Complications related to synthetic mesh placement at the esophageal hiatus are more common than previously reported. Multicenter prospective studies are needed to determine the best method and type of mesh for implantation.

The incidence of esophageal adenocarcinoma continues to rise in the USA. The percentage of patients diagnosed with in situ cancer has declined in the twenty-first century.

Background In patients undergoing a variety of procedures, surgical success is in part dependent on maintaining normal intra-abdominal pressure in the immediate postoperative period. Our objective was to quantify intragastric and intravesicular pressures during activities, through the use of manometry catheters. Methods Ten healthy volunteers had a manometry catheter placed transnasally, and a urinary Foley catheter placed. Baseline intragastric and intravesicular pressures were recorded and the catheters were then transduced continuously. Pressures were recorded with activity: coughing, lifting weights, retching (dry heaving), and vomiting. Results All pressure changes were significant from baseline except for weight lifting. The highest intragastric pressure was 290 mmHg, seen during vomiting. Comparison of intragastric and intravesicular pressures showed no significant difference. There was significantly higher intragastric pressure with vomiting and retching as compared with coughing, whereas coughing applied more pressure than weight lifting. Conclusions This is the first report of intragastric pressures during vomiting and retching (dry heaving). We conclude that vomiting and retching (dry heaving) can render significant forces on any tissue apposition within the stomach or the peritoneal cavity.Keywords Intragastric pressure Á Intravesicular pressure Á Manometry Á VomitingThe measurement and understanding of intra-abdominal pressure in the surgical patient is gaining clinical relevance. For patients with hernias (abdominal, inguinal, and hiatal) surgical success is dependent, in part, upon controlling intraabdominal pressures in the immediate postoperative period. This is also true for patients who undergo fundoplication procedures (both open and laparoscopic) because early postoperative vomiting is known to cause fundoplication disruption and intrathoracic migration [1]. We are currently investigating transoral gastroplasty alternatives and it would be useful to quantify the pressure that a gastroplasty would encounter during activities such as lifting, retching, and vomiting. The measurement of intra-abdominal pressure has become an integral part of the care of the critically injured patient, as excessive intra-abdominal pressures lead to abdominal compartment syndrome with disastrous consequences such as renal failure, hypotension, respiratory compromise, and decreased splanchnic circulation [2].A literature review of intra-abdominal pressure during everyday activities reveals a paucity of information. Determination of such pressures would establish a baseline force that needs to be withstood by abdominal closures, hernia repairs, prosthetic mesh, fundoplications, and a

The Pittsburgh PSS reliably reflects the seriousness of esophageal perforation and stratifies patients into low-, intermediate-, and high-risk groups with differential morbidity and mortality outcomes.