Hiatus hernia is treated by-a) Surgery when medical treatment has failedb) Nissens’ fundoplicationc) Medical treatment onlyd) None of the above
Correct Answer: ab
Description: • Greater than 95% of HHs is type I or sliding hernias
• Of all PEHs, type III is the most common
• PEHs are more common in females and have an autosomal dominant mode of transmission.
• MC structure to herniate is the fundus of the stomach; other structures that may be located in the hernia sac include the spleen, colon, and omentum
• Type IV PEH has a higher incidence of serious results, with 50% of patients presenting emergently.
Clinical Features
• Most common preoperative symptom and finding is the typical heatburn
• Others are chest pain, epigastric pain, dysphagia, postprandial fullness, regurgitation, vomiting, weight loss, anemia, and respiratory symptoms.
• Hematemesis or anemia is evident in about a third of patients with PEH.
Diagnosis
• Barium swallow is the most important diagnostic test.
• Endoscopy helps to identify mucosal erosions as a source of gastrointestinal blood loss.
• Manometry is needed to determine the motor function of the esophageal body.
Treatment
• Surgical approach: Transabdominal (laparoscopic or open) or transthoracic.
• Transabdominal laparoscopic approach for HH repair is preferred
Cameron Ulcer or Riding Ulcer
• Bleeding can be caused by ischemia of the gastric mucosa or by riding ulcers or Cameron’s ulcers.
• Cameron’s ulcers are due to the constant abrasive force as the stomach rubs against or is pinched by the diaphragmatic hiatus.
• The continuous movement of the stomach and esophagus as they travel up and down with respiration and swallowing compounds the problem.
• Anemia from a PEH resolves in 92% of patients after surgical repair.
Category:
Surgery
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