Peg Vs Radiological Or Surgical Gastrostomy

Although studies have shown no difference in morbidity and mortality when comparing surgical gastrostomy to PEG (9), PEG tube placement has been found to be more cost effective and offers the advantage of reducing operative and recovery time. Operative gastrostomies should be reserved for patients in whom endoscopy cannot be performed or when an anatomic aberration precludes a safe percutaneous approach, or for patients who are going to the operating room for another surgical procedure. The...

Alkaline reflux gastritis syndrome

Prolonged contact of pancreaticobiliary secretions with the gastric mucosa can produce damage. The quantity of bile entering the stomach does not correlate with symptoms, but slower gastric emptying does. Thus, the syndrome is likely from both bile reflux to the stomach and delayed clearing of the bile. The syndrome is characterized by bilious vomiting and epigastric abdominal pain. Marginal ulceration, anastomotic stricture, afferent-loop syndrome, and chronic gastroparesis are included in the...

References

Options in urinary diversion a review and critical assessment. Semin Urol 1993 11 235-250. 2. Frazier H, Robertson J, Paulson D. Complications of radical cystectomy and urinary diversion a retro spective review of 675 cases in 2 decades. J Urol 1992 148 1401-1405. 3. Sullivan J, Grabstald H, Whitmore W. Complications of ureteroileal conduit with radical cystectomy review of 336 cases. J Urol 1980 124 797-801. 4. Hensle T, Dean G. Complications of urinary tract...

Short Bowel Syndrome

Short bowel syndrome SBS has been defined as having an inadequate small bowel length with associated malabsorption. The syndrome is characterized by watery diarrhea, dehydration, fluid and electrolyte abnormalities, and malnutrition. SBS usually occurs if greater than 70 of the small bowel has been resected or if less than 180 cm of the small bowel remains 9 . These numbers vary depending on whether it is jejunum or ileum remaining, with the latter being preferable. Preservation of the...

Indications

The usual indications for a bypass are obstruction by a benign or a malignant stricture. Benign strictures are particularly likely to occur in the distal bile duct as a result of stones, or chronic pancreatitis. Benign strictures in the middle of the of the common duct, up to and including the bifurcation can also be caused by stones, parasitic infestations, autoimmune inflammation of the ducts e.g., sclerosing cholangitis , congenital problems e.g., Caroli's disease , or even trauma. However,...

Percutaneous Endoscopic Gastrostomy

Pull Through Gastrostomy

A gastrostomy is a fistulous communication between the stomach and the abdominal surface. It is generally indicated in patients who require supplemental nutrition for more From Clinical Gastroenterology An Internist's Illustrated Guide to Gastrointestinal Surgery Edited by George Y. Wu, Khalid Aziz, and Giles F. Whalen Humana Press Inc., Totowa, NJ Impaired swallowing mechanism Facial trauma Neoplasms of the oral cavity or esophagus Inadequate caloric intake Gastric decompression Gastric...

Cryoablation and Radiofrequency Ablation

There are several other nonresectional techniques for obliterating tumors in the hepatic parenchyma. These modern ablative procedures include cryoablation and radiofrequency ablation RFA . In both cases, a major operation is typically required, although both may be employed laparscopically and even percutaneously in select circumstances. In both cases, a probe is placed into the tumor, typically under ultrasound guidance. For RFA, microwave energy is passed down the probe into the tumor cooking...

Postvagotomy Diarrhea Syndrome

Vagal innervation is an important factor in the control of pancreaticobiliary secretion and intestinal absorption. Truncal vagotomy may result in excessive small bowel secretions or bile acids with resulting diarrhea. Diarrhea occurs in up to 25 of patients following a complete truncal vagotomy with gastric drainage or resection 17 . Less than 2 of patients have incapacitating symptoms. The syndrome is characterized by frequent watery stools, usually unrelated to meals, and occurring at night....

