“Laparoscopic paraesophageal hernia repair is a complex surgical problem with many variables that can affect the outcome. Based on the results of our carefully selected patients, the addition of a fundoplication minimizes postoperative reflux symptoms without additional operative time. In addition, neither dysphagia nor paraesophageal hernia recurrence is affected by the presence of a fundoplication.”
“Paraesophageal hernia repair remains a staple in the armamentarium of the foregut surgeon. Current literature suggests paraesophageal hernia repair should be approached
in a patient-centered, precision medicine manner. In general, hernia reduction, sac excision, and primary suture approximation of the hiatal crura are mandatory. Use of mesh should be based on individual risk factors; if mesh is used, biological meshes appear to have a more favorable safety profile, with the “reverse C” or keyhole configuration allowing for increase in crural tensile strength at it most vulnerable areas.”
“Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia).”
“Intestinal stomas are the surgical exteriorization of either small or large bowel through the anterior abdominal wall. While the principles behind stoma creation are typically the same, there are many different stoma configurations that are created for myriad indications.”
“Although the American Heart Association (AHA) and American College of Cardiology (ACC) and the American College of Chest Physicians (ACCP) provide guidelines on anticoagulation for patients with MHVs, limited guidance is provided for bridging anticoagulation 2,3 The guidelines are focused on preoperative bridging, with virtually no guidance on postoperative bridging.”
“Repeat intestinal resection in patients with Crohn’s disease is associated with an increased rate of anastomotic leakage when compared with initial resection despite similar patient, medication, and procedural factors.”
“The presence of involved histological margins at the time of index resection in Crohn’s disease is associated with recurrence, and plexitis shows promise as a marker of more aggressive disease. Further studies with homogeneity of histopathological and recurrence reporting are required.“”The presence of involved histological margins at the time of index resection in Crohn’s disease is associated with recurrence, and plexitis shows promise as a marker of more aggressive disease. Further studies with homogeneity of histopathological and recurrence reporting are required.“
Surgical Focus 