A mechanism of abnormal motility of the esophagus and stomach and associated sound phenomenon

The aim of the article is to update the pathophysiological mechanisms that cause the appearance and activation of pathological peristalsis of the esophagus and stomach and associated esophageal-gastrointestinal-diaphragmatic noise, described earlier, designed to expand the diagnostic capabilities of physical methods for diagnosing hiatal hernia and to facilitate the differential diagnosis of this disease with other diseases of the chest. The result of the study is to describe 5 the pathophysiological mechanisms of developing hernia hiatal and lead to the emergence of pathological motility of the esophagus and stomach in the form of the strengthening or emergence of antiperistaltic waves. The resulting acoustic phenomenon is the essence of a new physical symptom in this disease - esophageal-gastrointestinal-diaphragmatic noise. The first mechanism that determines the pathological motor activity of the smooth muscle cells of the esophageal wall is the so-called esophageal “cleansing” peristalsis, which prevents the regurgitation of the acidic contents of the stomach into the esophagus, where the environment is normally neutral. The second mechanism that causes the appearance and strengthening of pathological peristalsis of the stomach is the deformation during the passage of its part through the esophageal opening of the diaphragm into the chest cavity. The third mechanism that determines the occurrence of pathological peristalsis of the esophagus and stomach is a violation of the secretion and metabolism of nitric oxide in diaphragmatic hernias. The fourth mechanism that leads to the appearance of esophageal-diaphragmatic noise is the pathological peristalsis of the esophagus and stomach in patients with hiatal hernia, which causes the appearance of antiperistaltic waves accompanied by gastro-esophageal reflux and manifests itself in clinically pathological belching. The fifth mechanism that causes pathological peristalsis of the esophagus is the phenomenon of hydrodynamic cavitation, which occurs as a result of regurgitation of the contents of the stomach into the esophagus. Understanding the pathophysiological mechanisms that cause the appearance of pathological peristalsis and antiperistalsis of the esophagus and stomach in patients with diaphragmatic hernia allows us to understand the causes of the sound phenomenon and the associated physical symptom in this disease.

The use of the transabdominal approach to repair Morgagni hernia in a 28-year-old symptomatic female: a case report

Morgagni’s hernia is a congenital diaphragmatic hernia, which represents only 3 % of all diaphragmatic hernias. Herein, we report a case of a 28-years old symptomatic female with Morgagni’s hernia who underwent a trans-abdominal surgery using a mesh placed.

P010 FEASIBILITY OF MIDLINE RECONSTRUCTION WITHOUT MYOFASCIAL RELEASE (COMPONENT SEPARATION) AFTER PREOPERATIVE INFILTRATION OF LATERAL ABDOMINAL WALL MUSCULATURE WITH BOTULINUM TOXIN

Aim Aim of the analysis was to evaluate whether preoperative botulinum toxin infiltration may facilitate anatomical midline reconstruction without the need for – otherwise pre-operative assumed – surgical component separation. Material and Methods Total of 58 patients with complex abdominal wall hernias were included in our single-center retrospective analysis between 03/2015 and 12/2020. Size of the defect, HSV/ACV-ratio, rectus-to-defect-width-ratio (“Carbonell-Index”) as well as risk factors were analyzed. In all patients muscles of the lateral abdominal wall were infiltrated with 300-500 IE of botulinum toxin 4 weeks prior to the abdominal wall reconstruction. CT scans were performed before and 4 weeks after the botulinum toxin infiltration. Results Total of 58 patients (M/F-ratio 36:22), with a mean age of 63.8 years were included in our analysis. Mean BMI was 29.5 kg/m². Total of 50 incisional, 3 umbilical, 2 posttraumatic diaphragmatic hernias and 3 scrotal hernias were analyzed. Surgical component separation after the infiltration with botulinum toxin was necessary in 43% of the cases. Conclusions Preoperative infiltration of the lateral abdominal wall musculature with botulinum toxin facilitated midline reconstruction of the abdominal wall without the need for myofascial release in 57%. Reduction of surgical trauma could therefore be achieved in several patients.

Fibroblast-derived HGF integrates muscle and nerve development during morphogenesis of the mammalian diaphragm

The diaphragm is a domed muscle between the thorax and abdomen essential for breathing in mammals. Diaphragm development requires the coordinated development of muscle, connective tissue, and nerve, which are derived from different embryonic sources. Defects in diaphragm development cause the common and often lethal birth defect, Congenital Diaphragmatic Hernias (CDH). HGF/MET signaling is required for diaphragm muscularization, but the source of HGF and the specific functions of this pathway in muscle progenitors or potentially the phrenic nerve have not been explicitly tested. Using conditional mutagenesis and pharmacological inhibition of MET, we demonstrate that the pleuroperitoneal folds (PPFs), transient embryonic structures that give rise to the connective tissue, are the source of HGF critical for diaphragm muscularization and phrenic nerve primary branching. HGF not only is required for recruitment of muscle progenitors to the diaphragm, but is continuously required for maintenance and motility of the pool of progenitors to enable full muscularization. Thus, the connective tissue fibroblasts and HGF coordinately regulate diaphragm muscularization and innervation. Defects in PPF-derived HGF result in muscleless regions that are susceptible to CDH.Summary StatementFibroblast-derived HGF signals to Met+ muscle progenitors and nerve to control the expansion of diaphragm muscle and primary branching of phrenic nerve axons - structures critical for breathing in mammals.