Portacaval Shunt PCS

Portacaval Shunt Surgery

Small-diameter portacaval shunt. Fig. 4. Small-diameter portacaval shunt. The overall postoperative morbidity averages about 30 . Complications include perioperative bleeding requiring multiple transfusions, postoperative ascites including chylous ascites , pancreatitis from operative trauma to the gland, sepsis, and portal vein thrombosis. Specific complications from portasystemic shunting include postoperative hepatic encephalopathy, deterioration of liver function, and recurrent...

Gallbladder And Biliary Imaging

Gallbladder Wall Anatomy

Ultrasound and cholescintigraphy are the preferred imaging methods for the routine evaluation and diagnosis of gallbladder pathology and each offers unique advantages and limitations. Ultrasound is used most frequently for several reasons. First, the typical right upper quadrant ultrasound exam can be performed quickly and takes about 15 min for the experienced technician to complete. Second, other abdominal organs such as the liver, pancreas, kidneys, and spleen can be visualized and other...

Complications

Colonic Stent Migration

The ease of insertion and effectiveness in relieving dysphagia has made placement of SEMS the current therapy of choice for palliation of unresectable esophageal carcinoma. On one hand, immediate palliation is achieved in 70-80 of patients. On the other hand, the incidence of postinsertion complications, such as stent migration, hemorrhage, and fistulization is high, with a reported incidence of 20-40 . Patients with prior radiation or chemotherapy seem prone to more frequent and serious...

Small Stomach Syndrome

This syndrome is a result of loss of reservoir function when 80 or more of the stomach is removed. It differs from gastric stasis syndrome in that gastric emptying is normal. Symptoms include early satiety, epigastric pain after eating, and vomiting. Some patients develop severe weight loss, malnutrition, and anemia secondary to folate, vitamin B12 or iron deficiency. Dietary treatment is often successful and consists of increasing the frequency and decreasing the size of the meals, adding...

Postgastrectomy syndromes

Efferent Loop Gastrectomy

The most important common postgastrectomy syndromes are dumping, alkaline reflux gastritis, and gastric stasis. Less common postgastrectomy syndromes include small stomach syndrome, postvagotomy diarrhea, afferent loop syndrome, efferent loop syndrome, and recurrent ulcer. Most patients also develop iron deficiency anemia likely caused by exclusion of the duodenum from the enteral stream. The duodenum is the primary site of iron absorption. Poor mixing of the bile and food can result in...

Current Role Of Surgical Shunts

The management of a complex disease such as portal hypertension requires a multidisciplinary effort, and each specialist has a defined role and contribution gastroenterologist overall management of the liver disease, medical management of variceal hemorrhage, sclerotherapy or variceal banding , vascular transplant surgeon surgical shunting, liver transplantation , and interventional radiologist TIPS . The treatment of each patient should be selected based on the severity of the underlying liver...

Efferent Loop Syndrome

The efferent loop syndrome is a purely mechanical problem characterized by gastric outlet obstruction at or near the gastrojejunostomy. The etiology may be kinking or adhesions of the efferent limb, or internal herniation behind the gastroenterostomy. Symptoms include diffuse abdominal pain, nausea, and bilious vomiting. The syndrome may occur months to years after the operation. The diagnosis may be confirmed by contrast studies, which demonstrates obstruction of the efferent limb. Surgical...

Complications and Management

Circularstapler

The rate of complications following LAR has been reported as high as 41 5 . Most of these are common to most major abdominal procedures and would include atelectasis, urinary tract infection, wound infection, and deep venous thrombosis. Significant complications specific to LAR include anastomotic leakage, anastomotic stricture, and imperfections of continence or bowel habit. Leakage from the anastomosis after LAR Fig. 1. Use of a circular stapler to create an anastomosis. A Resection of bowel...

