hernie hiatale et reflux gastro-oesophagien juvenal thiare abita
TRANSCRIPT
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HERNIE HIATALEET
REFLUX GASTRO-OESOPHAGIEN
Juvenal Thiare ABITA
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DEFINITIONS
• HERNIE HIATALE– passage d’une partie de
l’estomac dans le thorax à travers l’orifice hiatale
phénomène anatomopathologique
• REFLUX GASTRO-OESOPHAGIEN (RGO)– Passage permanente ou
intermittente d’une partie du contenu gastrique dans l’œsophage
phénomène physiopathologique
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ANATOMIE: ORIFICE HIATALE
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ANATOMIE : LA JONCTION OESOGASTRIQUE
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PHYSIOPATHOLOGIE• HERNIE HIATALE
– Glissement – Roulement – Mixte
• RGO– Insuffisance de la
valve oeso-gastrique– Défaillance du
sphincter inférieur de l’oesophage
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GLISSEMENT
ROULEMENT
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DIAGNOSTIC
CLINIQUE
PYROSIS+++
AUTRES
TOUX
REGURGITATIONS
FETIDITE DE
L’HALEINE
EPIGASTRALGIE
EXAMENS COMPLEMENTAIRES FIBROSCOPIE PH METRIE TOGD
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CHIRURGIE
• INDICATIONS– Échec du traitement médical– Complications
• Oesophagites• Respiratoires• Endobrachy-oesophage
• OBJECTIFS– Empêcher l’agression de la muqueuse
oesophagienne– Combattre la douleur– Prévenir ou traiter les complications
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CHIRURGIE
• PRINCIPE – Réduction de la hernie hiatale
• Dissection médiastinale
– Réfection anatomique du SIO (mécanisme physiologique)
• fundoplicature
– Fermeture du hiatus oesophagien• Rapprochement des piliers diaphragmatiques
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INTERVENTIONS EN LAPAROSCOPIE
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INSTALLATION
-décubitus dorsal
-membres inférieurs écartés
-membres supérieurs écartés
-proclive: 20°
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DISPOSITION DES TROCARDS ET DE L’EQUIPE
-opérateur entre les jambes (1)
-aide opératoire à droite (2)
-instrumentiste à gauche (3)
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DISPOSITION DES TROCARDS
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VALVE
Passage rétro-oesophagien Confection de la valve
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FUNDOPLICATURES
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INTERVENTIONS EN LAPAROTOMIE
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INSTALLATION
HYPERLORDOSE DORSALE EXPOSITION DE LA REGION HIATALE
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VOIES D’ABORD
A: mediane sus-ombilicale
B:transversale
C:sous-costale gauche
D:thoracotomie gauche
D
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VALVE
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