DOCSLIB.ORG

Laparoscopic Antireflux Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

o 3','3'q. ), IMPROVING OUTCOMES FOLLOWING SURGERY FOR GASTRO.OESOPHAGEAL REFLUX DISEASE . LAPAROSCOPIC ANTIREFLUX SURGERY Thesis submitted in November,1997 for the degree of Doctor of Medicine in the University of Adelaide by David Ian'Watson M.B.,B.S. (Adel) 1984 F.R.A.C.S. (Gen Surg) 1992 The work described in this thesis was performed within the Department of Surgery at the University of Adelaide, and the Royal Adelaide Centre for Endoscopic Surgery at the Royal Adelaide Hospital 11 This work is dedicated to my wife Claire and my children James, Edward and Timotþ. I am forever indebted to them for their ongoing patience, considerable sacrifices, and unending support which has enabled this work to be completed. 111 SHORT TABLE OF CONTENTS 1 OUTCOME FOLLOWING LAPAROSCOPIC ANTIREFLUX SURGERY 2 1.1 Laparoscopic antireflux surgery - literature review 3 l-2 Outcome of prospective studies assessing outcomes following laparoscopic antireflux surgery 31 2 LABORATORY RESEARCH 122 2.I Comparison of anterior, posterior and total fundoplication using a viscera model t23 2-2 Effîcacy of anterior, posterior and total fundoplication in a porcine model r32 3 CONTROLLED TRIALS ASSESSING STRATEGIES TO IMPROVE OUTCOMES FOLLOWING SURGERY FOR GASTRO.OESOPHAGEAL REFLUX 146 3.1 Prospective randomised trial of laparoscopic versus open Nissen fundoplication for gastro-oesophageal reflux disease 147 3-2 Prospective double blind randomised trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels 166 3.3 Prospective double blind randomised trial of laparoscopic anterior partial versus Nissen fundoplication 191 4 CONCLUSIONS 214 5 BIBLIOGRAPHY 227 6 APPENDIX 256 1V TABLE OF CONTENTS ABSTRACT x DECLARATION xiii ACKNOWLEDGEMENTS xiv PREFACE xvi ANTIREFLUX 1 OUTCOME FOLLOWING LAPAROSCOPIC ., SURGERY 1.1 LAPAROSCOPIC ANTIREFLUX SURGERY . LITERATURE REVIE\ry 3 1.1.1 OPEN NISSEN FUNDOPLICATION 3 T.1.2 RANDOMISED TRIALS FOR OPEN FUNDOPLICATION 5 L.1.2-I Nissen versus partial fundoplication 6 Thor and Silander 6 |.I.2.IJ 'Walker I.1.2.1.2 et al 7 I.1.2.I.3 Lundell et al 8 I-1.2.1.4 DeMeester et al 9 1.I.2.2 Other trials 10 I.1.2.2.L Hill et al 10 1.1 2.2.2 Janssen et al 10 1.1 2.2.3 Luostarinen et al 11 1.1 2.2.4 Spechler et al 11 1.1.3 INDICATIONS FOR SURGERY 11 T.1.4 APPROPRIATE SITUATIONS FOR THE APPLICATION OF A 1.1.5 EARLY RESULTS AND COMPLICATIONS FOLLOWING LAPAROSC OPIC FUNDOPLICATION 13 1.1 .5.1 Pneumothorax t6 1.1 .5.2 Vascular injury L6 1.1 .5.3 Paraoesophageal hiatus herniation t7 1.1 .5.4 Dysphagia t7 1.1 .5.5 Pulmonaryembolism 18 1.1 .5.6 Perforation of the gastrointestinal tract 18 1.1 .5.7 Mortality 19 1.1.6 LAPAROSCOPIC VERSUS OPEN SURGERY 19 1. 1.6.1 Clinical outcome comparisons 20 1. 1.6.2 Cost comparisons 2t 1. 1.6-3 Randomised comparisons 22 T.1.7 RE-OPERATTVE SURGERY FOLLOWING LAPAROSCOPIC FUNDOPLICATION 22 1.1.8 RANDOMISED TRIALS FOR LAPAROSCOPIC SURGERY 23 v 1.1.9 CONTROVERSIES AND DISAGREEMENTS 24 1.1 .9.1 Laparoscopic partial fundoplication 25 1.1 .9.2 Laparoscopic division of the short gastric vessels 25 1.1 .9.3 Selective versus routine hiatal repair 27 1.1 .9.4 The tailored approach to laparoscopic fundoplication 27 1.1 .9.5 The short oesophagus 28 1.1.10 FUTURE DIRECTIONS 29 1.1.11 RESEARCH OVERVIEW AND AIMS 29 1.2 OUTCOME OF PROSPECTIVE STUDIES ASSESSING OUTCOMES FOLLOWING LAPAROSCOPIC ANTIREFLUX SURGERY 31 T.2.T AIMS 31 T.2.2 