Dr Sorin Cimpean, Digestive Surgeon

31/05/2026

Aortomesenteric compression primarily refers to Superior Mesenteric Artery (SMA) Syndrome, also known as Wilkie's syndrome, cast syndrome, or arterio-mesenteric duodenal compression syndrome.
In SMA syndrome, the angle between the superior mesenteric artery and the aorta is

24/05/2026

Nissen Sleeve is a modified bariatric surgery that combines laparoscopic sleeve gastrectomy with a Nissen fundoplication (an anti-reflux wrap).

-The Nissen Sleeve adds a 360-degree fundoplication wrap using the remaining fundus around the lower esophagus. This strengthens the lower esophageal sphincter, helps prevent acid reflux, and addresses hiatal hernias if present.

-It is primarily indicated for patients with morbid obesity who also have significant GERD or are at high risk for developing it after sleeve surgery.

-Higher technical complexity than standard sleeve or bypass.

-Potential complications include those of both procedures: leaks, strictures, dysphagia (from the wrap), gas bloat, or wrap slippage (rare).

01/05/2026

Hiatal Hernia and Dysphagia:

Several mechanisms can lead to swallowing difficulty:

1. Mechanical obstruction:
-In larger hernias, the diaphragmatic hiatus can impinge on the herniated stomach, slowing or blocking the food bolus. Food may accumulate in the herniated pouch, causing a sensation of blockage or regurgitation.

2. Associated GERD and inflammation: Hiatal hernias often weaken the lower esophageal sphincter, allowing acid reflux. Chronic acid exposure can inflame the esophagus (esophagitis), impair esophageal motility (peristalsis), or lead to scarring and esophageal stricture (narrowing), which directly causes dysphagia. Dysphagia tends to be more common with bigger hernias.

2. Dysmotility: Repeated reflux or altered anatomy can weaken esophageal contractions, making it harder to propel food downward.

Before and after:

04/04/2026

CHIREC Hospital Group

04/04/2026

The median arcuate ligament (MAL) is a fibrous band formed by the diaphragmatic crura that can compress the celiac artery (and sometimes the celiac plexus nerves). This leads to median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, which causes postprandial abdominal pain, weight loss, and other symptoms.
Surgical release (decompression) of the MAL is the primary treatment for symptomatic MALS when conservative measures fail.

Nyd de videoer og den musik, du holder af, upload originalt indhold, og del det hele med venner, familie og verden på YouTube.

22/03/2026

Median Arcuate Ligament Syndrome (MALS), also known as celiac artery compression syndrome or Dunbar syndrome is a rare vascular compression disorder where the median arcuate ligament compresses the celiac artery.

Causes
The condition arises from an anatomical variation where the median arcuate ligament is positioned lower than usual or is unusually tight/fibrous resulting:
-Compression of the artery itself (reducing blood flow).
-Irritation or compression of the celiac plexus nerves.

It often affects young adults more commonly thin females, though it can occur in children and others.
It is rare, affecting roughly 2 per 100,000 people.

Symptoms
-Chronic or recurrent upper abdominal pain, often triggered by eating (postprandial pain) or exercise.
-Nausea and vomiting.
-Weight loss (due to fear of eating or reduced appetite).
-Bloating.
-Diarrhea.
-Fatigue/exhaustion after meals.

Diagnosis:
-CT angiography (CTA) or MR angiography — shows characteristic narrowing ("beak-like" or hooked appearance) of the celiac artery origin, often worse on expiration.
-Doppler ultrasound (with breathing maneuvers).

Treatment
The primary treatment is surgical decompression to relieve the pressure:
Median arcuate ligament release (dividing/cutting portions of the ligament and sometimes surrounding ganglionic tissue).

08/03/2026

The goal of the hiatal closure is to restore normal anatomy, reinforce the lower esophageal sphincter, and prevent stomach herniation.

