{"id":5092,"date":"2014-09-01T09:37:56","date_gmt":"2014-09-01T12:37:56","guid":{"rendered":"https:\/\/revistaabcd.org.br\/?p=5092"},"modified":"2023-11-06T09:46:49","modified_gmt":"2023-11-06T12:46:49","slug":"dysphagia-after-hiatal-hernia-correction","status":"publish","type":"post","link":"https:\/\/revistaabcd.org.br\/pt-br\/dysphagia-after-hiatal-hernia-correction\/","title":{"rendered":"Dysphagia after hiatal hernia correction"},"content":{"rendered":"
The gastroesophageal reflux disease is chronic and common condition that affects about 10% of the population in general22<\/sup><\/span>\u00a0and corresponds to about 75% of esophageal disorders, with a progressive increase in incidence over the years18<\/sup><\/span>. Surgical treatment is permanent, in most cases, since the fundoplication restores the competence of the lower esophageal sphincter and the hiatoplasty reduces and treats the associated hiatal hernia. This is old procedure, firstly described in 1956 by Nissen through laparotomy and in 1991 by laparoscopy done by D'Allemagne. The laparoscopic surgical treatment proved to be better over the years for its significant improvement of postoperative pain, shorter hospital stay, faster return to activities and better aesthetic results4<\/sup><\/span>\u00a0,<\/sup>\u00a08<\/sup><\/span>\u00a0,<\/sup>\u00a013<\/sup><\/span>\u00a0,<\/sup>\u00a030<\/sup><\/span>.<\/p>\n Currently there is no doubt that surgical treatment of reflux disease by laparoscopy is safe and effective, with success rates above 85%2<\/sup><\/span>\u00a0,<\/sup>\u00a06<\/sup><\/span>\u00a0,<\/sup>\u00a07<\/sup><\/span>\u00a0,<\/sup>\u00a011<\/sup><\/span>\u00a0,<\/sup>\u00a012<\/sup><\/span>\u00a0,<\/sup>\u00a017<\/sup><\/span>\u00a0,<\/sup>\u00a021<\/sup><\/span>\u00a0,<\/sup>\u00a026<\/sup><\/span>\u00a0,<\/sup>\u00a028<\/sup><\/span>\u00a0being considered the \"gold-standard\" of laparoscopic surgery. However, some complications and failures have been reported in postoperatively3<\/sup><\/span>\u00a0,<\/sup>\u00a09<\/sup><\/span>\u00a0,<\/sup>\u00a016<\/sup><\/span>\u00a0,<\/sup>\u00a023<\/sup><\/span>\u00a0,<\/sup>\u00a024<\/sup><\/span>, among them the stenosis of the esophagogastric junction, dysphagia due to the very \"tight\" valve or fundoplication performed with the gastric body or its migration to the mediastinum. Additionally, recurrent gastroesophageal reflux valve migration resulting in total or partial dehiscence of suture may occur. However, not always these anatomic alterations produce symptoms of reflux disease20<\/sup><\/span>, but atypical ones.<\/p>\n It is the aim of this study is to describe and report the diagnostic methods employed in the occurrence of persistent postoperative dysphagia after laparoscopic surgery for repair of hiatal hernia and reflux disease, as well as the therapeutic approach employed in these cases.<\/p>\n <\/a><\/p>\n Three patients, two men aged 33 and 53 years and a woman aged 24 who underwent four years, two years and eight months before the surgical treatment of reflux disease, who developed persistent dysphagia were studied. All had undergone multiple postoperative endoscopies, with no conclusive diagnosis. So, it was indicated and performed in all cinedeglutogram, which revealed difficulty in emptying the barium contrast to the stomach (Figure 1<\/a>), with formation of diverticular appearance formation on the gastric fundus image, emptying cascade like to the stomach (Figure 2<\/a>).<\/p>\n <\/p>\n <\/a><\/p>\n All were re-operated on, again by laparoscopy, and was recognized that de Nissen fundoplication was done with the gastric body instead the fundus. The operation was to undo the fundoplication and rebuild a new one Lind or Toupet (270\u00b0) partial fundoplication.<\/p>\n All patients recovered uneventfully and were discharged in 48 hours. The evolution in two years later showed disappearance of dysphagia symptoms and absence of gastroesophageal reflux.<\/p>\nCASES REPORT<\/h1>\n