GENERALMETHODOLOGY 31 I.2.2.I Preoperative assessment 31 1.2.2.2 Surgical technique for laparoscopic Nissen fundoplication 32 1.2.2.3 Post-operative management 36 I.2-2.4 Data management and follow-up protocol 36 1.2.3 INITIAL OUTCOME ASSESSMENT OF PROSPECTTVE CASE SERIES 37 1.2.3.1 Initial outcomes - the first 70 patients 37 1.2.3.1.I Patients and methods 37 1.2.3.I.2 Results 38 1.2.3.1.3 Discussion 43 1.2.3.2 Experience with 230laparoscopic antireflux operations and resulting changing surgical strategies 45 L.2.3.2-I Patients and methods 45 1.2.3.2.2 Results 46 I.2.3.2.3 Discussion 50 t.2.4 UNIQUE COMPLICATIONS OF LAPAROSCOPIC FUNDOPLICATION 52 I.2.4.1 Pneumothorax 52 I.2.4.1.I Case reports 53 I.2.4.1.2 Discussion 54 1.2.4.2 Para-oesophageal hiatus hernia 56 I.2.4.2-I Patients and methods 56 1.2.4.2.2 Results 56 I.2.4.2.3 Discussion 58 L.2.4.3 Stenosis of the oesophageal hiatus 60 1.2.4.3.I Report of cases 60 I.2.4.3.2 Discussion 63 T.2.5 THE LEARNING CURVE FOR LAPAROSCOPIC FUNDOPLICATION 65 1.2.5-l Defining the learning curve for laparoscopic fundoplication 65 I.2.5.1.1 Methods 65 1.2.5.1.2 Results 67 1.2.5.I.3 Discussion 76 1.2.5.2 Experience with laparoscopic surgery for gastro-oesophageal reflux beyond the leaming curve 78 1.2.5-2.I Patients and methods 79 L.2.5.2.2 Results 79 I.2.5.2.3 Discussion 82 V1 T.2.6 SHOULD THE CHOICE OF PROCEDURE FOR REFLUX BE INFLUENCED BY PREOPERATIVE PATHOLOGY? 83 1.2.6.1 Preoperative endoscopic grading of oesophagitis versus outcome 83 1.2.6.1.I Patients and methods 84 1.2.6.I.2 Results 86 I.2.6.1.3 Discussion 89 I.2.6.2 Oesophageal motility parameters before and after laparoscopic Nissen fundoplication 9l 1.2.6.2.1 Methods 92 I.2 -6.2.I.1 Patient selection 92 l -2.6.2.1.2 Oesophageal Manometry 92 I.2.6.2.1.3 Data analysis 93 1.2.6.2.1.4 Clinical outcome scores 95 1.2.6.2.1.5 Statistical analysis 95 I.2.6.2.2 Results 95 1.2.6.2.3 Discussion 99 1.2.6.3 The outcome of laparoscopic Nissen fundoplication in patients with disordered pre-operative peristalsis r02 I.2.6.3.I Patients and methods t02 I.2.6.3.1.1 Manometry 102 I.2.6.3.1.2 Patients 103 1.2.6.3.1.3 Follow-uP 103 1.2.6.3.2 Results 103 I.2.6.3.3 Discussion 109 1.2.6.4 Illness behaviour versus outcome following laparoscopic antireflux surgery 110 I.2.6.4.1 Methods 111 I.2.6.4.I J Illness Behaviour Questionnaire 111 1.2.6.4.1.2 Clinical Follow-uP 113 1.2.6.4.1.3 Statistical Analysis 113 7.2.6.4.2 Results IT3 I.2.6.4.3 Discussion 118 1.2.7 CONCLUSIONS t19 2 LABORATORY RESEARCH 122 2.1 coMPARrsoN oF ANTERTOR, POSTERTOR AND TOTAL FUNDOPLICATION USING A VISCERA MODEL 123 2.1.1 ArM 123 2.1.2 MATERIALS AND METHODS 123 2.1..2.1 Baseline study t26 2.I.2.2 Parameters following oesophageal myotomy t26 2-1.2.3 Parameters following anterior hemi-fundoplication t26 2.1,.2.4 Parameters following posterior hemi-fundoplication 126 2.1.2.5 Parameters following total fundoplication r27 2.I.2.6 Statistics t2l 2.T.3 RESULTS r2'7 2.1.4 DISCUSSION t29 v11 2.2 EFFTCACY OF ANTERTOR, POSTERTOR AND TOTAL FUNDOPLICATION IN A PORCINE MODEL 132 2.2.1 AIM t32 2.2.2 MATERIALS AND METHODS r32 2.2-2.I General Operative Procedure t33 2.2.2.2 Anterior fundoPlication 135 2.2-2.3 Posterior fundoplication 136 2.2.2.4 Total fundoplication 136 2.2.2.5 Postoperative care 136 2.2.2.6 Postoperative studies r37 2.2.2.7 Statistics r37 2.2.2.8 Ethics 138 2.2.3 RESULTS 138 2.2.4 DISCUSSION 140 3 CONTROLLED TRIALS ASSESSING STRATEGIES TO IMPROVE OUTCOMES FOLLOWING SURGERY