Description Of Small Bowel Resection

Stapled Bowel Resection And Anastomosis

Thanks to the profuse collaterals within the mesenteric arterial arcades, surgeons may resect segments of small bowel anywhere along its length with little concern of compromising the blood supply. This is in contrast to colon resection, where the blood supply must be carefully considered. The resection margins are selected and the small bowel is divided proximally and distally with a linear stapler. The mesentery is divided between hemostats and the contents of each hemostat are ligated with...

Operations For Hernia Repair

Mcvay Hernia Repair

The repair of all hernias, regardless of their location or the technique used, requires first the reduction of the herniated tissue second, the closure or reduction of the peritoneal sack that contained the herniated tissue and finally, restoration of the anatomy of the abdominal wall to prevent a future hernia. Difficulties in this operation arise from the complexity of the anatomy especially in the groin , individual variations there of and alterations in the regional anatomy caused by the...

Complications And Their Management

Endograft Leak Type

Morbidity and mortality can result from endovascular grafting as they can from open repair. It is fairly well established that in high-risk patients, endovascular grafting holds a safety advantage over open repair, but it has been much harder to establish an advantage in low-risk patients. Open conversion refers to the abandonment of the endovascular approach in favor of a conventional open procedure. On intent to treat basis, this currently occurs acutely in 1-5 of cases. However, rates of...

Procedure

Mucus Fistula

Elective colon surgery requires bowel preparation. The goal of bowel preparation is to diminish the bacterial load logarithmically. The mechanical portion of the prep is accomplished by oral laxatives, which have replaced old-fashioned enema preps. The oral prep may be performed with a high volume solution of polyethylene glycol plus electrolytes, with Fleets phospho-soda solution, or with magnesium citrate. Additional antimicrobial preparation is achieved via the oral intake of poorly absorbed...

Biliaryenteric Anastomosis

Side Side Choledochoduodenostomy

When the bile duct is obstructed, it may be surgically bypassed. When resected, it must be surgically reconstructed. In both cases, the small intestine is anastomosed to the biliary tree. The only variation is which piece of small intestine is used for the anastomosis and how it is brought up to the biliary tree. The names of these procedures are based on these variations and the level of the anastomosis on the biliary tree. For example, a side-to-side choledochoduodenostomy refers to an...

Surgery For Rectal Prolapse

Ripstein Operation

Rectal prolapse is an uncommon condition defined as complete protrusion of the entire thickness of the rectal wall through the anus. It is seen far more commonly in women than in men and generally after the age of 40 15 . Pathologic defects noted are a diastasis of the levator ani muscles, an abnormally deep cul de sac, an elongated sigmoid colon, and loss of the rectal fixation to the sacrum. Prolapse can secondarily result in incontinence caused by a patulous anus. Numerous procedures have...

Open Technique

Peg Tube Ports Pictures

The Stamm gastrostomy is considered the standard today. The procedure may be performed under general or local anesthesia as part of a major abdominal procedure or for feeding access alone. The aim of the procedure is to create a serosa-lined fistula between the stomach and the anterior abdominal wall Fig. 4 . Fig. 3. A low-profile PEG port. For patients who are mobile, a low-profile PEG port eliminates the need for a permanently protruding feeding tube. A resealable cap...

Indications and Contraindications

Partial Wall Cholecystectomy Resection

Total pancreatectomy may be indicated in cases where there is obvious tumor along the main pancreatic duct, and disease-free margins cannot be obtained. Rarely, a giant cystadenocarcinoma or sarcoma extends along the whole gland, and requires a complete resection. It may also be performed if the pancreatic remnant is friable, and will not hold sutures for a safe reconstruction. Total pancreatectomy may also be required for diffuse Fig. 3. Total pancreatectomy. A Mobilization of pancreas and...

Gastric stasis syndrome

Truncal Vagotomy And Gastrojejunostomy

Gastric stasis also called gastric atony or gastroparesis results from two postgastrectomy derangements. Vagotomy decreases the frequency and amplitude of gastric contractions. Gastric resection disturbs the motility of the stomach, also impairing gastric emptying. These patients have postprandial epigastric pain, nausea, and vomiting of partially digested food eaten hours or even days before. They may be malnourished and Fig. 9. Gastric stasis after truncal vagotomy, partial gastrectomy and...

