SURGERY OF THE DIAPHRAGM 2 Professor Karam Mosallam

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SURGERY OF THE DIAPHRAGM 2 Professor : Karam Mosallam

SURGERY OF THE DIAPHRAGM 2 Professor : Karam Mosallam

Aquired Diaphragmatic Hernia 1 -Hiatal hernia ; 3 types – sliding. -paraoesophygeal. -combined. 2

Aquired Diaphragmatic Hernia 1 -Hiatal hernia ; 3 types – sliding. -paraoesophygeal. -combined. 2 - Traumatic hernia. *accidental trauma. **iatrogenic trauma.

Hiatal hernia Definition; upward dislocation of the oesophagus and /or stomach due to weakness

Hiatal hernia Definition; upward dislocation of the oesophagus and /or stomach due to weakness or stretching of Hiatus opening. *50% of Diaphragmatic hernias. *Acquired. . more common. *Congenital. . less common. *Incidence increase with age *Usually asypmtomatic. *1/5 of patients presented with GERD.

Sliding Hiatal Hernia The oesophagus (slides) through Hiatus. Usually present with reflux manifestations. May

Sliding Hiatal Hernia The oesophagus (slides) through Hiatus. Usually present with reflux manifestations. May be complicated by peptic ulcers and stricture oesophagus. Commonly associated with Barrett’s oesophagus (columnar epithelium lining the oesophagus) Which predispose to malignancy.

Paraesophygeal hernia Part of the stomach passes to thorax through a defect at the

Paraesophygeal hernia Part of the stomach passes to thorax through a defect at the Phrenoesophygeal membane alongside the oesophagus. However the Gatroesophygeal(GE) junction remains at peritoneal cavity. Reflux manifestations are rare but may incarcerate and there is high risk of gastric volvulus.

Combined hernia This is a rare type in which the lower esophagus and part

Combined hernia This is a rare type in which the lower esophagus and part of the stomach moves together to the chest which interferes with the action of GE junction. The manifestations are a mixture of reflux manifestations, peptic ulcer, may be Barrett’s esophagus with its complications.

DIAGNOSIS Abdominal ultrasound; can diagnose some cases. Chest X ray may need insertion of

DIAGNOSIS Abdominal ultrasound; can diagnose some cases. Chest X ray may need insertion of nasogastric tube(reveales stomach). Barium studies may need Trendlenburg position. CT & MRI Chest are very valuable. Upper GIT endoscopy is very helpful. Esophageal manometry may be needed.

Management Mild to moderate symptoms need medical treatment. Severe symptoms or failure of medical

Management Mild to moderate symptoms need medical treatment. Severe symptoms or failure of medical treatment requires surgery. Surgical procedures may be transabdominal or transthoracic. Surgery may be open Conventional or endoscopic(laparoscopy or thoracoscpy.

Surgical repair It is a procedure called Fundoplication, can be done by two techniques:

Surgical repair It is a procedure called Fundoplication, can be done by two techniques: Nissen (360 degees). Toupet (270 degees).

SURGERY OF THE DIAPHRAGM 3 Professor Karam MosallamSURGERY OF THE DIAPHRAGM 3 Professor Karam Mosallam
SURGERY OF THE DIAPHRAGM Professor Karam Mosallam IntroductionSURGERY OF THE DIAPHRAGM Professor Karam Mosallam Introduction
SURGERY OF THE Esophagus Professor Karam Mosallam IntroductionSURGERY OF THE Esophagus Professor Karam Mosallam Introduction
DIAPHRAGM WALLS DIAPHRAGM WALLS Diaphragm walls are undergroundDIAPHRAGM WALLS DIAPHRAGM WALLS Diaphragm walls are underground
Differential diagnosis of mediastinal masses Prof Karam MosallamDifferential diagnosis of mediastinal masses Prof Karam Mosallam
DIAPHRAGM MUSCLES OF THE POSTERIOR ABDOMINAL WALL DiaphragmDIAPHRAGM MUSCLES OF THE POSTERIOR ABDOMINAL WALL Diaphragm
Single Stage Press Diaphragms Diaphragm Material A DiaphragmSingle Stage Press Diaphragms Diaphragm Material A Diaphragm
ProSeries Diaphragm Pumps Overview Program ProSeries Diaphragm PumpsProSeries Diaphragm Pumps Overview Program ProSeries Diaphragm Pumps