-Studies suggest that V-Loc sutures provide comparable strength to traditional sutures with faster operative times. A 2023 study on laparoscopic hiatal hernia repair noted reduced suturing time (by ~15%) with V-Loc compared to interrupted sutures, with similar recurrence rates (~5-10% at 5 years).

-Advantages:
Faster closure compared to interrupted sutures.
Reduced risk of suture failure due to even tension distribution.
Knotless design minimizes foreign body reaction.

-Progrip reinforcement present lower hernia recurrence in selected cases; self-fixating design simplifies placement laparoscopically or robotically. Beware the risk of erosion!!! For that reason the mesh I placed is not in contact with the oesophagus and well covered by the gastric valve.

Nyd de videoer og den musik, du holder af, upload originalt indhold, og del det hele med venner, familie og verden på YouTube.

04/03/2026

Here is a patient sent by the cardiologist for postprandial cardiac arrhythmia.

There's a recognized association between hiatal hernia (HH) and certain cardiac arrhythmias, particularly atrial fibrillation (AF), though it's not common and often linked to larger hernias.

The most frequently reported arrhythmia is atrial fibrillation (AF), including new-onset or paroxysmal AF. Studies and case reports show people with HH (particularly larger ones) have a higher prevalence of AF compared to the general population. One large study found AF in about 7.1% of HH patients, with dramatically higher rates (17–19 times higher) in younger patients (3 cm were associated with higher incidence.

Other arrhythmias have been reported less commonly, including:
Atrial flutter
Supraventricular tachycardia
Premature ventricular contractions (PVCs, sometimes in bigeminy)
Bradycardia or sinus bradycardia
Rarely, more severe issues like ventricular standstill in extreme compression cases

The main proposed mechanism is mechanical compression or irritation of the heart (especially the left atrium) by the herniated stomach, which sits directly behind the heart. This can:
-Cause direct pressure → electrical conduction abnormalities or reentry circuits.
-Irritate nearby structures like pulmonary veins (triggers for AF).
Stimulate the vagus nerve (increased vagal tone potentially triggering arrhythmias).
-In some cases, related inflammation from GERD (often co-occurs with HH) may play a role via cytokines or neural effects.

28/02/2026

A mixed hiatal hernia, also known as Type III hiatal hernia (or mixed paraesophageal hernia), is a combination of the two main forms of hiatal hernia: sliding (Type I) and paraesophageal (Type II).
In this type:
-The gastroesophageal junction (GEJ) — where the esophagus meets the stomach — slides upward through the diaphragmatic hiatus (similar to a sliding hernia).
-At the same time, a portion of the stomach (typically the fundus or upper part) herniates or "rolls" alongside the esophagus into the chest cavity (paraesophageal component).

Risks and Complications
Because of the mixed nature and larger hiatal defect, Type III carries higher risks than pure sliding hernias, including:
-Gastric volvulus (twisting of the stomach).
-Incarceration or strangulation (compromised blood supply to herniated stomach).
-Obstruction, bleeding, or respiratory compromise.

The treatment consist in:
-Reduction of herniated stomach.
-Hiatal closure (often with mesh reinforcement for larger defects).
-Anti-reflux procedure (e.g., Nissen or partial fundoplication) to prevent post-repair GERD.

22/02/2026

Here is hiatal recurrence few years after the placement of a slowly resorbable mesh. In this case this late recurrences (>12 months post-op) occurred in left-lateral hiatus, in the least reinforced area in traditional posterior-focused repairs where the mesh was not previously placed.
If native tissue healing is incomplete or compromised, recurrence can develop after mesh resorption.
In case of U-shaped posterior mesh configuration leaves the anterior and left-lateral hiatus vulnerable to stretching.
This is attributed to progressive stretching from ongoing physiological stresses rather than acute technical failure.
If native tissue ingrowth is suboptimal (e.g., due to tension or poor healing), recurrence can emerge as support diminishes—though studies show no direct link to resorption timing causing failure; instead, it's more about overall repair durability.

Nyd de videoer og den musik, du holder af, upload originalt indhold, og del det hele med venner, familie og verden på YouTube.