Transmural Or Transenteric Drainage

Endoscopic Nasal Pancreatic Drainage

Transmural or transenteric endoscopic drainage procedures are performed through several endoscopic approaches through the stomach endoscopic cystogastrostomy or duodenum endoscopic cystoduodenostomy . Several prerequisites need to be fulfilled pursuant to endoscopic transmural drainage Table 1 . Ideally, the pseudocyst must be situated within the pancreatic head or body, and must be firmly adherent to the gastrointestinal tract to cause a visible impression on the gastric or duodenal wall at...

Complications Of Biliaryenteric Anatomosis

The acute complications of these procedures are related to the magnitude of the upper-abdominal operation to accomplish them outlined in the section on liver resection as well as bile leaks. Bile leaks can occur not only from the anastomosis itself, but also from unappreciated ducts in the liver. This latter problem occurs almost exclusively in the setting of an acute repair of a bile duct injury when an injured segmental duct joins the injured bile duct at or below the bifurcation and is...

Preoperative Testing And Preparation

Mesenteric Vein

In the elective or reasonably stable patient, preoperative testing is desirable for planning the approach to the shunt and alerting to the risk of preventable complications. Keep in mind that patients requiring emergency TIPS for catastrophic bleeds may not have time for any preoperative imaging at all. Imaging is focused on the evaluation of patency of the portal vein and hepatic veins and in planning approach to the more challenging patients. Doppler ultrasound is the easiest and least...

Duodenum Sparing Proximal Pancreatic Resection

Subtotal Pancreatectomy

Up to one-third of patients with chronic pancreatitis can develop an inflammatory mass predominantly at the head of the pancreas. The pancreatic head becomes enlarged, and develops parenchymal calcifications, ductal calculi, and necrosis. When resection is considered, some centers advocate a pancreaticoduodenectomy. However, given that chronic pancreatitis is a non-malignant disease, a Whipple procedure may be excessive. The duodenum-sparing pancreatic head resection spares the stomach,...

Surgical Shunts

Denver Shunt

A second option is the placement of LeVeen or Denver peritoneovenous shunts, devices with one-way valves that allow the return of ascitic fluid from the peritoneal cavity back to the systemic circulation. This results in an immediate natriuresis and diuresis in most patients 3 , increases renal blood flow with reduced sodium retention, improves nutritional status with the preservation of protein, increases mobility, and avoids the repeated accumulation of large amounts of ascites with the...

Billroth ii reconstruction

Afferent Loop Syndrome

A Billroth II Fig. 4 is a loop gastrojejunostomy and was first performed by Billroth for a large pyloric cancer. After distal gastrectomy, the proximal stomach is anastomosed to a jejunal loop, performing a gastrojejunostomy. It is important to remove the entire antrum, because any retained antrum secretes gastrin and is a potent cause of ulcer recurrence. The jejunal loop can be brought up either anterior to the transverse colon antecolic , or through the transverse mesocolon retrocolic for...

Types of hepatectomy Resections

Extended Hepatectomy

Although 75 of a normal liver may be resected with a reasonable expectation that enough hepatic function will remain to support regeneration of the hepatic remnant, this percentage is significantly reduced when the liver parenchyma is diffusely diseased. A larger hepatic remnant will be necessary to support regeneration and reduce the risk of fulminant hepatic insufficiency. Typically, when more than 50 of the functional capacity of the liver is removed, the possibility of liver failure becomes...

Operative techniques

Truncal Vagotomy And Gastrojejunostomy

The evolution of operations for ulcer disease has progressed as surgical techniques and understanding of gastric physiology advanced. Gastrojejunostomy and subtotal Fig. 1. Gastroenterostomy. An anastomosis is made on the dependent portion of the greater curvature of the antrum The direction of peristalsis of the stomach matches the small bowel isoperistaltic anastomosis to enhance gastric emptying. The vagus nerves are intact. Fig. 1. Gastroenterostomy. An anastomosis is made on the dependent...