FOR GASTRO- OESOPHAGEAL REFLUX L46 3.1 PROSPECTIVE RANDOMISED TRIAL OF LAPAROSCOPIC VERSUS OPEN NISSEN FUNDOPLICATION FOR GASTRO. OESOPTIAGEAL REFLUX DISEASE 147 3.1.1 AIMS 147 3 1 .2 METHODS t47 3.1 .2.I Participant assignment r47 3.L .2.2 Patient selection and pre-operative assessment 148 3.1 .2.3 Operating technique 148 3.1 .2.4 Post-operative care 1,49 3.r .2.5 Masking t49 3.1 .2.6 Clinical follow-up r49 3.L.2.7 Objective follow-up 151 3-1.2.1 I Oesophageal manometrY 151 3.1.2.7.2 Ambulatory 24hr pH monitoring r52 3.1.2.7.3 Upper gastrointestinal endoscopy r52 3.I.2.8 Statistical analysis r52 3.I.2.9 Ethical approval 153 3.7.3 RESULTS t53 3.1.3.1 Pre-operative assessment r53 3.1 .3.2 Surgery 158 3.1 .3.3 Early hospital outcomes 158 3.1 .3.4 Late hospital outcomes 160 3.1 .3.5 Clinical outcome assessment 160 3.r 3.6 Objective post-operative investigations 161 3.1.4 DISCUSSION t62 v111 3.2 PROSPECTIVE DOUBLE BLIND RANDOMISED TRIAL OF LAPAROSCOPIC NISSEN FUNDOPLICATION WITH DIVISION AND WITHOUT DIVISION OF SHORT GASTRIC VESSELS 166 3.2.1 AIM r66 3.2.2 METHODS 166 3.2.2.I Participant assignment r66 3-2.2.2 Patienf selection and preoperative investigation t67 3.2.2.3 Operating technique r67 3.2.2-4 Post-operative care 168 3.2.2.5 Masking 168 3.2.2.6 Clinical follow-up r69 3.2.2.7 Objective follow-uP r7l 3.2.2.7.I Oesophageal ManometrY t7r 3.2.2.7.2 Ambulatory 24hout pH monitoring r72 3.2.2.7.3 Radionuclide Oesophageal Emptying Study t72 3.2.2.7.4 Barium Swallow examination 772 3.2.2.8 Statistical analysis t72 3.2.2.9 Ethical approval r73 3.2.3 RESULTS r74 3.2.3.1 Preoperative assessment 175 3.2.3.2 Surgery r82 3.2.3.3 Early hospital outcomes 183 3.2.3.4 One to six month post-operative clinical outcome 185 3.2.3.5 Objective post-operative investigations 186 3.2.4 DISCUSSION r87 3.3 PROSPECTIVE DOUBLE BLIND RANDOMISED TRIAL OF LAPAROSCOPIC ANTERIOR PARTIAL VERSUS NISSEN FUNDOPLICATION 191 3.3.1 AIMS 191 3.3.2 METHODS 191 3.3.2.1 Participant assignment 191 3 -3.2.2 Patient selection and preoperative investigation 191 3.3.2.3 Operating technique t92 3.3.2.4 Post-operative care t93 3.3.2.5 Masking 193 3.3.2.6 Clinical follow-up 193 3.3.2.7 Objective follow-uP 194 3.3.2.7.1 Oesophageal ManometrY t94 3.3.2.7.2 Ambulatory 24hour pH monitoring 194 3.3.2.7.3 Radionuclide Oesophageal Emptying Study 194 3.3-2.7.4 Upper Gastrointestinal Endoscopy 194 3.3.2.8 Statistical analysis 195 3.3.2.9 Ethical approval 196 3.3.3 RESULTS 196 3.3 3.1 Preoperative assessment r97 3.3 3.2 Surgery 204 3.3 3.3 Early hospital outcomes 206 3.3 3.4 One to six month post-operative clinical outcome 207 3.3 3.5 Objective post-operative investigations 209 3.3.4 DISCUSSION 2t0 1X 4 CONCLUSIONS 2L4 4.I IS LAPAROSCOPIC ANTIREFLUX SURGERY ADVANTAGEOUS? 215 4.1.1 Outcome of case series studies 215 4.1.2 Prospective randomised trials of laparoscopic versus open Nissen fundoplication 216 4.2 SHORT GASTRIC VESSELS 218 4.3 NISSEN VERSUS PARTIAL FUNDOPLICATION 220 4.3.1 Uncontrolledstudies 220 4.3-Z Experimentalmodels 220 4.3.3 A role for patients with oesophageal dysmotility 22I 4.3.4 Prospective randomised trials of Nissen versus partial fundoplication 22r 4.4 IMPLICATIONS 223 4.5 FUTURE DIRECTIONS 223 5 BIBLIOGRAPHY 227 6 APPENDIX 256 X ABSTRACT The advent of laparoscopic surgical techniques has refocussed the medical community's interest in surgery for gastro-oesophageal reflux disease.
Recommended publications
  • New and Emerging Technology 147 111. The

