The Surgical Management of GORD and Paraoesophageal Hernia

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The Surgical Management ofGORD and
Paraoesophageal Hernia

• Mr A McMurray
• 13 Dec 2002

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GORD Patient Identification for Fundoplication
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O.G.D.

• Normal
• Abnormal

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Normal

• Wrong Diagnosis
• Still on P.P.I.s
• Hypersensitive mucosa

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Abnormal

• Oesophagitis
• Hiatus Hernia
• Stricture
• Contractions in body of oesophagus
• O.G.J. obscured Fluid
• Metaplasia
• N.G.

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P.H.Studies

• Little value when oesophagitis present
• Very useful when not
• Useful post-operatively

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Manometry

• Dysphagia
• P.H. studies normal
• Post-operatively

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Consent

• Operation
• Open or Laparoscopic
• Stay
• Complications
• Duration
• Success

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Post Op

• Pain
• Fluids
• Food
• Home

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Complications

• Pneumothorax
• Oesophageal Perforation
• Surgical Emphysema
• Complete dysphagia

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Investigations

• C.X.R.
• Contrast studies
• Re-laparoscope

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Paraoesophageal Hernias
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Paraoesophageal Hernias

• Type II hiatus hernia
• Type III hiatus hernia
• Rolling
• Incarcarated
• Gastric volvulus

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P.O.H. Symptoms

• Absent
• Pain
• Dysphagia
• Short of breath
• Early satiety
• Vomiting/regurgitation

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P.O.H. Typical history

• Years of symptoms
• Treated for angina
• On acid suppression
• Has had O.G.D.
• Has had abdominal surgery
• Diagnosis made but mistreated

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P.O.H. complications

• Anaemia
• Haemorrhage
• Obstruction
• Acute gastric dilatation
• Gastric perforation
• Collapse

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P.O.H. treatment

• Surgery or
• Nothing

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P.O.H. Surgery

• Laparoscopic reduction and hiatal repair
• Possibly fundoplication
• Reduction only plus gastropexy
• Thoracotomy