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1.
The preoperative predictability of the short esophagus in patients with stricture or paraesophageal hernia 总被引:4,自引:2,他引:2
Mittal SK Awad ZT Tasset M Filipi CJ Dickason TJ Shinno Y Marsh RE Tomonaga TJ Lerner C 《Surgical endoscopy》2000,14(5):464-468
Background: Esophageal shortening is a known complication of advanced gastroesophageal reflux disease that may preclude a tension-free
antireflux procedure. A retrospective analysis was performed to test the accuracy of preoperative testing.
Methods: From September 1993 to December 1998, 39 patients underwent esophageal mobilization with intraoperative length assessment.
Patients were selected on the basis of irreducible hiatal hernia, stricture formation, or both. Patients in the upright position
with a fixed hiatal hernia larger than 5 cm on an esophagram were considered to have a short esophagus. Manometric length
two standard deviations below the mean for height was considered abnormally short.
Results: In 31 patients, intraoperative mobilization was sufficient to allow the gastroesophageal junction to lie 2 cm below the diaphragmatic
crus, so no esophageal-lengthening procedure was required. Eight patients with a short esophagus required an esophageal-lengthening
procedure after complete mobilization. Two patients subsequently underwent intrathoracic migration of the gastroesophageal
junction (GEJ), with recurrence of symptoms and required gastroplasty during the second surgery. An esophagram had a sensitivity
of 66% and a positive predictive value of 37%, whereas manometric length had a sensitivity of 43% and a positive predictive
value of 25% for the diagnosis of short esophagus. The preoperative endoscopic finding of either a stricture or Barrett's
esophagus was the most sensitive test for predicting the need for a lengthening procedure.
Conclusions: Manometry and esophagraphy are not reliable predictors of the short esophagus. Additional tests and/or tests combined with
other parameters are needed.
Received: 1 April 1999/Accepted: 10 August 1999/Online publication: 17 May 2000 相似文献
2.
Background: There is a certain amount of controversy regarding the need to divide the short gastric vessels (SGV) in laparoscopic fundoplication
for treatment of gastroesophageal reflux disease (GERD). In addition, there is often difficulty in identifying the crural
fibers when encircling the lower esophagus.
Methods: We determine whether it is necessary to divide the SGV by trying to appose the gastric fundus to the anterior abdominal wall
intraoperatively. If this could be done easily, the SGV are preserved. When their division is required, a posterior gastric
approach is employed. We have also found that the injection of methylene blue into the left crural fibers anterior to the
esophagus is helpful in identifying the left side when dissection posterior to the gastroesophageal junction is difficult.
Results: Between 1992 and 1995 we performed 20 laparoscopic fundoplications for GERD. All patients had at least grade 3 esophagitis
(Savary-Miller scale), increased esophageal exposure to acid (median DeMeester score of 195), and decreased lower esophageal
sphincter (LES) pressure. The median operative time was 175 min. There were no conversions to open surgery, and there was
no mortality. Three patients developed transient postoperative dysphagia and one patient had pneumonia. The median hospital
stay was 3 days; all patients were free of reflux symptoms at follow-up ranging from 7 to 42 months.
Conclusion: We conclude that the techniques described by us aid in intraoperative decision making and allow laparoscopic fundoplication
to be both simple and effective.
Received: 29 March 1996/Accepted: 28 May 1996 相似文献
3.
Complications of laparoscopic antireflux surgery in childhood 总被引:6,自引:2,他引:4
Background: The aim of this study was to assess the complications associated with the laparoscopic treatment of gastroesophageal reflux
disease (GERD) in children.
Methods: From March 1992 to March 1998, we used the laparoscopic approach to treat 289 children affected by gastroesophageal reflux
disease. The patients' ages ranged between 4 months and 17 years (median, 4.3 years), and their body weight ranged between
5 and 52 kg. In 148 children (51.3%), we adopted a Nissen-Rossetti procedure and in 141 (48.7%) a Toupet technique.
