The Cause of Dysphagia in Uncomplicated Sliding Hiatal Hernia and its Relief by Hiatal Herniorrhaphy

Kaul, B.; DeMeester, Tom R.; Oka, Masaaki; Ball, Chris S.; Stein, Hubert J.; Kim, Choong B.; Cheng, Shih-Chuan

doi:10.1097/00000658-199004000-00005

Cited by 33 publications

(17 citation statements)

References 10 publications

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“…The most distal pressure transducer (level 5) was positioned 2 cm above the upper border of the lower esophageal sphincter when we performed the functional study of the esophageal body. The sphincter pressure was measured at the respiratory inversion point, and the sphincter was considered to be incompetent if the resting pressure was below 8 mmHg and/or the intra-abdominal sphincter length was below 1 cm [11]. The definition of defective contractions included one or more of the following criteria: (1) contraction amplitudes in the distal esophagus below 30 mmHg, (2) occurrence of simultaneous contractions (propagation [20 mm/s), or (3) interrupted contraction waves (contraction amplitudes \15 mmHg).…”

Section: Preoperative Esophageal Testingmentioning

confidence: 99%

The use of medication after laparoscopic antireflux surgery

et al. 2009

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Section: Preoperative Esophageal Testingmentioning

confidence: 99%

The use of medication after laparoscopic antireflux surgery

et al. 2009

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“…This can create insufficiency of the LES since the negative intrathoracic pressure lowers its effective resting pressure and crural pressure support is lost. Due to displacement of the LES sphincter muscle into the chest, patients with a hiatal hernia often display a characteristic double-hump (DH) tracing on esophageal manometry [7]. This effect is created by separation of the manometrically observed HPZ into two distinct locations with a near-baseline pressure bea matter of subjective measurement.…”

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confidence: 99%

Manometric Components of the Lower Esophageal Double Hump

Alexander¹,

Raiser²,

Swain³

et al. 2000

Dig Dis

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Background/Aims: The lower esophageal sphincter manometry of patients with hiatal hernia often displays a double hump configuration. It seems that this is due to gastric herniation above the high-pressure zone of the crura. This study examines this manometric phenomenon in patients with hiatal hernia and relates it to the lower esophageal antireflux barrier. Methods: Manometric and 24-hour pH studies of 68 consecutive patients with suspected gastroesophageal reflux disease were analyzed to obtain information regarding the double hump and acid reflux. Results: The findings of a manometric double hump correlated well with the presence of a hiatal hernia of >5 cm. The overall length of the sphincter complex was greater in patients with a double hump, but the length below the respiratory inversion point was constant. Resting pressures at the respiratory inversion point were significantly lower than those measured at either high-pressure zone. The location of the respiratory inversion point was seen most commonly at the superior margin of the distal high-pressure zone. Double hump patients with a negative acid reflux score were found to have higher pressures in the distal high-pressure zone than those patients with acid reflux. Conclusions: The two high-pressure zones comprising the manometric double hump represent the crural and muscular components of the lower esophageal sphincter. Descriptive information regarding the double hump phenomenon is given, and the importance of the crural component of the lower esophageal sphincter in preventing acid reflux is stressed.

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“…Die Verbesserung der Dysphagierate könnte auch eine Folge der operativen Reduktion der axialen Hiatushernie sein. Sie kann per se zur Dysphagie führen [23], da es durch den Verlust der phrenoösophagealen Befestigung zu einem Spannungsverlust der longitudinalen Ösophagusmuskulatur kommt [24]. Dieser ist für die Funktion der zirkulären Muskelfasern und somit für die Peristaltik von erheblicher Bedeutung [25].…”

Section: Diskussionunclassified

Laparoskopische Toupet-Fundoplicatio bei Patienten mit gastroösophagealer Refluxkrankheit und gestörter Ösophagusperistaltik

Klingler¹,

Gadenstätter²,

Eltschka³

et al. 2001

Visc Med

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LaparoscopicToupet Fundoplication in Patients with Gastroesophageal Reflux Disease and Impaired Esophageal Peristalsis In patients with gastroesophageal reflux disease and impaired esophageal body motility the Nissen fundoplication has been discussed controversially due to its relatively high dysphagia rate. It was the aim of the present cohort study to investigate mid- to long-term results of laparoscopic Toupet fundoplication in these patients. 126 Toupet fundoplications have been performed between 1994 and 2000 at the Department of General Surgery, University Hospital Innsbruck, and the Department of Surgery, Kaiserin-Elisabeth-Spital Vienna. The study population comprises 86 patients (62% male, 38% female, mean age 53 years) with complete postoperative evaluations. Upper gastrointestinal endoscopy, esophageal manometry, 24-hour pH-metry, and the assessment of clinical symptoms were carried out preoperatively and median 23 months postoperatively. Impaired esophageal peristalsis was defined manometrically by means of contraction amplitudes in the distal esophagus and the rate of simultaneous and interrupted waves. 70 patients (81%) were completely free of symptoms postoperatively; heartburn/regurgitation or esophagitis were present in 6 patients (7%). The rate of dysphagia decreased from 51% preoperatively to 9% postoperatively (p < 0.001). Esophageal peristalsis improved significantly: The contraction amplitudes increased (p < 0.001), and the rate of defective waves decreased (p < 0.0001). The lower esophageal sphincter pressure as well as the intra-abdominal sphincter length were significantly improved (p < 0.001). The Nissen fundoplication still represents the gold standard in antireflux surgery – if only due to the long-standing surgical experience. According to our results, the Toupet fundoplication seems to be the better procedure in patients with impaired esophageal peristalsis.

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The Cause of Dysphagia in Uncomplicated Sliding Hiatal Hernia and its Relief by Hiatal Herniorrhaphy

Cited by 33 publications

References 10 publications

The use of medication after laparoscopic antireflux surgery

The use of medication after laparoscopic antireflux surgery

Manometric Components of the Lower Esophageal Double Hump

Laparoskopische Toupet-Fundoplicatio bei Patienten mit gastroösophagealer Refluxkrankheit und gestörter Ösophagusperistaltik

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