Transesophageal echocardiography in the diagnosis of acute pericardial tamponade during hiatal hernia repair

摘要

WHEN MEDICAL TREATMENT of hiatal hernia is unsuccessful (eg, worsened symptoms of gastroesophageal reflux) or when there is progressive enlargement of the hernia defect, surgical repair is indicated.Among several surgical techniques described for hiatal hernia repair, the Nissen fun-doplication has been superior, with symptomatic improvement occurring in 85%-90% of patients. This procedure entails wrapping the gastric fundus around the distal esophagus and gastroesophageal junction to reinforce them. Laparoscopic performance of Nissen fundoplication shortens hospital stay compared with performing the surgery with an open laparot-omy. A relatively recent selective addition to the procedure is implantation of a mesh graft to decrease the diaphragmatic defect. This provides an additional mechanical barrier and, therefore, is thought to decrease recurrence. In general, Nissen fundoplication is a safe procedure. However, life-threatening complications have been described and include injury to the stomach and spleen, bleeding complications, and injury to neighboring organs.