Hiatal Hernia Surgery PEEP Table Tilt
Solution Overview
Problem
During surgical procedures involving the stomach or esophagus, sliding hiatal hernias pose a challenge as they cause the gastroesophageal junction to slide into the chest, complicating procedures like fundoplication and gastric banding due to breathing-induced pressure changes.
Innovation Solution
Applying positive pressure ventilation with positive end-expiratory pressure (PEEP) of 5-10 mmHg and tilting the operating table slightly downward to maintain the gastroesophageal junction below the diaphragm, preventing the stomach from being pulled into the chest during surgery.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If positive pressure ventilation with PEEP is applied, then the gastroesophageal junction is maintained below the diaphragm, but the patient's respiratory function is altered
Solution Approach 1:
The patent applies positive pressure ventilation with PEEP set at 5-10 mmHg, changing the pressure parameters of the respiratory system to achieve the desired effect of maintaining the gastroesophageal junction below the diaphragm while minimizing adverse respiratory effects
Solution Approach 2:
The PEEP is applied before and during the surgical procedure to proactively prevent the gastroesophageal junction from sliding into the chest, rather than correcting the position after the problem occurs
2Reliability
If the operating table is tilted downward, then the gastroesophageal junction is maintained below the diaphragm, but the patient's positioning becomes more complex
Solution Approach 1:
The downward tilt of the operating table creates a gravitational field that helps maintain the gastroesophageal junction below the diaphragm by utilizing gravity to counteract the upward pull during inspiration
Solution Approach 2:
The gravitational force acting on the stomach and gastroesophageal junction due to table tilting acts as a counterbalancing force against the negative intrathoracic pressure that pulls the stomach upward during breathing
3Ease of operation
If conventional surgical procedures are performed without PEEP on patients with sliding hiatal hernia, then the surgical procedure can be performed, but the gastroesophageal junction slides into the chest causing complications
Solution Approach 1:
Positive pressure ventilation with PEEP is applied in advance to counteract the negative intrathoracic pressure that would otherwise cause the gastroesophageal junction to slide into the chest during the surgical procedure
Applied Scientific Principles
This section explains which scientific principles are used to turn an abstract innovation direction into a practical engineering solution.
Function Achieved in This Case
This method allows for safe and stable performance of various surgical procedures by maintaining the gastroesophageal junction below the diaphragm, enabling procedures such as fundoplication, gastric banding, and other interventions without the complications caused by hiatal hernias.
Implementation Method 1
The invention is a method of lowering the gastroesophageal junction below the diaphragm of a patient with a sliding hiatal hernia during the performance of surgical procedures performed via natural orifices. The method comprises applying positive pressure ventilation with positive end expiratory pressure (PEEP) to the patient.
Implementation Method 2
When the person exhales, if he/she is lying down, the stomach may stay up; but, if he/she is standing, it is pulled down by gravity and slides back down.
Data Source
AI summary
The invention is a method of lowering the gastroesophageal junction below the diaphragm of a patient with a hiatal hernia during the performance of surgical procedures performed via natural orifices. The method comprises applying positive pressure ventilation with positive end expiratory pressure (PEEP) to the patient.