Literature review: a surgeon’s view of recurrent hiatal hernia

Las hernias hiatales recidivantes constituyen una patología común que generan un reto diagnóstico y terapéutico para cirujanos y gastroenterólogos. Generalmente se presentan de forma asintomática o con síntomas atípicos y se asocian a factores fisiológicos, propios del paciente y de la técnica quirúrgica. Su tratamiento es complejo y dependiendo de la causa de los síntomas pueden requerir manejo médico o quirúrgico. En este artículo, se pretenden definir pautas para la identificación y manejo de esta patología, así como establecer claves para el tratamiento desde un enfoque quirúrgico.Recurrent hiatal hernias are a common pathology that generate a diagnostic and therapeutic challenge for surgeons and gastroenterologists. They are generally asymptomatic or present with atypical symptoms and are associated with the patient’s own physiological factors and the surgical technique. Treatment is complex and, depending on the cause of the symptoms, will require either medical or surgical management. This article starts from a surgical approach to define guidelines for identification and management of this condition and to establish keys to treatment

Evaluation of gastroesophageal reflux after standardized gastric sleeve with the gastroesophageal reflux disease questionnaire (Gerdq)

Objetivo: Evaluar la aparición de reflujo gastroesofágico (RGE) posterior a gastrectomía en manga como manejo para la obesidad, con el Gastroesophageal Reflux Disease Questionnaire (GerdQ). Método: Estudio retrospectivo de pacientes llevados a gastrectomía en manga durante 2016 y 2017, habiendo descartado RGE con endoscopia digestiva alta prequirúrgica, y evaluación posoperatoria con la escala GerdQ. Resultados: Se incluyeron en el estudio 129 pacientes, con un promedio de edad de 45 años, el 77.5% de sexo masculino y como comorbilidad más frecuente hipotiroidismo (25.6%) e hipertensión arterial (23.3%). El 12.4% tenían un puntaje ≥ 8, 14 eran mujeres y 2 hombres, y no hubo relación estadísticamente significativa con el índice de masa corporal preoperatorio. Conclusiones: Estandarizar la técnica de manga gástrica en los servicios de cirugía bariátrica, teniendo en cuenta los factores técnicos asociados a RGE posoperatorio de novo, disminuye la aparición de RGE según lo evaluado por la escala GerdQ.Objective: To evaluate the appearance of gastroesophageal reflux in our population after sleeve gastrectomy as management for obesity, with the Gastroesophageal Reflux Disease Questionnaire (GerdQ). Method: Retrospective study of patients undergoing sleeve gastrectomy during 2016 and 2017, having ruled out gastroesophageal reflux (GER) with pre-surgical upper digestive endoscopy, and post-operative evaluation with the GerdQ scale. Results: 129 patients were included in the study, average age was 45 years, gender of greater male appearance was 77.5%, the most frequent comorbidities were hypothyroidism 25.6% and hypertension 23.3%. 12.4% had a score greater than or equal to 8, 14 were women and 2 men, there was no statistically significant relationship with the preoperative mass index. Conclusions: Standardizing the gastric sleeve technique in the bariatric surgery services, taking into account the technical factors associated with post-operative GERD de novo, decreases its appearance as evaluated by the GerdQ scale

Robot assisted giant paraesophageal hernias repair in a fourth level hospital in Bogotá, Colombia, Shaio Clinic: case series and literature review

Background: Giant paraesophageal hernias have a surgical indication in case of symptoms. Since twenty years ago robot-assisted repair was incorporated to overcome the limitations of the laparoscopic surgery, and to offer new advantages. Objective: To report the experience on repairing giant paraesophageal hernias assisted by robot in a fourth level hospital in Bogotá, Colombia, Shaio Clinic. Method: Retrospective and descriptive study of five cases of giant paraesophageal hernia type III or IV, taken to robotic correction during August 2016 to June 2018. Evaluation of post-surgery outcomes. Results: Five paraesophageal robot-assisted repair were performed. Mean surgical time was 146 minutes, one conversion to open surgery, the average intraoperative bleeding was 100 mL, hospital stay time of 2.2 days. Morbidity, mortality and recurrence percentages in the short time were equal to 0%. Conclusions: Robot-assisted repair of giant paraesophageal hernias, has shown advantages that overcome the limitations of the laparoscopic approach such as dissections in difficult-to-reach angles, increased accuracy, ergonomics, three-dimensional, and closer view of the workspace. In addition, robot-assisted repair promotes better surgical and postoperative outcomes; these advantages have been demonstrated mainly in the repair of giant paraesophageal hernias.Background: Giant paraesophageal hernias have a surgical indication in case of symptoms. Since twenty years ago robot-assisted repair was incorporated to overcome the limitations of the laparoscopic surgery, and to offer new advantages. Objective: To report the experience on repairing giant paraesophageal hernias assisted by robot in a fourth level hospital in Bogotá, Colombia, Shaio Clinic. Method: Retrospective and descriptive study of five cases of giant paraesophageal hernia type III or IV, taken to robotic correction during August 2016 to June 2018. Evaluation of post-surgery outcomes. Results: Five paraesophageal robot-assisted repair were performed. Mean surgical time was 146 minutes, one conversion to open surgery, the average intraoperative bleeding was 100 mL, hospital stay time of 2.2 days. Morbidity, mortality and recurrence percentages in the short time were equal to 0%. Conclusions: Robot-assisted repair of giant paraesophageal hernias, has shown advantages that overcome the limitations of the laparoscopic approach such as dissections in difficult-to-reach angles, increased accuracy, ergonomics, three-dimensional, and closer view of the workspace. In addition, robot-assisted repair promotes better surgical and postoperative outcomes; these advantages have been demonstrated mainly in the repair of giant paraesophageal hernias. Keywords: Cirugía laparoscópica; Cirugía robótica; Giant paraesophageal hernia; Hernia paraesofágica; Hernia paraesofágica gigante; Laparoscopic surgery; Paraesophageal hernia; Robotic surgery