Dr Sorin Cimpean, Digestive Surgeon

11/01/2026

Hiatal closure with non-absorbable barbed V-Loc (running suture) to approximate the crura under reduced tension is described as safe, efficient, and effective in several series, with advantages including:
- Better tissue apposition and even tension distribution: potentially better tissue approximation and less tearing through fragile crural muscle.
- Permanent strength → may help resist long-term recurrence from diaphragm motion and intra-abdominal pressure.
- Knotless design avoids bulky knots that could cause irritation or dysphagia, but also adhesions.

Here is a video of a Nissen surgery that I performed using non-absorbable V Loc:

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10/01/2026

Retrore**al hamartoma, also known as retrore**al cystic hamartoma or tailgut cyst, is a rare congenital cystic lesion that develops in the presacral (retrore**al) space — the potential space located behind the re**um and in front of the sacrum and coccyx.
It arises from embryonic remnants of the postanal primitive hindgut (tailgut) that fail to regress completely during fetal development.

-Extremely rare — only a few hundred cases reported in medical literature.
-Strong female predominance (typically 3:1 to 5:1 ratio), most commonly diagnosed in middle-aged women (30–60 years), though it can occur at any age, including rarely in children or men.
-Usually benign, but carries a small but important risk of malignant transformation.

Symptoms:
-Chronic constipation or change in stool caliber
-Re**al fullness or pressure
-Lower abdominal, pelvic, or perineal pain
-Lower back pain
-Urinary symptoms (e.g., frequency)
-Rarely: re**al bleeding, infection (mimicking abscess or fistula), or neurological issues

Complete surgical excision is the standard of care — even in asymptomatic cases — to prevent complications like infection, recurrence, fistulization, or malignant degeneration.
Approaches depend on size/location:
Transsacral, transanal/transre**al, abdominal (open/laparoscopic), or combined.

24/12/2025

20/12/2025

19/12/2025

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10/12/2025

Intrathoracic Hiatal Hernia

An intrathoracic hiatal hernia occurs when a significant portion of the stomach protrudes through the diaphragm into the chest cavity, often representing an advanced stage of a hiatal hernia. While smaller hiatal hernias may be asymptomatic, intrathoracic variants can lead to serious complications due to the mechanical distortion of the stomach and pressure on surrounding structures like the esophagus, lungs, and heart

Complications:

1. Gastroesophageal Reflux Disease (GERD) and Esophagitis
Large hernias allow stomach acid and contents to reflux into the esophagus, causing heartburn, regurgitation, acid reflux, difficulty swallowing (dysphagia), chest or abdominal pain, early satiety, and shortness of breath.

2. Mechanical Obstruction and Vascular Compromise
-Incarceration and Strangulation: This is a surgical emergency with a risk of about 5% in paraesophageal types.
-Gastric Volvulus: Twisting of the stomach (often >180 degrees) can cause acute obstruction, severe pain, and vomiting.
-Tension Gastrothorax: Extreme herniation compresses the lungs and heart, mimicking tension pneumothorax and causing hemodynamic instability.

3. Bleeding and Anemia
Chronic or acute bleeding from erosions (e.g., Cameron ulcers in the herniated stomach), esophagitis, or ulcers can lead to iron-deficiency anemia. This is often insidious but can present with fatigue, pallor, or melena.

4. Perforation
Rare but life-threatening rupture of the herniated stomach, often due to ulceration or increased pressure, leading to peritonitis or mediastinitis.

5. Respiratory Complications
-Compression of lung tissue by the herniated organs can cause dyspnea (shortness of breath), exertional dyspnea, atelectasis (lung collapse), and reduced lung function.
-Aspiration of gastric contents into the lungs may trigger pneumonia, asthma exacerbations, or chronic cough.

Many complications are preventable with early surgical repair for symptomatic or large hernias.

29/11/2025

Diastasis recti abdominis (DRA) is the abnormal widening of the gap between the two halves of the re**us abdominis muscle (the “six-pack” muscle) along the midline linea alba.

Normal inter-re**us distance:
– ≤2 cm at rest (some experts say ≤1.5–2 cm above the umbilicus, ≤1 cm below)

Diastasis is diagnosed when the gap is ≥2–3 cm (measured 3–4 cm above/below umbilicus) or when there is significant loss of tension in the linea alba even if the gap is smaller.

In this case I performed a laparoscopic suture of the re**us sheet.
For this technique I placed 3 trocarts in the lower part of the abdomen, for esthetic reasons.
The linea alba was reapproximated with running suture of Vycril 1.
A mesh was placed to reinforce the plication.

28/11/2025

Hiatal hernia after gastric bypass surgery rates ranging from 2–20% depending on the study.

Why It Happens After Gastric Bypass:
- Weight loss → loss of intra-abdominal fat → reduced "buttressing" effect that fat previously provided around the diaphragmatic hiatus → the hiatus can widen.
- Increased intra-abdominal pressure changes after surgery (especially if patients have chronic cough, constipation, heavy lifting, etc.).
- Surgical disruption of the phrenoesophageal ligament and crural fibers during the original operation
- Negative intrathoracic pressure "sucks" the stomach upward over time once the hiatus is lax.

Typical Presentation
-New or worsening GERD symptoms years after bypass (many patients had little reflux right after bypass because the gastric pouch is small and pressure is low).
-Epigastric/chest pain, dysphagia, early satiety, nausea/vomiting.
-Food trapping in the lower esophagus or herniated stomach.
In severe cases: volvulus, incarceration, or strangulation (rare but surgical emergency).

The surgical repair consist usually in hiatal hernia reduction + posterior crural closure (with or without mesh)+ gastropexy (fixation of the gastric pouch on the crura).

22/11/2025

Rencontre du Pôle Visceral de la Clinique Sainte-Anne Saint-Remy.
Thank you all for the participation and for the high quality of the presentations.











Thanks to by for the support.

20/11/2025

Why Can a Hiatal Hernia Develop or Worsen After Sleeve Gastrectomy?

-Surgical factors:
Dissection around the hiatus (the diaphragm opening) during surgery can weaken supporting ligaments (phreno-esophageal and phreno-gastric).
-Anatomical changes:
The new tube-shaped stomach has higher internal pressure, a smaller volume, and sometimes altered shape (e.g., narrowing or dilation), which can push stomach tissue upward.
-Weight loss effects:
Rapid weight loss reduces intra-abdominal fat/pressure initially but can later loosen the hiatus; extreme or regained weight adds stress.
Some reports show de novo hiatal hernia in up to 20–37% of patients in the first few years.

Conversion to Roux-en-Y gastric bypass (RYGB) is often the most effective long-term fix, as it bypasses the problem area entirely.
Repair alone (without conversion) works well for many, but heartburn can persist in ~50% if other sleeve-related factors (high pressure, poor motility) are present.

Here is an CTscan image with a hiatal hernia with gastric migration post gastric sleeve.

20/11/2025

In colore**al surgery, in low anterior resection, a protective (diverting) loop ileostomy is created to mitigate the severe consequences of an anastomotic leak. Before reversing the ileostomy (typically 8–12 weeks postoperatively, or earlier if adjuvant chemotherapy is planned), the surgeon must verify that the distal anastomosis has healed adequately to avoid pelvic sepsis, peritonitis, or the need for re-diversion.

Here is an image of a water-soluble contrast e***a control of a colo-re**al anastomosis, before closing the protective ileostomy.

15/11/2025

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