Results: The duration of surgery ranged between 40 and 180 min (median, 70). There were no deaths and no anesthesiological complications
in our series. We recorded 15 (5.1%) intraoperative complications: six pleural perforations, four lesions of the posterior
vagus nerve, two esophageal perforations, two gastric perforations, and one pericardiac perforation. Conversion to open surgery
was necessary in only four cases (1.3%). We recorded 10 (3.4%) postoperative complications: one peritonitis due to an esophageal
perforation not detected during the intervention that required a reoperation, five cases of herniation of the epiploon through
a trocar orifice, three cases of dysphagia that disappeared spontaneously after a few months, and one case of delayed gastric
emptying that subsequently required a pyloroplasty. We had six recurrences of GERD (2.1%). In two cases, a new fundoplication
was performed using the laparoscopic approach; in the other four, the GERD was controlled with medical therapy.
Conclusion: Our results show that laparoscopic fundoplication is an adequate treatment for children with GERD that has a low rate of
complications. When severe complications do occur, they can be treated effectively via the laparoscopic approach.
Received: 16 November 1999/Accepted: 16 December 1999/Online publication: 5 June 2000 相似文献
4.
Totally endoscopic Ivor Lewis esophagectomy 总被引:8,自引:4,他引:4
Esophagectomy is associated with significant risks of perioperative morbidity and mortality, as well as prolonged convalescence
due to effects of the incisions used for conventional surgical access. Because the outcome of this procedure is palliative
in the majority of patients, it is possible that laparoscopic techniques could improve initial postoperative outcomes and
therefore make surgery more acceptable for patients with esophageal cancer. A new technique is described for Ivor Lewis esophagectomy,
which incorporates a hand-assisted laparoscopic approach for gastric mobilization and a thoracoscopic approach for esophageal
dissection and anastomosis. Initial experience in two patients has been encouraging, with postoperative hospital stay and
convalescence shortened.
Received: 17 December 1997/Accepted: 18 March 1998 相似文献
5.
Background: The short esophagus increases the difficulty and limits the effectiveness of laparoscopic Nissen fundoplication. In our experience,
∼20–25% of esophagi judged by preoperative criteria to be foreshortened will, after dissection, be insufficiently long to
allow 2 cm of esophagus to reside below the diaphragm without inferior distraction (i.e., tension free). Collis gastroplasty
combined with Nissen fundoplication has become the standard approach for the creation of an intraabdominal neoesophagus and
fundic wrap.
Methods: After developing methods of performing totally laparoscopic stapled gastroplasty in the cadaver lab in 1994, we started applying
the technique clinically in 1996. We performed 220 laparoscopic antireflux procedures between January 1996 and July 1997.
Of these 220 patients, 26% were suspected to have esophageal foreshortening based on preoperative barium studies and/or endoscopy.
Results: After hiatal dissection, nine patients, or 16% of those suspected to have esophageal foreshortening and 4% of the entire
population, required the laparoscopic Collis-Nissen procedure. There was symptomatic improvement in all patients as assessed
by patient-initiated symptom scores.
Conclusions: The management of patients with esophageal foreshortening is a complex problem. We believe that our technique of laparoscopic
Collis-Nissen provides an effective means of achieving intraabdominal placement of the fundic wrap while maintaining the benefits
of a minimally invasive approach.
Received: 8 September 1997/Accepted: 17 December 1997 相似文献
6.
A. S. Lowham C. J. Filipi R. A. Hinder L. L. Swanstrom K. Stalter A. dePaula J. G. Hunter T. G. Buglewicz K. Haake 《Surgical endoscopy》1996,10(10):979-982
Background: This study retrospectively assesses the mechanisms of 13 esophageal or gastric injuries resulting from dilator or nasogastric
tube placement during laparoscopic foregut surgery and is intended to assist in determining methods of prevention.
Methods: Information regarding esophageal or gastric injury during laparoscopic foregut surgery was obtained from six experienced
laparoscopic surgeons. The specific mechanisms of injury were determined by discussion with the operating surgeon and review
of the operative reports.
Results: Eleven cases of esophageal or gastric perforation occurred during bougie insertion and two perforations occurred secondary
to nasogastric tube placement during Nissen fundoplication or Heller myotomy. Five perforations required conversion to open
operation for repair including two delayed thoracotomies. The 13 injuries occurred during the performance of 1,620 laparoscopic
foregut operations for an overall incidence of 0.8%.
Conclusion: Foregut injury resulting from esophagogastric intubation during laparoscopic surgery is more common than expected. Risk factors
include esophageal anatomy, intrinsic pathologic changes of the esophagus, and inexperience. Prevention must focus on close
communication between the surgeon and anethesiologist and safe techniques of dilator insertion. 相似文献
7.