    New and Emerging Technology 147 111. The

    Chapters with icon are web-only 11. BASIC SURGICAL SKILLS: NEW AND EMERGING TECHNOLOGY 147 Chapter 10: Abdominal Wall Incisions and Repair CARE OF THE SURGICAL Including Release 148 Stephen R. T Evans and Parag Bhanot Chapter 11: Laparoscopic Suturing and Stapling 163 1: Metabolic and Idammatory Responses to andInfection 2 Daniel B. Jones and Henry Lin Hubbard ibnmJulia Wamheril, Wbj. Chapter 12: Ultrasonography by Surgeons 180 Junji Machi Managemenk Practical is of Risk, and Future Chapter 13: Cancer Ablation: Understanding the Technologies and 'Iheir Applications 196 Salomao Faintuch, Muneeb Ahmed, and S. Nahum Goldberg Jeremy W Cannon, and Jas#E. Beher 3: Enteral Nutrition Support 56 Chapter 14: Upper and Lower Gastrointestinal Endoscopy 205 rand Laura E Maturese Jefiey L. Ponsky andJonathan l? Pearl r 4: Crvdiov8scular Monitoring and Support 65 Chapter 15: Soft Tissue Reconstruction with Flap Kron adGorav Ailawadi Techniques 214 and Ventilatory Support 83 Luis 0. Vasconez,Salman AshruJ; and Franziska Huettner Chapter 16: Hand Surgery: Traumatic Injuries of the Hand 243 :Hemorrhagic Risk and Blood Kevin C. Chung mdan and Amy Evenson Chapter 17: Robotic Surgery 256 Santiago Horgan andMichael E Sedrak ter 7: Perioperative Antimicrobial Prophylaxis and ment of Surgical Infection 117 Chapter 18: Diagnostic Laparoscopy 264 Kevin C. Conlon and Paul E: Ridgway Chapter 8: 'Ihe Multiple Organ Dysfunction Syndrome: 111. THE HEAD AND NECK 271 y Prevention and CLinical Management 127 John C. Marshall Chapter 19: Anatomy of the Head and Neck 272 Aaron Ruhalter Chapter 9: Immunosuppression in Organ Transplantation 140 Chapter 20: Surgery of the Submandibular and I Sublingual Salivary Glands 296 Carol M Lewis and M~chaelE.
  • Mesh in the Hiatus: a Controversial Issue

