2005 Abstracts: A Novel, Comprehensive Model of Paraesophageal Hernias
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A Novel, Comprehensive Model of Paraesophageal Hernias
Stephen M. Kavic, Ross Segan, Ivan George, Patricia Turner, Adrian Park, University of Maryland, Baltimore, MD
The existing classification system of hiatal and paraesophageal hernias has been developed and presented through textbooks and the gastrointestinal literature for generations. However, experience has shown that this classification system does not serve as an adequate basis for surgical decision-making, as there is wide variability among actual paraesophageal hernias of a given classification type. Recent advances in imaging capabilities, and computer software that allows graphic representations of actual patient's anatomy, have allowed for a clearer understanding of the true anatomical relationships in these complex foregut hernias.
We examined five patients with known paraesophageal hernias. We used polygonal mesh surface modeling techniques to render dynamic three-dimensional representations of paraesophageal hernias based on computerized tomographic data. We then correlated these images with intraoperative photographs from the laparoscopic viewpoint during the surgical repair. Combined with the detailed patients' history, it has been possible to provide initial multi-modality illustrations of the different paraesophageal hernias. These new, comprehensive techniques of collating data from the patient, diagnostic imaging, and operative characteristics allows for a better understanding and management of paraesophageal hernias. At the same time, it highlights the flaws in the current conceptual model of paraesophageal hernias. With further patient accrual, it is our intent to develop a new system of classification that is both more anatomically accurate and surgically relevant.
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