Transcript of Morgan Randall. Paraesophageal Hernia Indications Patients with a PEH will present with:...
- Slide 1
- Morgan Randall
- Slide 2
- Paraesophageal Hernia
- Slide 3
- Indications Patients with a PEH will present with:
Gastroesophageal Reflux Disease (GERD) Dysphagia Epigastric Pain
Vomiting Barretts Epithelium Postprandial Fullness or Pain
Pulmonary Dysfunction
- Slide 4
- Preoperative Tests Chest X-Ray Barium Esophagram
Esophagogastroduodenoscopy Esophageal pH Study CT Scan (rare) MRI
(rare) Pulmonary Function Test (rare)
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- Slide 6
- Classification Type I not considered a true PEH Upward
migration of the GE junction into the mediastinum Hernia sac
consists of visceral peritoneum, paraesophageal membrane, anterior
wall of gastric cardia Type II Upward dislocation of fundus of
stomach alongside a normally positioned intraabdominal GE
junction
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- Classification cont. Type III Upward displacement of both GE
junction and gastric fundus More common than Type II Type IV aka
Giant Contains viscera other than stomach
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- Laproscopic vs Open Advantages of Laproscopic Procedure Quicker
Recovery Decreased Length of Hospital Stay Quicker Return to Normal
Activities Reduced Recurrence Rate Fewer Infections Smaller
Incisions Advantages of Open Increased Abdominal Access
- Slide 9
- Contraindications Contraindications for the laparoscopic
approach Absolute contraindications: abdominal or mediastinal
perforation. Relative contraindications single or multiple
recurrences in patients with multiple abdominal scars (the thoracic
route may be indicated in these patients),
- Slide 10
- Instruments Used Scalpel Syringe 5mm, 10mm, 12mm Trocars 30
Laproscope Liver Retractor Harmonic Scalpel Atraumatic Graspers
Articulating Grasper Penrose Drain 56 French Bougie
Suction/Irrigation System Endo Universal 65 Stapler Bioilogic
Implant Mesh Suture 0 Braided Silk 2-0 Braided Silk
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- Room Setup
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- Port Placement
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- 10mm Port 5mm Port 12mm Port 5mm Port 15 cm
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- Room Setup
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- Place Liver Retractor
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- Important Structures
http://upload.wikimedia.org/wikipedia/commons/4/4b/Gray793.png
http://www.biology-online.org/articles/computer_simulation_analysis_normal/figures.html
http://www.med.umich.edu/anatomy/plastinate/galleries/Green_Lab/Abdominal_Cross_Section.html
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- Hernia Dissection
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- Mobilize Fundus of Stomach
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- Place Penrose Drain
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- Hernia
- Slide 21
- Stitch Hernia Closed
- Slide 22
- Slide 23
- Add Mesh and Staple in Place
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- Nissen Fundoplication
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- Endoscopy to Check Alignment
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- Questions?
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- Thank You
- Slide 28
- Refrences Special Thanks to Dr. John Roth Benign Esophageal
Disease. Thoracic Surgery. Stanford School of Medicine.
http://thoracicsurgery.stanford.edu/patient_care/benign_esophageal.html
Pierre, Andrew F. and Luketich, James D. Laproscopic Repair of
Giant Paraesophageal Hernias. Cardiothoracic Surgery Network.
http://www.ctsnet.org/sections/clinicalresources/thoracic/expert_tech-9.html
Paraesophagel Hernia. Mount Sinai School of Medicine.
http://www.mssurg.net/Team5Conferences/Paraesophageal%20Hernia%20-
2.pdf Laparoscopic Paraesophageal Hernia. Ohio State University
Center for Minimally Invasive Surgery. The Ohio State University.
Department of Surgery. http://cmis.osu.edu/8818.cfm www.websurg.com
UK HealthCare. Hernia Facts Sheet.
http://www.ukhealthcare.uky.edu/publications/healthfocus/fact_sheets/herni
as.asp
- Slide 29
- Endo Universal 65
http://www.covidien.com/hernia/us/fixation/endouniversal
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- Slide 30
- 30 Endoscope
http://www.stryker.com/en-us/products/Endoscopy/Laparoscopy/Laparoscopes/StandardLengthLaparoscopes/index.htm
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- Slide 31
- Trocar Available in 5mm, 8mm, 10mm, 12mm
http://www.ethiconendosurgery.com/Clinician/Product/access/trocars/xcelbladeless#About
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- Slide 32
- Biologic Implant Mesh
http://www.covidien.com/hernia/us/biologics/permacol RETURN
- Slide 33
- Maryland Dissector
http://www.ethiconendosurgery.com/Clinician/Product/endodevices/endohandinstruments#description-specs
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- Slide 34
- Penrose Drain
http://www.covidien.com/criticalcare/pageBuilder.aspx?webPageID=0&topicID=67861&xsl=xsl/productPagePrint.xsl
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- Slide 35
- 56 French Bougie
http://www.stryker.com/en-us/products/Endoscopy/Laparoscopy/AccessoriesandDisposables/InfraVisionEsophagealKit/index.htm
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- Slide 36
- Articulating Grasper
http://www.covidien.com/autosuture/pagebuilder.aspx?topicID=195028&breadcrumbs=0:63659,172308:0,195057:0
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- Slide 37
- Suction/Irrigation System
http://www.endotek.com.tr/default.asp?L=EN&mid=173&cat_id=216
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- Slide 38
- Scalpel
http://www.google.com/search?hl=en&sugexp=ldymls&xhr=t&q=scalpel&cp=6&bav=on.2,or.r_gc.r_pw.&wrapid=tljp1303234486536010&um=1&ie
=UTF-8&tbm=isch&source=og&sa=N&tab=wi&biw=1259&bih=617
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- Slide 39
- Harmonic Scalpel
http://www.ethiconendosurgery.com/Clinician/Product/energy
http://www.hhsurgical.com/Products/Product/Electrosurgical-Units/NoSub/1445-Ethicon-G110-Harmonic-Scalpel-.chtml
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- Slide 40
- Syringe
http://www.mediray.com/Pages/Products/SyringeShields.html
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- Slide 41
- Liver Retractor
http://www.bristolsurgery.com/article.aspx?articleid=100749
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- Slide 42
- Suture
http://www.syneture.com/syneture/pageBuilder.aspx?topicID=315
http://www.sosmedicalsuperstore.com/PhotoGallery.asp?ProductCode=A306H
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