    Mesh in the Hiatus: a Controversial Issue

    REVIEW ARTICLE Mesh in the Hiatus A Controversial Issue Eduardo M. Targarona, MD, PhD; Gali Bendahan, MD; Carmen Balague, MD, PhD; Jordi Garriga, MD; Manuel Trias, MD, PhD Objective: To analyze the experience acquired to date cedure have been published to date. The information avail- on the use of prosthetic mesh to prevent recurrence af- able showed that the use of a mesh for hiatal repair was ter laparoscopic repair of paraesophageal hernia. safe and prevented recurrence. However, data on the long- term results were lacking, and infrequent but severe com- Data Sources: Current English-language literature re- plications may arise. view. Conclusions: The mesh should be used selectively, and Study Selection: Case reports, series, and opinion ar- the decision to proceed should be based on clinical ex- ticles on the use of mesh for paraesophageal hernia repair. perience. In light of the evidence available, however, it appears to be safe, and the fears expressed in the past have Data Extraction and Synthesis: Study type and re- not been confirmed. sults were analyzed. Most articles were short case series. Few comparative or randomized trials assessing the pro- Arch Surg. 2004;139:1286-1296 UCCESS IN THE DEVELOPMENT THE PROBLEM of laparoscopic fundoplica- tion has made this procedure a valid alternative to medical Laparoscopic repair of PEH and mixed hi- therapy for the treatment of atal hernias is a feasible, safe, but complex gastroesophageal reflux. Thanks to the ex- procedure. The experience during the past S 15 years suggests that viscera reduction, perience acquired, the laparoscopic ap- proach is now used to treat more complex sac excision, retrogastric crural closure, situations, such as paraesophageal hernia and fundoplication are the key technical 1-8 (PEH) or type III (mixed) hiatal hernia.1-8 factors.
  • SSAT Abstract Book 1.Indb

    SSAT Abstract Book 1.Indb

    THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT 54th Annual Meeting May 17-21, 2013 Orange County Convention Center Orlando, Florida ABSTRACT SUPPLEMENT Table of Contents Schedule-at-a-Glance .............................................................................................................2 Sunday Plenary, Video, and Quick Shot Session Abstracts ....................................................6 Monday Plenary, Video, and Quick Shot Session Abstracts ................................................22 Tuesday Plenary Session Abstracts .......................................................................................50 Sunday Poster Session Abstracts ..........................................................................................59 Monday Poster Session Abstracts .......................................................................................112 Tuesday Poster Session Abstracts .......................................................................................166 THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT PROGRAM BOOK ABSTRACT SUPPLEMENT FIFTY-FOURTH ANNUAL MEETING Orange County Convention Center Orlando, Florida May 17–21, 2013 THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT Schedule-at-a-Glance FRI, MAY 17, 2013 SATURDAY, MAY 18, 2013 300 208ABC Other 6:30 AM 6:45 AM 7:00 AM 7:15 AM 7:30 AM 7:45 AM 8:00 AM 8:15 AM 8:30 AM 8:45 AM 9:00 AM 9:15 AM 9:30 AM 9:45 AM 10:00 AM 10:15 AM 10:30 AM 10:45 AM NAFLD DDW CCS: 11:00 AM Therapeutic 11:15 AM Approaches in 11:30 AM 11:45 AM (by invitation only)
  • Jadu Fatima M 201211 Phd T