Oberg S Peters JH DeMeester TR Lord RV Johansson J Crookes PF Bremner CG 《Surgical endoscopy》1999,13(12):1184-1188
Background: It has been suggested that endoscopic grading of the gastroesophageal flap valve is a good predictor of the reflux status.
Methods: To test this hypothesis, 268 symptomatic patients underwent endoscopic grading of the gastroesophageal valve using Hill's
classification, with grades I through IV. Esophageal acid exposure, lower esophageal sphincter characteristics, and the degree
of esophageal mucosal injury were compared among the groups.
Results: The prevalence of a mechanically defective sphincter, abnormal esophageal acid exposure, erosive esophagitis, and Barrett's
esophagus increased with increasing alteration of the gastroesophageal valve. The presence of a grade IV valve indicated increased
esophageal acid exposure in 75% of patients. As a predictor, this is similar to lower esophageal sphincter pressure but not
as good as the presence of esophageal mucosal injury.
Conclusions: Endoscopic grading of the gastroesophageal valve provides useful information about the reflux status but is less useful as
an indicator of gastroesophageal reflux disease (GERD) than the presence of esophageal mucosal injury.
Received: 28 April 1999/Accepted: 23 June 1999 相似文献
8.
By now, the feasibility of laparoscopic surgery in obese patients is well established; a conversion rate of 1.4–4.3% has
been reported [1, 2]. The main reason for conversion in these cases is the difficulty encountered in exposing the gastroesophageal
junction due to a huge fatty liver that covers the entire upper abdomen (``the invisible stomach' [1]). We report here a
simple method that allows easy access to the upper stomach in such cases. This technique involves the exposure of the gastroesophageal
junction using a laparoscopic suprahepatic route.
Received: 30 April 1999/Accepted: 5 October 1999/Online publication: 24 March 2000 相似文献
9.
10.
Awad ZT Filipi CJ Mittal SK Roth TA Marsh RE Shiino Y Tomonaga T 《Surgical endoscopy》2000,14(5):508-512
Laparoscopic antireflux surgery is the procedure of choice for gastroesophageal reflux disease (GERD). However, many clinicians
have reservations about its application in patients with complicated GERD, notably those with esophageal shortening. In this
report, we present our experience with the laparoscopic management of the shortened esophagus. A total of 235 patients with
primary GERD underwent laparoscopic antireflux procedures, 38 of whom were suspected preoperatively to have a shortened esophagus.
Of the 235 patients, 8 (3.4%) needed a left thoracoscopically assisted gastroplasty in addition to laparoscopic Toupet repair
(n= 4) or Nissen fundoplication (n= 4). Complications included pleural effusion (n= 1), pneumothorax (n= 2), and minor atelectasis (n= 1). The average hospital stay was 3 days. Results were satisfactory in 7 of 8 patients, with a mean follow-up of 20.2 months
(range, 9–34 months). The surgical management of the shortened esophagus is difficult. However, the role of minimally invasive
techniques is justified. Early results are appealing, with less morbidity, satisfactory control of GERD related symptoms,
and a shortened hospital stay.
Received: 3 August 1999/Accepted: 10 November 1999/Online publication: 17 April 2000 相似文献
11.
M. Anselmino G. Zaninotto M. Costantini M. Rossi C. Boccu' D. Molena E. Ancona 《Surgical endoscopy》1997,11(1):3-7
Background: The Heller-Dor operation has recently been proposed for the treatment of esophageal achalasia even via a laparoscopic approach.
Methods: To measure the medium-term effectiveness of this new minimally invasive technique, an evaluation of pre- and postoperative
symptoms, esophagogram, endoscopic findings, esophageal manometry, and pH monitoring was prospectively designed in 43 patients
with primary esophageal achalasia. The mean clinical follow-up for all the patients is 12 months (range 3–43), while the mean
radiological follow-up is 11 months (range 1–23). Endoscopic data 1 year after surgery are currently available for 27 patients
(63%), whereas a 12-month (range 1–26) functional follow-up (including manometric and pH-monitoring studies of the esophagus)
is currently available for 35 patients (81.4%).
