الفهرس 
SURGICAL ANATOMY OF GASTROESOPHAGEAL JUNCTION AND ESOPHAGEAL HIATUSOnly 14 pages are availabe for public view
 |  | from | 132 |  |  |
| | | from | 132 | | |
Abstract
SUMMARY
H
iatal hernias are relatively common, it has been reported to affect 10–50% of the population. Sliding hernias account for more than 85% of hiatal hernias. The reported incidence of paraoesophageal hernia varies between 3.5 and 5% of all operated hiatal hernias.
Most people with hiatal hernias are asymptomatic. Hiatal hernias may predispose to reflux or worsen existing reflux. No clear correlation exists between the size of a hiatal hernia and the severity of the symptoms. A very large hiatal hernia may be present with no symptoms at all.
Incarceration of a hiatal hernia is rare and is observed only with para-esophageal hernia. When this occurs, it can present abruptly, with a sudden onset of vomiting and pain, sometimes requiring immediate operative intervention
The current guideline for the surgical treatment of hiatal hernia was elaborated by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) in the year 2013. Includes symptomatic patients with sliding or paraesophageal hernia, where regurgitation persists despite medical treatment with PPI. Especially those with obstructive symptoms and gastric volvulus, which require urgent surgery..
Usually, a Nissen fundoplication (360°) is performed after most hiatal hernia repairs, unless there is a preexisting esophageal dysmotility, in which case the Toupet fundoplication (270°) is preferred.
In our study, an objective comparison was made between two procedures focusing on multiple aspects of both procedures to stand on the superiority of each one over the other. We compared data including: subjective results of quality of life (HR- QOL score), operative time, operative morbidities and complications, post-operative complications and hospital stay, along with the objective results obtained via barium meal, upper endoscopy and esophageal manometry.
Patients were divided into two equal groups, ten (10) patients each; who were chosen randomly by choosing a sealed envelope method. group (A), underwent laparoscopic mesh hiatal hernioplasty, group (B), underwent laparoscopic hiatal hernia suture cruroplasty
Both procedures were nearly efficient and equal as regards the symptomatic control for the patients, the improvement in their quality of life, healing of esophagitis, and post-operative hospital stay, Laparoscopic mesh hiatal hernioplasty results are superior in terms of short term postoperative hernia recurrence, but evidence supporting routine use of mesh cruropasty is low, mesh should be used according to surgeon preference until additional studies of long term follow up are available