Gastric reconstruction

Subtotal Gastrectomy

Following distal gastric resection, the continuity of the small bowel with the stomach must be reestablished. The goal is to accomplish this in a way that will minimize the risk of postoperative complications. A thorough knowledge of the physiology of vagal innervation and gastric emptying are the main factors that will determine optimal gastric reconstruction. The condition of the patient, the extent of gastric resection, and surgeon preference may also play a role. Reconstruction following...

Physiological Changes

Frey Pancreaticojejunostomy

A Excavation of head of pancreas. B Creation of enterostomy. C Side-to-side pancreaticojejunostomy. Fig. 6. Frey procedure. A Excavation of head of pancreas. B Creation of enterostomy. C Side-to-side pancreaticojejunostomy. Usually, patients with normal pancreatic function preoperatively can tolerate an 80 pancreatic resection without significant physiological changes. On the other hand, patients with diffuse parenchymal disease as seen with chronic pancreatitis may not...

Gastric resevoir reconstruction

Hunt Lawrence Pouch

A near total gastrectomy mandates a Roux-en-Y type reconstruction. Otherwise, the extremely bothersome syndrome of alkaline reflux esophagitis results. The question then becomes whether a standard Roux-Y or some sort of Roux-Y-reservoir is best for Hunt-Lawrence Pouch Tanner Roux-19 Pouch Fig. 7. Gastric reservoir reconstruction for small stomach syndrome. The Hunt-Lawrence pouch and Tanner Roux-19 pouch are the most common gastric reservoir operations. Arrows show the general direction of...

Pancreaticojejunostomy

Frey Pancreaticojejunostomy

The Puestow procedure has a reported mortality rate of 4 , and a complication rate between 10-15 27-33 . Because pancreatic parenchyma is preserved, endocrine and exocrine insufficiency is not exacerbated. Despite the fact that a longitudinal pancreaticojejunostomy is a safe procedure, long-term mortality remains high with a 5-yr survival as low as 40 . This is attributed to continued alcoholism, and comorbid conditions. Recurrent inflammatory changes occur in 15-20 of patients, as a result of...

Types Of Urinary Diversion History

Indiana Pouch Urinary Diversion

The earliest attempts at urinary diversion occurred in the mid-19th century. This idea was based on the observation that birds possessed a cloaca, through which both urine and feces were expelled. Improving surgical techniques culminated in the successful creation of the ureterosigmoidostomy in 1911, which was to become the most commonly employed form of urinary diversion for the next 40 yr 8 . The operation had the advantages of being relatively easy to perform, and it allowed the patient to...

Preoperative Evaluation And Preparation

Coronary Vein Pancreas

The etiology of the portal hypertension should be determined because this has a direct impact on outcome. Patients with nonalcoholic cirrhosis e.g., postnecrotic cirrhosis, primary biliary cirrhosis and those with extrahepatic portal vein thrombosis or primary hepatic fibrosis do better, and have an improved survival after the DSRS than alcoholic cirrhotics 17,18 . Because prognosis is directly related to liver functional reserve, the Child-Pugh class status should be assessed. Ideally, the...

Contraindications

Transhepatic Intraportal Shunt System

Right heart failure is an absolute contraindication to TIPS, as these patients respond badly to arrival of high-volume portal venous flow directly into their compromised right hearts. Fatal cases of congestive heart failure have occurred. Severe hepatic encephalopa-thy or liver failure is a relative contraindication to TIPS, as the shunt decreases intrahe-patic portal venous flow in most patients, potentially diminishing already compromised function. That being said, TIPS is often performed in...