Results: No dysphagia was reported in 38 cases (88.4%); two (4.6%) complained of occasional swallowing discomfort which regressed
spontaneously; two (4.6%) had persistent dysphagia which regressed with pneumatic dilatation. One patient (2.8%) reported
mild occasional dysphagia after a 1-year asymptomatic period. Preoperatively, esophagograms showed an average maximum diameter
of 40.6 ± 9.1 mm which decreased to 24.1 ± 6.0 mm after operation. Mean lower esophageal sphincter (LES) resting and residual
pressures decreased significantly from 28.6 ± 10.7 mmHg to 8.8 ± 4.1 mmHg and from 17.0 ± 9.7 mmHg to 4.7 ± 4.0 mmHg, respectively
(p < 0.0001). These effects on esophageal diameter and LES function seem to persist over time. The complete absence of any peristaltic
contractions recorded preoperatively in all cases remained unchanged after surgery in all but four patients. However, this
rare recovery of peristalsis proved to be transient, and patients revealed a manometric impairment of their esophageal body
function, but without complaining of dysphagia. Twenty-four-hour pH monitoring showed abnormal gastroesophageal reflux episodes
in two (5.7%) of the 35 patients who were monitored: one was asymptomatic; the other had heartburn and endoscopically demonstrated
grade II esophagitis.
Conclusions: Laparoscopic Heller-Dor operation achieves excellent medium-term results which, together with the already-demonstrated advantages
of a minimal surgical trauma and rapid convalescence, validate the use of such a minimally invasive approach to treat patients
with primary achalasia of the esophagus.
Received: 19 March 1996/Accepted: 15 May 1996 相似文献
12.
Reardon PR Scarborough T Matthews B Preciado A Marti JL Brunicardi FC 《Surgical endoscopy》2000,14(3):298-299
Passing the stomach behind the esophagus during laparoscopic Nissen fundoplication is a common source of frustration for
the laparoscopic surgeon. It often leads to an incorrect formation of the fundoplication, resulting in a wrapping or twisting
of the fundus around the distal esophagus. The correct technique should result in the distal esophagus being enveloped inside
the fundus without distorting the orientation of the greater curve. We have developed an easy, precise, and reproducible technique
to perform this maneuver. The steps for performance of this maneuver are described.
Received: 12 March 1999/Accepted: 24 September 1999 相似文献
13.
Development of a laparoscopic approach to neurolytic celiac plexus block in a porcine model 总被引:1,自引:0,他引:1
Background: Neurolytic celiac plexus block (NCPB) is an effective method of palliative pain control in cases of inoperable pancreatic
cancer. This study was undertaken to evaluate the feasibility of a laparoscopic approach to NCPB in an experimental animal
model.
Methods: The laparoscopic technique for NCPB was developed in an acute study of six domestic swine followed by a chronic study of
nine domestic swine that were monitored 3–21 days after surgery for adverse neurologic, gastrointestinal, or other sequelae.
Using a four-port laparoscopic technique, the esophageal hiatus was dissected to expose the aorta at the level of the diaphragmatic
crura. Under combined endoscopic and laparoscopic ultrasound (LUS) guidance, 5 ml of sclerosant dye (95% ethanol mixed with
India ink) was injected into either side of the para-aortic soft tissue via a percutaneously placed 18-gauge spinal needle.
After the animals were killed, the aorta and periaortic tissue were harvested from each animal for gross and histologic analysis.
Results: Under LUS guidance, sclerosant was injected successfully into the para-aortic soft tissue in all animals. There were no intraoperative
complications in the acute animal group. Placement of sclerosant injection was successful in all nine chronic cases. Two pigs
in the chronic study group died in the immediate postoperative period secondary to pneumothorax. No adverse neurologic, gastrointestinal,
or other sequelae were observed in the remaining seven animals at 3–21 days postoperatively. After the animals were killed,
we found no injuries to the aorta or esophagus, and histologic analysis demonstrated good placement of dye-labeled sclerosant
with no compromise of aortic structural integrity.
Conclusion: A laparoscopic approach to the aortic hiatus and NCPB is feasible. Further studies are warranted to evaluate this approach
in patients who undergo staging laparoscopy for pancreatic cancer and are found to have unresectable disease.
Received: 19 March 1999 /Accepted: 18 November 1999 /Online publication: 26 July 2000 相似文献
14.
Background: This study was designed to determine the feasibility and outcome of laparoscopic cardiomyotomy in patients with achalasia
who have persistent or recurrent dysphagia following balloon dilatation.