    Jadu Fatima M 201211 Phd T

    Development and Application of a Technique for Three-Dimensional Sialography Using Cone Beam Computed Tomography By Fatima M. Jadu BDS, MSc A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Oral Radiology Graduate Department of Dentistry University of Toronto © Copyright by Fatima M. Jadu BDS, MSc 2012 Development and Application of a Technique for Three-Dimensional Sialography Using Cone Beam Computed Tomography Fatima M. Jadu BDS, MSc Doctor of Philosophy Graduate Department of Dentistry University of Toronto 2012 ABSTRACT Introduction: Salivary gland obstructive conditions are common and may necessitate imaging of the glands for diagnosis and management purposes. Many imaging options are available but all have limitations. Sialography is considered the gold standard for examining obstructive conditions of the parotid and submandibular glands but it is largely influenced by the imaging technique to which it is coupled. Cone beam computed tomography (cbCT) is a relatively new and very promising imaging modality that has overcome many of the inherent limitations of other imaging modalities used in the past for sialography. Materials and methods: A RANDO®Man imaging phantom was used to determine the effective radiation doses from the series of plain film images that represent the current standard of practice for sialography. Similar experiments were then undertaken to determine the effective radiation doses from cbCT when varying the field-of-view (FOV) size and center, x-ray tube peak kilovoltage (kVp) and milliamperage (mA). Next, cbCT image quality, measured using the signal-difference-to-noise-ratio (SDNR) was used to determine those technical factors that optimized image quality.
  • Surgical Spring Week SAGES 2017 Scientific Session & Postgraduate Courses SAGES Is Home: Collaborate, Communicate, Connect

    Surgical Spring Week SAGES 2017 Scientific Session & Postgraduate Courses SAGES Is Home: Collaborate, Communicate, Connect

    Surgical Spring Week SAGES 2017 Scientific Session & Postgraduate Courses SAGES is Home: Collaborate, Communicate, Connect PROGRAM CHAIR: HORACIO ASBUN, MD PROGRAM CO-CHAIR: MELINA VASSILIOU, MD George R. Brown Convention Center HOUSTON, TX | MARCH 22 - 25, 2017 FINAL PROGRAM Table of Contents 3 General Information, Registration Hours, Exhibits & Posters 65 Symposium: International Hernia Collaboration Symposium Dates & Hours, Speaker Prep Room Hours, Shuttles 66 Video Face-Off Panel: Common Bile Duct Exploration - More 4 News for SAGES 2017, National Quality Strategy Priorities than one way to Skin a Cat 5 Hotel & Complex Map, Childcare Options 67 The Devil is in the Details Session: Technical Tips from the Masters - Laparoscopic Gastrectomy for Malignancy 6 SAGES 2017 Schedule at a Glance SAGES 2017 8 SAGES Community Service Initiatives, Social Programs 68 Industry Educational Events 9 SAGES Policy on Conflict of Interest 70 FRIDAY, MARCH 24, 2017 10 SAGES 2017 Meeting Commercial Bias Reporting Form 71 Medical Student Townhall 11 SAGES 2017 CME Hours, Accreditation 71 SS15 Plenary 1 12 CME Credit, Learning Theme Symbols, Guidelines 71 Presidential Address - Daniel J. Scott, MD 13 SAGES 2017 Meeting Leaders 72 Gerald Marks Lecture - H. Jaap Bonjer, MD 15 2017 SAGES Webcast Sessions 72 Your Session: Management of Complications of Bariatric Surgery 16 WEDNESDAY, MARCH 22, 2017 72 Refreshment Break/Morning Mimosas in the Exhibit Hall 17 Military Surgical Symposium 73 SS16 Exhibit Hall Video Presentations Session 1 19 SS01 Biliary 73 Panel:
  • Surgical Endoscopy © Springer-Verlag New York Inc

    Surgical Endoscopy © Springer-Verlag New York Inc

    Surg Endosc (1997) 11: 1213–1215 Surgical Endoscopy © Springer-Verlag New York Inc. 1997 Minimally invasive surgical biopsy confirms PET findings in esophageal cancer J. D. Luketich, P. Schauer, K. Urso, D. W. Townsend, C. P. Belani, C. Cidis Meltzer, P. F. Ferson, R. J. Keenan University of Pittsburgh Medical Center, 300 Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA Received: 6 December 1997/Accepted: 14 January 1997 Abstract. This report describes our initial experience using the T3 vertebral body and the sacroiliac region of the pelvis and an un- positron emission tomography (PET) scanning in esopha- suspected liver metastasis. The presence of metastases was confirmed through laparoscopic biopsy. Surgical resection of the esophagus was not geal cancer patients. In two patients PET identified distant undertaken. Subsequently the patient developed a T3 radiculopathy and metastatic disease missed by conventional staging. Laparo- died of extensive metastatic disease 3 months later. scopic biopsy provided histological confirmation of metas- tases. In the third patient, locoregional lymph nodes were Case 2 identified by PET and confirmed by surgical staging. In this A 64-year-old male was diagnosed with adenocarcinoma of the distal preliminary report, PET appears to be a promising new esophagus. CT scans of the chest and abdomen and a bone scan were noninvasive modality for staging patients with esophageal negative for metastases. Endoscopic ultrasound revealed enlarged peri- cancer. esophageal and gastrohepatic lymph nodes. A PET scan was ordered to evaluate the extent of disease. The PET scan (Fig. 2) revealed foci of increased FDG uptake in the Key words: Esophageal Cancer — Positron emission to- distal esophagus, periesophageal, and gastrohepatic lymph regions, con- mography (PET) — Thoracoscopy — Laparoscopy sistent with a primary tumor and lymph node metastases.
  • Laparoscopic Antireflux Surgery for Gastroesophageal Reflux Disease (GERD) Results of a Consensus Development Conference