A case of a strangulated diaphragmatic hernia

Diaphragmatic hernias are still rarely described, especially in Russian literature.

On the issue of diaphragmatic hernias

The issue of diaphragmatic hernias has been the subject of persistent and fruitful research since the last half of the last century. Until that time, the more or less developed doctrine of diaphragm hernias, one might say, did not exist at all - if individual cases of this kind of hernias were described, then the number of these descriptions was not so great, and these descriptions were of a purely casuistic nature.

Plastic for diaphragmal hernia

Aim. The article discusses the results of a study using a patented method of two-layer laparoscopic repair of large and giant hiatal hernias using a biocarbon implant in comparison with other surgical techniques.Materials and methods. 716 patients were divided into 3 study groups based on the area of the size of the esophageal hernia defect: group I (314 patients) – with small (less than 5 cm2) and medium (5–10 cm2) hiatal hernias, that is, up to 10 cm2, which hernioplasty was performed only by the method of posterior cruraphy; group II (323 patients) – with large hernias 10–20 cm2: subgroup 1 (92 patients) underwent posterior cruraphy, subgroup 2 (231 patients) – alloplasty. Depending on the alloplasty technique, subgroup 2, in turn, was divided: subgroup A (89 people) – hernioplasty with a polypropylene implant and subgroup B (142 people) – hernioplasty with a medical biocarbon construction. Study group III (79 patients) – patients with giant diaphragmatic hernias of more than 20 cm2 using alloplasty: subgroup A (29 people) – hernioplasty with a polypropylene implant and subgroup B (50 patients) – alloplasty with a medical biocarbon construction.Results. When comparing group I with subgroup 1 of group II, the following results were obtained. Statistically significant differences were found in the degrees and types of diaphragmatic hernias. The average age of patients and statistical differences for it were insignificant. When comparing subgroup 1 with subgroup 2 of group II, statistically insignificant differences were found in the degrees and types of hiatal hernias. The difference in the average age of patients was also statistically insignificant. The difference in the average age of patients was also statistically insignificant. When comparing subgroup A with subgroup B of group II, statistically insignificant differences were found among themselves in the degrees and types of hiatal hernias. When comparing subgroup 2 of group II with group III, the difference turned out to be statistically significant in the distribution of patients by types and degrees of diaphragmatic hernias. When comparing subgroup A with subgroup B of group III by degrees and types of hiatal hernias, statistically insignificant differences were revealed.Conclusion. Posterior cruraphia in small and medium diaphragmatic hernias had significant statistical differences in types and degrees compared to that in large hernias, as well as in the average area of the hernial defect. Posterior cruraphia with hernioplasty in large hiatal hernias did not differ statistically significantly according to any of the criteria. Plastic surgery with a polypropylene implant with alloplasty of a biocarbon implant for large hernias did not differ significantly according to any of the criteria. Hernioplasty for large hiatal hernias, when compared with giant hernias, differed significantly only in the degree and type, as well as in the area of the hernial defect. «Onlay» plastic surgery with a polypropylene implant with alloplasty of biocarbon structures for giant hernias did not differ significantly according to any of the criteria, except for gender distribution, which did not have significant fundamental significance, which made it possible to make a more correct comparison of the results of surgical interventions in these research subgroups.

Laparoscopic Repair of Morgagni Hernia Combined with Right Hemicolectomy for Bleeding Ascending Colon Carcinoma Lodged within the Chest: A Case Report and Review of the Literature

Background. Morgagni hernias are rare in adults and may be asymptomatic but, nevertheless, require surgical repair, with laparoscopy offering an excellent option. The colon dislodged into the chest through diaphragmatic hernias may be affected by various disorders, including malignancies. Case Report. A 70-year-old obese male presented with fatigue and shortness of breath. CT scan showed the right colon lodged in the chest through a Morgagni hernia. He was anaemic, and colonoscopy revealed a colon cancer. He underwent combined laparoscopic hernia repair with bioabsorbable mesh and right hemicolectomy. Recovery was uneventful, but the patient died 5 months later from chemotherapy-associated cardiac failure. Literature review revealed eight similar published cases, and including ours, there were seven Morgagni hernias, one traumatic hernia, and one Bochdalek hernia. Median age of the five men and four women was 66 (range 49-85) years. Surgical approach was thoracotomy (2), laparotomy (5), and laparoscopy (2). Conclusion. Outcome of the rare condition is determined by the course of the colon cancer. Hernia repair was successful in ours and all other published cases. A combined laparoscopic approach can be safely done.