Paraesophageal Hernia

Suturehttp://www.syneture.com/syneture/pageBuilder.aspx?topicID=315http://www.sosmedicalsuperstore.com/PhotoGallery.asp?ProductCode=A306H

RETURNParaesophageal Hernia

IndicationsPatients with a PEH will present with:Gastroesophageal Reflux Disease (GERD)DysphagiaEpigastric PainVomitingBarretts EpitheliumPostprandial Fullness or PainPulmonary DysfunctionPreoperative TestsChest X-RayBarium EsophagramEsophagogastroduodenoscopyEsophageal pH StudyCT Scan (rare)MRI (rare)Pulmonary Function Test (rare)

ClassificationType I not considered a true PEHUpward migration of the GE junction into the mediastinumHernia sac consists of visceral peritoneum, paraesophageal membrane, anterior wall of gastric cardiaType II Upward dislocation of fundus of stomach alongside a normally positioned intraabdominal GE junctionClassification cont.Type IIIUpward displacement of both GE junction and gastric fundusMore common than Type IIType IV aka GiantContains viscera other than stomachLaproscopic vs OpenAdvantages of Laproscopic ProcedureQuicker RecoveryDecreased Length of Hospital StayQuicker Return to Normal ActivitiesReduced Recurrence RateFewer InfectionsSmaller IncisionsAdvantages of OpenIncreased Abdominal Access30 Endoscopehttp://www.stryker.com/en-us/products/Endoscopy/Laparoscopy/Laparoscopes/StandardLengthLaparoscopes/index.htm

RETURNInstruments UsedScalpelSyringe5mm, 10mm, 12mm Trocars30 LaproscopeLiver RetractorHarmonic ScalpelAtraumatic GraspersArticulating GrasperPenrose Drain56 French BougieSuction/Irrigation SystemEndo Universal 65 StaplerBioilogic Implant MeshSuture0 Braided Silk2-0 Braided Silk

Liver Retractorhttp://www.bristolsurgery.com/article.aspx?articleid=100749

RETURNHarmonic Scalpelhttp://www.ethiconendosurgery.com/Clinician/Product/energyhttp://www.hhsurgical.com/Products/Product/Electrosurgical-Units/NoSub/1445-Ethicon-G110-Harmonic-Scalpel-.chtml

RETURNMaryland Dissectorhttp://www.ethiconendosurgery.com/Clinician/Product/endodevices/endohandinstruments#description-specs

RETURNArticulating Grasperhttp://www.covidien.com/autosuture/pagebuilder.aspx?topicID=195028&breadcrumbs=0:63659,172308:0,195057:0

RETURNPlace Liver Retractor

Penrose Drainhttp://www.covidien.com/criticalcare/pageBuilder.aspx?webPageID=0&topicID=67861&xsl=xsl/productPagePrint.xsl

RETURN56 French Bougiehttp://www.stryker.com/en-us/products/Endoscopy/Laparoscopy/AccessoriesandDisposables/InfraVisionEsophagealKit/index.htm

RETURNSuction/Irrigation Systemhttp://www.endotek.com.tr/default.asp?L=EN&mid=173&cat_id=216

RETURNEndo Universal 65http://www.covidien.com/hernia/us/fixation/endouniversal

RETURNHernia

Biologic Implant Meshhttp://www.covidien.com/hernia/us/biologics/permacol

RETURNStitch Hernia Closed

Add Mesh and Staple in Place

Nissen Fundoplication

Endoscopy to Check Alignment

Questions?Thank YouRefrencesSpecial Thanks to Dr. John RothBenign Esophageal Disease. Thoracic Surgery. Stanford School of Medicine. http://thoracicsurgery.stanford.edu/patient_care/benign_esophageal.html Pierre, Andrew F. and Luketich, James D. Laproscopic Repair of Giant Paraesophageal Hernias. Cardiothoracic Surgery Network. http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-9.htmlParaesophagel Hernia. Mount Sinai School of Medicine. http://www.mssurg.net/Team5Conferences/Paraesophageal%20Hernia%20-2.pdfLaparoscopic Paraesophageal Hernia. Ohio State University Center for Minimally Invasive Surgery. The Ohio State University. Department of Surgery. http://cmis.osu.edu/8818.cfmwww.websurg.comUK HealthCare. Hernia Facts Sheet. http://www.ukhealthcare.uky.edu/publications/healthfocus/fact_sheets/hernias.asp