    Laparoscopic Antireflux Surgery for Gastroesophageal Reflux Disease (GERD) Results of a Consensus Development Conference

    UvA-DARE (Digital Academic Repository) Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD): results of a consensus development conference Eypasch, E.; Neugebauer, E.; Fischer, F.; Troidl, H.; Study group members AMC, :; van Lanschot, J.J.B. DOI 10.1007/s004649900382 Publication date 1997 Published in Surgical Endoscopy and other interventional Techniques Link to publication Citation for published version (APA): Eypasch, E., Neugebauer, E., Fischer, F., Troidl, H., Study group members AMC, ., & van Lanschot, J. J. B. (1997). Laparoscopic antireflux surgery for gastroesophageal reflux disease (GERD): results of a consensus development conference. Surgical Endoscopy and other interventional Techniques, 11, 413-426. https://doi.org/10.1007/s004649900382 General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:27 Sep 2021 Surgical Consensus statement Endoscopy Surg Endosc (1997) 11: 413–426 © Springer-Verlag New York Inc.
  • Laparoscopic Hill Repair: 25-Year Follow-Up

    Laparoscopic Hill Repair: 25-Year Follow-Up

    Surgical Endoscopy and Other Interventional Techniques https://doi.org/10.1007/s00464-018-6150-z Laparoscopic Hill repair: 25-year follow-up Yeseul Park1 · Ralph W. Aye1 · Jeffrey R. Watkins1 · Alex S. Farivar1 · Brian E. Louie1 Received: 29 July 2017 / Accepted: 21 March 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Background The open Hill repair for gastroesophageal reflux disease and hiatal hernia is remarkably durable, with a median 10-year reoperation rate of only 3% and satisfaction of 93%. No long-term data exist for the laparoscopic Hill repair (LHR). Methods Patients who underwent primary LHR at Swedish Medical Center for reflux and/or hiatal hernia at least 5 years earlier (1992–2010) were identified from an IRB-approved database. There were 727 patients who met inclusion criteria, including 648 undergoing repair for reflux and 79 for paraesophageal hernia. Two questionnaires were administered via mail to evaluate long-term quality of life using validated GERD-HRQL, Swallowing score, and global satisfaction score. Outcomes were defined by GERD-HRQL score, Swallowing score, resumption of proton pump inhibitor (PPI) therapy, need for reoperation, and global satisfaction with overall results. Results Two hundred forty-two patients completed and returned the survey (226 lost to follow-up, 90 deceased, 3 denied undergoing LHR, 166 non-responders), of which 52% were male. The average age at the time of surgery was 49.5 years. Median follow-up was 18.5 years (range 6.2–24.7). The average GERD-HRQL score (7.1) and the average Swallowing score (39.9) both indicated excellent symptomatic outcomes.
  • Gastro-Oesophageal Reflux Treatment for Prolonged

