Dr Sorin Cimpean, Digestive Surgeon

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

https://www.chirec.be/fr/specialiste/cimpean

Si vous avez besoin d'une aide médicale urgente, d'une intervention des services d'incendie ou d'une aide policière, veuillez composer le 112.

05/11/2025

https://rosa.be/fr/hp/ioan-sorin-cimpean/

Prenez rendez-vous en ligne avec Ioan-Sorin CIMPEAN (Chirurgien digestif et pariétal). Découvrez les disponibilités en quelques clics sur Rosa !

19/10/2025

Ventral rectopexy (VR) is a minimally invasive abdominal surgical technique that can effectively treat rectocele—a condition where the re**um bulges into the posterior vaginal wall due to weakened pelvic floor support, often causing symptoms like obstructed defecation syndrome (ODS), constipation, incomplete evacuation, and f***l incontinence. While traditionally used for re**al prolapse, VR addresses rectocele by providing ventral support to the re**um and rectovaginal septum, particularly in cases with associated internal re**al intussusception or multicompartment pelvic floor prolapse.

VR achieves high anatomic success (96-100% correction on imaging) and functional improvement in rectocele, with low recurrence (1-5% at 2-5 years). In a 2025 randomized controlled trial (RCT) of 40 women with anterior rectocele, VR reduced constipation from 17±2.8 to ~8 at 12 months (p

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12/10/2025

The anore**al angle (ARA), also known as the ano-re**al angle, is the anatomical angle formed at the junction between the a**l ca**l and the re**um, specifically between the central axis of the a**l ca**l and a line tangent to the posterior wall of the re**al ampulla. It plays a key role in continence and defecation, as it is influenced by the pubore**alis muscle (part of the levator ani), which helps maintain f***l continence by creating a functional barrier.

Normal Measurements
- At rest:
-Typically averages 95–120 degrees, with a normal range of 70–134 degrees.
-Often wider ( >120°) in symptomatic rectocele due to pelvic floor laxity, though some studies show a sharper angle (e.g., ~100°) if coexisting spasticity is present.

- During squeeze/lift (contraction):
-ARA decreases (sharpens) to facilitate continence.
-In rectocele may widen excessively (e.g., ~120°) compared to normals (~110°), indicating reduced pubore**alis tone.

- During evacuation/defecation:
-ARA opens to 100–140 degrees, allowing passage of stool; the anore**al junction also descends slightly (less than 3.5 cm).
-In rectocele typically fails to widen adequately contributing to incomplete evacuation and symptoms like straining or digital assistance. In contrast, excessive widening (>155°) can occur with severe descent.

Clinical Relevance
Abnormal ARA in rectocele often correlates with obstructed defecation syndrome, coexisting intussusception (40%), or enterocele (13%). Abnormal ARA indicates poor coordination between the pubore**alis and pelvic floor, often requiring biofeedback, pelvic floor therapy, or surgery for correction.

09/10/2025

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29/09/2025

19/09/2025

Great Teambuilding with the Digestive Surgery Team

CHIREC Hospital Group