Other Considerations Ineffective Esophageal Motility

There has long been concern about performing a fundo-plication in patients with abnormal peristaltic function of the esophagus. For this reason manometry is generally recommended in the preoperative work-up, with surgeons performing a partial fundoplication or "tailoring" the operation when manometric data reveal ineffective esophageal motility. The implication of this is not trivial. Ineffective esophageal motility is more likely in patients with severe GERD, and many studies have demonstrated the inferiority of a partial fundoplication compared with a total fun-doplication. There is increasing evidence, however, to suggest that a total fundoplication does not increase the incidence of dysphagia in patients with ineffective peristalsis. Because a full fundoplication provides superior reflux control, it would be preferred if it did not lead to higher incidence of dysphagia.

At the University of Washington, we abandoned the use of a partial (Toupet) fundoplication in 1997 for most patients with impaired peristalsis. We observed that although both procedures were effective at controlling typical symptoms of GERD (heartburn, regurgitation, etc), a total fundoplication was more likely to relieve existing dysphagia than a partial fundoplication. Furthermore, there was essentially no development of new dysphagia, the most feared outcome. It is now our practice to perform a full 360° wrap in all patients, with the exception of those who essentially have aperistalsis of the esophagus.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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