenterology Unit, Queen Elizabeth Hospital for Children, Hackney Road, London, between December 1994 and August 1995.
RESULTS: The median age at referral was 16 months. Presenting symptoms were recurrent vomiting (72%), epigastric and abdominal pain (36%), feeding difficulties (29%), failure to thrive (28%) and irritability (19%). Continuous 24-h lower oesophageal pH studies performed in 57 children showed 20 (35%) had a reflux index of between 10% to 20%, 14 (25%) had a index > 20%, and six (11%) had a postprandial reflux index > 10%. Reflux was shown in 38 (62%) of 62 children who underwent barium studies. None had significant anatomical abnormalities, but in the 22 children who had a negative barium studies, six had severe reflux (reflux index > 20%). Upper gastrointestinal endoscopy performed in 47 children showed reflux oesophagitis in 29 (62%), oesophageal ulceration in three, and Barrett's oesophagus in one. All of the children were treated with standard medical therapy. Sixty-six per cent were able to discontinue medication within 12 months and remained well. Four children (6%) required Nissen's fundoplication for failure to respond to medical therapy.
CONCLUSIONS: Most infants with GOER have an uncomplicated course. False negative results were noted in both pH monitoring and barium meal. Up to 80% of children, with therapy, will improve within 12 months.

Matched MeSH terms: Fundoplication