Esophageal adenocarcinoma (EAC) is a highly lethal disease associated with a survival of less than 20% at 5 years. The American Cancer Society estimates that 16,940 new esophageal cancer cases will be diagnosed in the United States in 2017, the…
Crural repair and reduction of hiatal hernia (HH) are paramount to the success of an antireflux surgery. Case series from the early laparoscopic era (i.e., the 1990s) reported an unacceptably high recurrence rate of HHs. In addition, some patients were…
Normally, several centimeters of the distal esophagus and the gastroesophageal junction (GEJ) lie below the hiatus within the abdomen. When the GEJ, the fundus of the stomach, or both migrate into the chest above the hiatus, a hiatal hernia is…
Laparoscopic repair of a large hiatal hernia with a widened hiatus is challenging and objective hernia recurrence rates are high. In a recent randomized trial, the recurrence rate exceeded 50% at 5 years after laparoscopic paraesophageal hernia. Tension on the…
Hiatal hernia (HH) was first recognized more than 400 years ago. In 1610 Ambrose Paré described a patient with the stomach herniating through the esophageal hiatus. Bowditch was the first to report repair of an HH in 1853, and Akerlund…
Pathophysiology, Incidence, and Clinical Presentation In normal esophageal anatomy the gastroesophageal junction (GEJ) is located below the hiatal orifice. It is held in place by both the phrenoesophageal ligaments and an aggregate of posterior attachments between the GEJ and cardia…
Paraesophageal hernias are the results of defects in the diaphragmatic hiatus. Widening of the hiatus between the left and right diaphragmatic crura provides the pathway for upward displacement of abdominal contents into the mediastinum. Paraesophageal hernias are an increasingly common…
Over the last three decades bariatric surgery moved from open to laparoscopic procedures, with all the benefits of minimally invasive surgery. All existing restrictive bariatric procedures may affect the esophagus over time, with the possibility of mild or sometimes severe…
Patients with recurrent, persistent, or new symptoms after antireflux surgery can be a challenging problem for the foregut surgeon. Determining who will benefit from reoperation and what operation to perform requires that the surgeon be able to interpret a host…
Gastroparesis is described as delayed gastric emptying (DGE) without evidence of mechanical outlet obstruction. Common symptoms of gastroparesis include chronic nausea, emesis, abdominal pain, early satiety, and bloating. Abdominal pain can be significant and is associated with narcotic dependence in…