Chirurgie-Digestive.com Docteur Paul Lachowsky
 
Surgery of the Digestif Tract
Surgery of Obesity
Laparoscopy

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Centre Hospitalier Inter-régional Edith Cavell

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Pangaertstreet 37
1083 Brussels
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Medical Institute Edith Cavell
Edith Cavell street
32 1180-Brussels
Tel.(0032).2.434.42.40.

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Laparoscopic Digestive > Repair of a hiatal hernia (and of the Gastro-esophageal Reflux)
REPAIR OF A HIATAL HERNIA (and of gastro-esophageal reflux)

The junction between the esophagus and the stomach (cardia) is normally maintained under the diaphragm with strong ligaments. In this position the cardia is a valve allowing the nutrients to pass through to the stomach but blocking the reflux of the gastric acid. If the ligaments are lose, a migration of the cardia through the diaphragmatic opening (hiatus) in the thorax can occur with loss of the valve function. The reflux of gastric acid can inflammate the esophagus - Gastro-Esophageal Reflux Disease- typically recognised with heartburn, a bitter taste, coughing.

One can speak of a sliding hernia with a reflux esophagitis.

The treatment of the hiatus hernia consists out repositioning the stomach under the diaphragm; by stitching  the hiatal opening and recreate the anti-reflux valve. This valve is created by fixing the upper part of the stomach around the esophagus in a fundoplication, as from Nissen (360°) or Toupet (270°)  (photo)

This intervention is justified if a conservative medical treatment is insufficient or resistant.

This intervention is performed on a regular base with excellent results on the long term with disappearing of the symptoms in 90% of the cases.

The principal adverse event is a sense of nutritional blockage (dysphagia) -for solid food- that can occur around 6 to 8 weeks after the intervention.

The procedure can be done by laparoscopy through 5 trocars holes (see picture). Discharge of the patient can be after 48 to 72 hours.

incisions  hernie hiatale par glissement

anatomie du cardia Radiographie: hernie hiatale par glissement

 orifice hiatal très élargi

 


valve anti-reflux de 360°valve anti-reflux de 360°

 

 valve anti-reflux de 270°

(Click on pictures to enlarge) 



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