Fundoplication is used in treatment of
Correct Answer: Hiatus hernia
Description: Ans. a (Hiatus hernia). (Ref. LB 25th ed., 1024)PARAOESOPHAGEAL ('ROLLING') HIATUS HERNIA# Rolling hiatus hernias are dangerous# Unlike sliding hiatus hernia a rolling hiatus hernia is a true hernia that is prone to complications. True paraoesophageal hernias in which the cardia remains in its normal anatomical position are very rare and confined to museum exhibits and personal collections of interesting cases. The hernia is commonest in the elderly, but may occur in young fit people.# The symptoms of rolling hernia are mostly due to twisting and distortion of the oesophagus and stomach. Dysphagia is common. Chest pain may occur due to distension of an obstructed stomach. Classically the pain is relieved by a loud belch. Symptoms of GORD are variable.# The hernia may be visible on a plain X-ray of the chest as a gas bubble, often with a fluid level behind the heart. Fluid levels are not seen in sliding hernias. A barium meal is the best method of diagnosis. Endoscopic look may be confusing, especially in large hernias endoscopist feels as if have lost sense of direction.# Rolling hernias always require surgical repair as they are potentially dangerous. However, major surgery may not be an attractive prospect in frail elderly patients or in someone who has few symptoms. The essential part of the operation is reduction of the hernia and some form of gastropexy. Some surgeons perform a fundoplication arguing that this is a very effective means of maintaining reduction and that it deals with the associated GORD.# Laparosopic repair has recently become popular. Full anatomical repair of a large rolling hernia can be tedious and difficult by the laparoscopic approach and it is more common simply to reduce the hernia and perform a gastropexy. Some surgeons lay a sheet of prosthetic mesh across the hiatal opening to stop the bowel entering it.# Total or partial fundoplication? The disadvantage of the Nissen fundoplication is that it can produce an overcompetent cardia resulting in dysphagia or the gas bloat syndrome in which belching is prevented. As a result the stomach fills with air and the patient feels very full after meals and passes excessive flatus. The problem of the overcompetent cardia has been largely overcome by the floppy Nissen in which the fundoplication is made very loose around oesophagus and also by making a short fundoplication of 1 cm or so.
Category:
Surgery
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