    Gastro-Oesophageal Reflux Treatment for Prolonged

    Gastro-oesophageal reflux treatment for prolonged non- specific cough in children and adults (Review) Chang AB, Lasserson TJ, Gaffney J, Connor FL, Garske LA This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2006, Issue 4 http://www.thecochranelibrary.com Gastro-oesophageal reflux treatment for prolonged non-specific cough in children and adults (Review) Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 6 Figure1. ..................................... 7 Figure2. ..................................... 8 Figure3. ..................................... 9 Figure4. ..................................... 10 Figure5. ..................................... 10 Figure6. ..................................... 11 Figure7. ..................................... 11 Figure8. ..................................... 12 DISCUSSION ..................................... 13 Figure9. ..................................... 15 AUTHORS’CONCLUSIONS . 15 ACKNOWLEDGEMENTS . 16 REFERENCES ..................................... 16 CHARACTERISTICSOFSTUDIES . 21 DATAANDANALYSES. 43 Analysis 1.1. Comparison 1 Thickened versus unthickened
  • Technical Surgical Failures: Presentation, Etiology, and Evaluation Carrie A

    Technical Surgical Failures: Presentation, Etiology, and Evaluation Carrie A

    8 Technical Surgical Failures: Presentation, Etiology, and Evaluation Carrie A. Sims and David W. Rattner Approximately 48,000 patients undergo anti- surgery, many perceive that residual symptoms reflux procedures each year in the United States. represent an indication of fundoplication Although surgery is the most effective treatment failure.It is well known,however,that symptoms for gastroesophageal reflux disease (GERD),anti- correlate poorly with the presence of acid reflux reflux operations have reported failure rates after fundoplication. Soper and Dunnegan1 between 3–30%.This wide variability reflects dif- found that 26% of those undergoing laparo- ferences in operative technique,differences in the scopic anti-reflux surgery reported postopera- length of reported follow-up, and differences in tive foregut symptoms. After an extensive the definitions used to describe failure. For the evaluation, 35% had no demonstrable abnor- purposes of this chapter, failure is defined as the mality and their symptoms resolved without development of recurrent or new symptoms after intervention.1 Galvani et al.2 studied 124 anti-reflux surgery combined with documented patients with persistent or recurrent foregut pathologic gastroesophageal reflux or anatomic symptoms after laparoscopic fundoplication. failure. Failures occurring within the first 3 Only 39% were found to have acid reflux by 24- months of surgery are termed early failures and hour pH monitoring. Viewed another way, two- are generally caused by technical errors.Diaphrag- thirds of the patients who were taking matic stressors such as coughing,straining,vom- acid-reducing medications postoperatively were iting,retching,and weight lifting increase the risk found to have normal 24-hour pH probes of recurrence, especially in the early postopera- studies (the studies were performed off med- tive period.
  • The Official Patient's Sourcebook

    The Official Patient's Sourcebook

    THE OFFICIAL PATIENT’S SOURCEBOOK on JAMES N. PARKER, M.D. AND PHILIP M. PARKER, PH.D., EDITORS ii ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2002 by ICON Group International, Inc. Copyright 2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1 Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician.

  • Download the Program Book Abstract Supplement

    The Society for Surgery of the Alimentary Tract 52ND ANNUAL MEETING Program Book Abstract Supplement May 6 – 10, 2011 McCormick Place Chicago, Illinois THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT Table of Contents Schedule-at-a-Glance .............................................................................................................2 Sunday Plenary Video, and Quick Shot Session Abstracts ....................................................4 PROGRAM BOOK ABSTRACT SUPPLEMENT Monday Plenary, Video, and Quick Shot Session Abstracts ................................................17 Tuesday Plenary, Video, and Quick Shot Session Abstracts .................................................38 FIFTY-SECOND ANNUAL MEETING Sunday Poster Session Abstracts ..........................................................................................55 McCormick Place Chicago, Illinois Monday Poster Session Abstracts .........................................................................................95 May 6–10, 2011 Tuesday Poster Session Abstracts .......................................................................................138 PLEASE BRING THIS PROGRAM BOOK ABSTRACT SUPPLEMENT WITH YOU TO THE ANNUAL MEETING. 12:45 PM 12:30 PM 12:15 PM 12:00 PM 11:45 AM 11:30 AM 11:15 AM 11:00 AM 10:45 AM 10:30 AM 10:15 AM 10:00 AM 5:45 PM 5:30 PM 5:15 PM 5:00 PM 4:45 PM 4:30 PM 4:15 PM 4:00 PM 3:45 PM 3:30 PM 3:15 PM 3:00 PM 2:45 PM 2:30 PM 2:15 PM 2:00 PM 1:45 PM 1:30 PM 1:15 PM 1:00 PM 9:45 AM 9:30 AM 9:15 AM 9:00 AM 8:45 AM 8:30 AM 8:15