Late Complications

Some patients report an increase in the number or looseness of bowel movements in the first few weeks to months after cholecystectomy. This is often mistakenly blamed on steatorrhea but is probably a result of bile salt malabsorption. Bile salt malabsorption is thought to result from the constant secretion of bile into the intestine once the reservoir function of the gallbladder is lost after cholecystectomy. In most patients, this resolves spontaneously within several months. Steatorrhea...

Cystojejunostomy

Cystojejunostomy

The mortality rate for the internal drainage procedures are between 0 and 5 2 for cystogastrostomy, 1.9 for cystojejunostomy, and 0 for cystoduodenostomy 34 . The recurrence rate is 8 . Fig. 9. Cystogastrostomy. A Anterior gastric wall incision. B Posterior gastric wall incision. C Creation of cystogastrostomy. D Gastrostomy closure. Fig. 9. Cystogastrostomy. A Anterior gastric wall incision. B Posterior gastric wall incision. C Creation of cystogastrostomy. D Gastrostomy closure. Fig. 10....

Current surgical treatment of ulcer complications

Duodenotomy

The primary treatment of bleeding ulcers is endoscopic control followed by treatment for H. pylori if present. Even rebleeding is best treated by repeat attempts at endoscopic control 4 . Surgery is indicated for significant bleeding requiring over five units of blood that cannot be controlled by endoscopy. Most uncontrolled bleeding ulcers are from the gastroduodenal artery in the posterior aspect of the duodenal bulb. Treatment is by duodenotomy, and ligation of the bleeding site Fig. 6 . The...

Tube Removal

Removal of PEG tubes intentionally or inadvertently is usually followed by prompt wound closure. Tract maturation generally occurs within 1 wk following insertion, but may be delayed in patients who are severely malnourished or who are on steroids. PEG tubes that are removed within the first 4 wk following PEG tube placement should not be reinserted blindly at the bedside because the PEG tube tract may have not matured adequately and may result in PEG tube placement within the peritoneal...

Patient selection

Left Gastric Lymph Node

The primary therapy for gastric cancer is surgical resection. The type of surgical resection depends primarily on the location of the primary lesion, the size of the primary lesion, and the overall stage of disease at presentation. Advances in computed tomography CT , endoscopy staging, as well as greater use of laparoscopy have allowed both the surgeon and the gastroenterologist to tailor treatment based on the stage of disease. Laparoscopy remains the single most sensitive means of detecting...

Beger Procedure

Begers Procedure

The perioperative mortality is reported to be 1 in a large series 15 . Early complications include bleeding, anastomotic leakage, and abscess. Ischemia of the duodenum Fig. 5. Beger procedure. A Pancreatic head resection. B Reconstruction with Roux-en-Y pan-creaticojejunal anastomosis. Fig. 5. Beger procedure. A Pancreatic head resection. B Reconstruction with Roux-en-Y pan-creaticojejunal anastomosis. may occur as well, and the rate for reexploration is about 5 . Late mortality after a median...

Contraindications To Urinary Diversion

The patient with a history of inflammatory bowel disease poses a challenge to the surgeon in the selection of an appropriate bowel segment for diversion. Clearly, the use of the large bowel is to be avoided in the patient with ulcerative colitis. Likewise, the terminal ileum should not be used in patients with a history of Crohn's disease. This is particularly problematic because Crohn's disease may involve the entire gastrointestinal tract. In this situation, the use ofjejunum or stomach is...

Repair of paraesophageal hernia

The repair can be performed transthoracally, transabdominally, or laparoscopically. Factors including patient age, medical conditions, elective vs emergency procedure, presence of esophageal shortening, prior surgery, obesity, and body habitus all influence choice of surgical approach and procedure performed 2,4,6 . The thoracic approach is favored in patients who are obese, who have had extensive upper abdominal surgery, and who have a type III hernia with severe esophageal shortening...

