Acute complications of hiatal hernias

Česká verzia

Authors: Prochazka V. ¹; Marek F. ¹; Kunovsky L. ^1,2; Čan V. ¹; Dolina J. ²; Kroupa R. ²; Dastych M. ²; Vaculová J. ²; Bartušek D. ³; Ivičič J. ¹; Kala Z. ¹
Authors place of work: Chirurgická klinika LF MU a FN Brno ¹; Interní gastroenterologická klinika LF MU a FN Brno ²; Klinika radiologie a nukleární medicíny LF MU a FN Brno ³
Published in the journal: Gastroent Hepatol 2019; 73(3): 220-227
Category: Digestive Endoscopy: Review Article
doi: https://doi.org/10.14735/amgh2019220

Summary

Hiatal hernias are often associated with treatment of gastroesophageal reflux disease. In such cases, continuation of proton pump inhibitor treatment or surgery is often considered. The rate of complications is low in cases with small hiatal hernias. Unfortunately, the risk of potentially life-threatening acute complications increases as the hernia size grows. Prevention is an important component of hiatal hernia treatment. Planned surgical repair of hiatal hernias is associated with very good functional outcomes and a low risk of postoperative complications. Thus, paraesophageal and large mixed hiatal hernias should be operated on in advance. The most common acute complications of hiatal hernias are stomach volvulus and severe bleeding. Stomach volvulus is a life-threatening acute condition that must be rapidly diagnosed and treated. Its typical symptoms might not be present in every patient and it can be difficult to establish an exact diagnosis. The basis of acute complications of surgical treatment of hiatal hernias is repositioning of the stomach into the abdominal cavity and of the stomach pexis into the abdominal wall. In acute surgery of a large hiatal hernia, the risks are significantly greater with laparotomy than with elective surgery, which usually involves laparoscopy. There is an increased risk of perioperative injury of the esophagus and spleen as well as non-surgical postoperative complications such as pneumonia, delirium, and arrhythmia. Endoscopic treatment might also be an option in specific patients with stomach volvulus without stomach wall perforation. Acute surgery is also required for cases with massive bleeding from a huge hiatal hernia when the possibilities for endoscopic and conservative treatment are limited.

hiatal hernia – reflux esophagitis – laparoscopy – endoscopy – GIT bleeding – stomach volvulus – fundoplication

Keywords:

endoscopy – hiatal hernia – laparoscopy – stomach volvulus – fundoplication – reflux esophagitis – GIT bleeding

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