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conferenceseries
.com
Volume 7, Issue 3 (Suppl)
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
Gastro 2017
June 12-13, 2017
June 12-13, 2017 Rome, Italy
11
th
Global
GastroenterologistsMeeting
J Gastrointest Dig Syst 2017, 7:3(Suppl)
DOI: 10.4172/2161-069X-C1-050
Laparoscopic giant type IV hiatal hernia repair; my most difficult case: Video presentation
Kece Can
Bahcesehir University, Turkey
A
57-year-old man presented to the outpatient clinic with shortness of breath, dyspnea and vomiting. He noted that shortness of
breath aggravated with exertion and after the ingestion of food. The patient did not describe an underlying chronic disease and
did not use any medication within the previous six months. On the physical examination, vital signs were stable and no pathologic
condition was observed. Blood analyses were found to be within the normal range. On the posteroanterior chest radiograph, there
was an air-gas appearance that reflected the whole stomach on the chest. A thoracoabdominal CT scan including axial and coronal
sections was performed in the patient because of the suspicion of a large hiatal hernia with available image. It was found that a large
part of the stomach was herniated into mediastinum without any finding of incarceration. After three months of the operation, CT
scan evaluation was performed again and no pathologic findings were observed (figure 1). Giant hiatal hernia is defined as greater than
one third of the stomach in the thoracic cavity (chest) and representing 5 to 10% of all hiatal hernia. Although a uniform definition
does not exist; most commonly with both the gastroesophageal junction and the fundus herniating through the hiatus. The fundus
lies above the gastroesophageal junction. There are four types of HH. The current anatomic classification has evolved to include a
categorization of hiatal hernias into Types I–IV. Greater than 95% of hiatal hernias are Type I. Type IV hiatal hernias are characterized
by the presence of a structure other than stomach, such as the omentum, colon or small bowel within the hernia sac. Although the
cause for the development of hiatal hernia is unknown, its incidence increases by advancing age. Two potential mechanisms exist:
Gastroesophageal reflux disease (GERD) leads to esophageal scarring and shortening with resulting traction on the gastroesophageal
junction and gastric herniation; and chronic positive pressure on the diaphragmatic hiatus combined with a propensity to herniation
leads to gastric displacement into the chest, resulting in GERD. Symptoms are often related to gastroesophageal reflux disease in
the hiatal hernia which is usually asymptomatic. Asymptomatic hernia may not require any treatment, while multiple studies have
supported the recommendation of early elective repair as a safer route in symptomatic patients. Repair of hiatal hernias has been
performed traditionally via open laparotomy or thoracotomy. Since first laparoscopic hiatal hernia repair in 1992, this method
has a growing popularity and today, it is the standard approach in experienced centers specialized for minimally invasive surgery.
A successful repair of giant HH requires adherence to basic hernia repair principles i.e., hernia sac excision, tension-free repair,
recognition and correction of a short esophagus, and a well-performed anti-reflux procedure. The laparoscopic approach for repair
of large hiatal hernias is a relatively safe method with significant long-term efficacy in terms of symptom control and quality of life.
cankece@gmail.comSignificance of tumor necrosis factor a-308 (G/A) gene polymorphism in the development of prostate cancer
Nega Berhane
1
, Rabinder Chandera Sobti
2
, Shiferaw Melesse
1
, Salih Abdul Mahdi
2
and
Afework Kassu
1
1
University of Gondar, Ethiopia
2
Panjab University, India
P
rostate cancer (PCa) is the most common noncutaneous cancer among men, accounting for 10% of male cancer-related deaths
worldwide. The etiology of PCa is largely unknown, although multiple environmental and lifestyle factors such as ultraviolet
irradiation, smoking, and diet might increase the risk of the disease. Risk of disease varies most prominently with age, ethnicity,
family history, and diet. The multifunctional cytokine tumor necrosis factor alpha (TNF-a) has an important role in the pathogenesis
of inflammatory, autoimmune and malignant diseases. In this case, control study 150 prostate cancer patients and 150 ages matched
benign prostate hyperplasia (BPH) and equal numbers of healthy control groups were involved. The aim of this study was to analyze
the effect of
TNF-a-308
(G/A) polymorphism on risk of prostate cancer on north Indian prostate cancer patients. The polymerase
chain reaction (PCR) technique was utilized to genotype
TNF-a-308
(G/A) polymorphism. The present study showed statistically
significant increased risk of prostate cancer among individuals that carried the A allele of
TNFa-308
gene (OR=1.81, 95% CI 1.00–
3.481, p = 0.03).
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