Endoscopic sclerotherapy with tissue adhesive bucrylate hystoacryl fig

Tips For Gastric Varices

Standard endoscopic methods used in the treatment of esophageal varices have not been found effective for gastric varices. In the United States, at present, most patients with type II and III gastric variceal hemorrhage are treated with transjugular intrahepatic portosystemic shunt TIPS . A new sclerotherapy technique for bleeding gastric varices, utilizing cyanoacrylate glue Histoacryl injection, was introduced in Europe. In the United States, Histoacryl is not approved by the FDA for clinical...

Esophagectomy for Achalasia

Heller Myotomy Fundoplication

Laparoscopic Heller Myotomy and Dor Fundoplication Joshua M. Braveman, md, Lev Khitin, md, and David M. Brams, md At length the Disease having overcome all remedies, he was brought into that condition, that growing hungry he would eat until Oesophagus was filled up to the Throat, in the mean time nothing sliding down into the Ventricle, he cast up raw or crude whatsoever he had taken in when that no Medicines could help and he languished away for hunger, and every Day was in Danger of Death. I...

Types of esophageal stents

Esophageal

Currently, there are three esophageal stents used in the United States. They are as follows Table 1 . Gianturco Z-stents are made from 0.018-in stainless steel wire bent in a zig-zag fashion to form segments 2-cm long, which are connected using nonabsorbable suture to form lengths from 6 to 14 cm. The stent is 18 mm in its internal diameter, with the proximal and distal ends flared to 25 mm. The Z-stents are available in fully covered and 1Gianturco Z-Stent Wilson-Cook Medical, Winston-Salem,...

Zenkers Diverticulum

Zenker Diverticulum Nasojejunal Tube

Lafreniere, md The Zenker's diverticulum is an out pouching of the hypopharynx arising between the fibers of the cricopharyngeus inferiorly and the inferior constrictor superiorly. This region of herniation is known as Killian's triangle. Patients often present with a longstanding history of gradually increasing dysphagia of both solids and liquids. Regurgitation of undigested food hours after a meal is a classic presentation. In addition, patients often complain of...

Hiatal Hernia Repair

Type Paraesophageal Hernia

Brams, md The history of surgery for hiatal hernia and gastroesophageal reflux disease GERD has paralleled our gradual understanding of the physiological features of the esophagus. The association between GERD and esophagitis was not established until the 1940s, and much controversy arose concerning the relationship between hiatal hernia and GERD. Initial attempts at simply reducing the hernia by closing the crura proved to have unac-ceptably high failure rates. The...

Surgery for Gastroesophageal Reflux Disease

Type Hiatal Hernia

Brams, md Introduction Pathophysiology of Gerd Symptoms of Gerd Indications for Surgery Contraindications to Surgery Preoperative Evaluation Laparoscopic Fundoplication Conduct of Operation Gastroesophageal reflux disease GERD is one of the most common problems seen in medical practice. Approximately 10 of the U.S. population experiences heartburn daily, and 40 of the population has heartburn monthly. Seven percent of the population 40 million individuals use...

Esophagectomy and Reconstruction

Gastric Pull

Michael Kent, md, Jeffrey Port, md, and Nasser Altorki, md EPIDEMIOLOGY OF ESOPHAGEAL CANCER PREOPERATIVE EVALUATION TREATMENT OPTIONS FOR ESOPHAGEAL RECONSTRUCTION COST OF SURGERY AND FUNCTIONAL OUTCOME Esophagectomy is one of the most formidable operations performed by the gastrointestinal GI surgeon. Esophageal resection carries a complication rate of more than 40 , and should only be performed in centers experienced with the management of these patients. Indeed, the mortality of...

Indications for procedure

Strangulated Sliding Hernia

The majority of sliding hiatal hernias are asymptomatic. Only when surgical intervention is indicated for GERD should Type I sliding hiatal hernia be repaired see Chapter 3 2 . The presence of Type II paraesophageal hiatal hernias has traditionally been considered an indication for surgery in a patient who is otherwise fit for surgery. Paraesophageal hiatal hernias have been associated with the risk of strangulation of incarcerated viscera and the potential need for emergency operations. In...