Stem aperture

There are many surgical treatments for HH. These are presented in two main requirements:

1) Reposition and retention under the diaphragm esophageal-gastric junction;

2) restoration of permanent kardiofundalnogo acute angle.

Interesting operation antelateralnogo brand viagra online move under with herniorrhaphy tight.

R. Belsey in 1955 first reported on transthoracic ezofagofundoplikatsii with subsequent fixation to diaframe V - shaped seams. Relapse in 12% of cases. Many surgeons are usually sutured the stomach to the anterior abdominal wall. In 1960 L. Hill has developed an operation back gastropeksii to "gauge" of the cardia. Some surgeons to restore valve function of the cardia used ezofagofundorafiyu (stomach stapling the bottom of the terminal esophagus).

Transperitoneal access is preferable for uncomplicated hernias. If the hernia is combined with the shortening of the esophagus due to stenosis, it is better to use transthoracic. Transabdominal access deserves attention also because of the patients with eeofagitom have biliary lesions that require surgical correction. Approximately 1 / 3 of patients with esophagitis suffer from duodenal ulcer, therefore, advisable to eliminate hernia combined with vagotomy and pyloroplasty. A common surgical method of treatment is surgery Nissen, combined with the closure of the angle of branch block. In 1963, Nissen fundoplication for the proposed treatment of esophageal hernia complicated by esophagitis. With this operation, the bottom of the stomach wraps around the abdominal esophagus, stomach stapled along the edge of the wall of the esophagus. When particularly large oesophageal hiatus matched stem aperture. This operation is well warned of cardio-oesophageal reflux and it does not impede the passage of food from the esophagus. Fundopliktsiya Nissen is equally good as treatment for a hernia and to prevent reflux. Relapses of the disease are rare, especially in cases not running. Restoration of anatomic relationships with sliding hernia leads to a cure of reflux esophagitis. When hernias, combined with shortening of the esophagus due to esophagitis, the best results are obtained by the operation, BV Petrovsky. After fundoplication is cut in front of the diaphragm, the stomach is stitched seams to separate the diaphragm and remains fixed in the mediastinum (mediastinolizatsiya cardia). After this operation, reflux disappears due to the presence of the valve and there is no infringement of the stomach, as the hole in the diaphragm is wide enough. Fixation to the diaphragm prevents its further displacement into the mediastinum. Nissen at the location of the cardia in the mediastinum than 4 cm above the diaphragm recommends the use of such patients fundoplication transplevralnym, access, leaving the upper section of the cardia the pleural cavity. BV Petrovsky, in these cases applies gastroptyxis valve, which can produce transabdominal, which is very important for elderly patients.

Traumatic diaphragmatic hernia. Especially it is necessary to distinguish between diaphragmatic-intercostal hernia, when the diaphragm generic levitra rupture occurs at the site of attachment of fibers to the lower ribs or in the soldered pleural sinus. In these cases, the hernial protrusion not fall into the free pleural cavity, and in one of the intercostal space, usually on the left.

Clinical picture. Distinguish between symptoms of acute displacement of appearing after the injury and chronic diaphragmatic hernia.

Characterized by:

1) respiratory distress and cardiac activity;

2) symptoms of disorders of the abdominal cavity (vomiting, constipation, bloating)

Complications. Nevpravimost and impairment (30-40% of DW). Hernia after injury are more likely to infringe.

Factors contributing to infringement: the generic viagra small size of the defect, the rigidity of the ring, bountiful meals, physical tension. The clinical picture in abuses - corresponds to the clinic of intestinal obstruction. When infringement of the stomach can not establish a gastric tube.
Differential diagnosis between diaphragmatic hernia and relaxation of the diaphragm. Pneumoperitoneum

Operative treatment. Chrezplevralnym or transabdominal approaches.

Problem of general practitioner:
- When a complaint specific to gastrointestinal manifestations (dysphagia, nausea, vomiting, peristaltic noises in the chest, etc., especially after meals, heavy lifting) or cardiorespiratory (cyanosis, apnea, seizures, birth asphyxia, under the same conditions) should be sent patient to be examined.

obese patients
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