PubMed · 5115841
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K S Mullard. 1971-10-23. Reflux and hernia.. https://doi.org/10.1136/bmj.4.5781.236
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BACKGROUND: Laparoscopic treatment of large mixed hiatal hernias was attempted in eight patients. METHODS: One patient (12.5%) was converted to open surgery due to difficulty in repositioning the LES into the abdomen resulting from a shortened esophagus. One left pleural tear occurred intraoperatively and was repaired without further consequence. Median duration of the operation was 150 min (range 120-300 min). RESULTS: No postoperative complications were recorded. All patients are asymptomatic after a median follow-up of 14 months (range 7-15 months). Correct repositioning of the stomach was confirmed by radiological evaluation 1 month after surgery. Early functional results are good. (One asymptomatic gastroesophageal reflux was detected and medical treatment was undertaken). CONCLUSIONS: Laparoscopic crural repair and fundoplication are feasible even in paraesophageal and large mixed hiatal hernias. Advantages of the minimally invasive approach are clear in terms of morbidity, patient comfort, and duration of hospital stay. Nevertheless, long-term assessment is required to confirm the effectiveness of the laparoscopic approach in patients with large mixed hiatal hernias.
Glucose-6-phosphatase is an endoplasmic reticulum system which is found primarily in liver and kidney. Recently, it has become clear that it is also present in lower amounts in a variety of other tissues. Previous histochemical studies of glucose-6-phosphate hydrolysis in trachea have given equivocal results and only one study on adult oesophagus has shown glucose-6-phosphatase, enzymatic activity but without cellular localization. We have now shown, using microassay techniques, that microsomes isolated from human foetal trachea and oesophagus both contain low levels of specific glucose-6-phosphatase activity (mean = 0.9 and 1.5 nmol min-1 mg-1 microsomal protein, respectively) which are less than 10% of the levels in microsomes of human foetal liver of similar age. In the developing trachea, glucose-6-phosphatase immunoreactivity has been found, using a monospecific antibody to the catalytic subunit of the glucose-6-phosphatase enzyme, to be first present at 10-11 weeks' gestation, and thereafter in foetal life, predominantly present in ciliated cells, with smaller amounts in non-ciliated secretory cells, duct lining cells, and occasional basal cells. The foetal oesophageal epithelium is transiently ciliated from 10 to 11 weeks' gestation, but ciliated cells are gradually replaced by squamous cells from 14 to 16 weeks onwards. Glucose-6-phosphatase immunoreactivity in human foetal oesophagus is predominantly confined to ciliated cells, but non-ciliated luminal cells are also reactive, as are occasional basal cells. Mucus secretory cells in foetal trachea and oesophagus are immunonegative, as is the entire epithelium of both organs in the embryo (up to 56 postovulatory days.
The purpose of this study was to validate the use of intraoperative manometry for assessing fundoplication and to search for predictive manometric criteria. This prospective study concerned 48 patients operated for gastroesophageal reflux. The manometry was carried out pre- and intraoperatively for all patients and postoperatively as well for 30 patients. The operative procedures were total fundoplication (n = 25) and posterior (partial) fundoplication (n = 5). The lower esophageal sphincter (LES) pressures and lengths were similar in the preoperative and intraoperative measurements before any esophageal mobilization, whereas the intraoperative LES pressure was significantly higher after fundoplication. The mean postoperative LES pressure decreased by 50 +/- 19% compared with the intraoperative pressure after fundoplication. The final intraoperative pressures of two dysphagic patients were not the highest of the study. More importantly, their final intraoperative pressures were 7.5 and 8.2 times the initial pressure, respectively, which was significantly greater than the intraoperative pressure increase of the nondysphagic patients (4.6 +/- 2.0 times). The final intraoperative pressure of the only patient with recurrence (18.2 mmHg) was the lowest of the study. In conclusion, intraoperative manometry is an effective method for evaluating the LES, and it could have predictive value for the surgical management of gastroesophageal reflux disease.