Chapter 44 – Hiatal Hernia and Gastroesophageal Reflux Disease

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1、CHAPTER44HIATALHERNIAANDGASTROESOPHAGEALREFLUXDISEASERebeccaP.Petersen,CarlosA.Pellegrini,andBrantK.Oelschlagerthedistalesophagusisthediaphragm.Astheesophaguspassesgastroesophagealrefluxdiseasefromthechesttotheabdomen,itissurroundedbythecruraofparaesophag

2、ealherniasthediaphragm.Duringinspiration,theanteroposteriordiametersummaryofthecruralopeningisdecreased,compressingtheesophagusandincreasingthemeasuredpressureattheLES.Thisconceptisparticularlyimportantfortheinterpretationofesophagealmanometrytracings.Byc

3、onvention,assesstheLESpressureatTheroleofoperativetreatmentforgastroesophagealrefluxandmidorendexpiration,therebyprovidingreliable,reproduciblehiatalherniaschangeddramaticallyduringthe1990s.Onceapressuremeasurements.Thelastcomponentofthepressuregen-relati

4、velyuncommonprocedure,manyantirefluxoperationsanderatedattheloweresophagealhigh-pressurezoneisthetransmit-hiatalherniarepairs(mostlyforparaesophagealhernias)arenowtedpressureoftheabdominalcavity.Theabdominalcompartmentperformedinmanycentersaroundtheworld.

5、Thedrivingforcehasarelativelyhigherpressurethanthethoraciccavity.AGEJbehindincreasedsurgicalreferralfortreatmentwasthedevelop-thatisfirmlyanchoredintheabdominalcavitywillbeexposedmentofminimallyinvasivesurgery.Althoughthetechniquesoftoagreatertransmuralpr

6、essurethanonethatisintheposteriorantirefluxoperationshavenotchanged,theapproachtothemediastinum.operationhasbecomemoreacceptabletothepatientandrefer-Gastroesophagealrefluxmayoccurwhenthepressureofringphysicianbecauseofthesmallincisions,relativelyshorttheh

7、igh-pressurezoneinthedistalesophagusistoolowtohospitalstay,andlackofassociatedperioperativepainwhenpreventgastriccontentsfromenteringtheesophagusorwhenacomparedwithopenapproaches.Thus,thesurgeonmustbesphincterwithnormalpressureundergoesspontaneousrelax-fa

8、miliarwithallaspectsofevaluatingandtreatingbothentitiesation,notassociatedwithaperistalticwaveinthebodyofthe1becauseheorsheisultimatelyresponsibleforthesuccessfulesophagus.Otherchangesinthehigh-pressurezone,suchasou