Methods: Ten patients who had undergone a minimum of two (range, two to seven) previous balloon dilatations underwent a single anterior
cardiomyotomy extending from the gastroesophageal junction onto the esophagus proximally for 6 cm. Four patients had a Toupet
fundoplication. Patients were analyzed using pre- and postoperative DeMeester symptom scores for dysphagia, regurgitation,
and heartburn (0 = none–3 = maximal) and esophageal manometry.
Results: Mean operating time was 90 min. Periesophagitis was noted in some patients but was rarely troublesome. Submucosal fibrosis
was present in all patients and made dissection more difficult particularly around the cardioesophageal junction. As a result,
three patients had mucosal perforations that required repair by laparoscopic suturing. There were no subsequent postoperative
complications. Median (IQR) postoperative stay was 3 (2–4) days. At 3-month reassessment, there was a reduction in the median
dysphagia score from 3 to 0, and also in the regurgitation score from 3 to 0. At last follow-up (median, 22 months), one patient
had developed recurrent dysphagia (grade 2), which improved with dilatation. Overall success of the laparoscopic procedure
was therefore 90%. Only one patient developed new symptoms of reflux (mild, grade 1) after surgery.
Conclusions: Laparoscopic cardiomyotomy provides good control of the symptoms of dysphagia and regurgitation without the morbidity of
a laparotomy or thoracotomy incision. Although technically more difficult, the technique can be extended to those who have
had previous balloon dilatation with complication and success rates similar to published results in patients who have not
undergone previous dilatation.
Received: 7 January 1998/Accepted: 22 June 1998 相似文献
15.
Laparoscopic anatomy of the region of the esophageal hiatus 总被引:1,自引:0,他引:1
16.
The short esophagus: pathophysiology, incidence, presentation, and treatment in the era of laparoscopic antireflux surgery 总被引:9,自引:0,他引:9
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OBJECTIVE: To discuss the pathophysiology and incidence of the short esophagus, to review the history of treatment, and to describe diagnosis and possible treatments in the era of laparoscopic surgery. SUMMARY BACKGROUND DATA: The entity of the short esophagus in antireflux surgery is seldom discussed in the laparoscopic literature, despite its emphasis in the open literature for more than 40 years. This may imply that many laparoscopic patients with short esophagi are unrecognized and perhaps treated inappropriately. Intrinsic shortening of the esophagus most commonly occurs in patients with chronic gastroesophageal reflux disease that involves recurring cycles of inflammation and healing, with subsequent fibrosis. The actual incidence of the short esophagus is estimated to be approximately 10% of patients undergoing antireflux surgery. Of this group, 7% can be appropriately managed with extensive mediastinal mobilization of the esophagus to achieve the required esophageal length. The remaining 3% require an aggressive surgical approach, including the use of gastroplasty procedures, to create an adequate length of intraabdominal esophagus to perform a wrap. Several effective minimally invasive techniques have been developed to deal with the short esophagus. CONCLUSIONS: Because a short esophagus is uncommon, there is a natural concern that many surgeons will not perform enough antireflux procedures to become familiar with its diagnosis and management. A complete understanding of the short esophagus and methods for surgical correction are critical to avoid "slipped" wraps and mediastinal herniation and to achieve the best patient outcome. 相似文献
17.
DeMeester SR Sillin LF Lin HW Gurski RR 《Journal of the American College of Surgeons》2003,197(4):558-564
BACKGROUND: New laparoscopic techniques allow both mediastinal mobilization and performance of a Collis gastroplasty when necessary, and the utility of a transthoracic approach is questioned. The aim of this study was to compare the increase in esophageal length achievable with laparoscopic and transthoracic esophageal mobilization in pigs, and to assess the impact of vagal trunk division on esophageal length. STUDY DESIGN: Baseline esophageal length was obtained in 20 farm pigs by measuring the distance between a stitch placed in the esophagus to a K-wire placed in a vertebral body. Subsequently, laparoscopic and then transthoracic mediastinal mobilization of the esophagus were performed in 15 pigs and the length gain after each procedure recorded. In 7 of 15 animals, the vagal nerve trunks were divided after esophageal mobilization and the increase in esophageal length measured. In five animals, vagal trunk division was performed without earlier esophageal mobilization. RESULTS: Esophageal length gain after laparoscopic mobilization (median 4 mm) was significantly less than that after transthoracic mobilization (median 12 mm, p < 0.0001). Unilateral vagal nerve transection resulted in a median 2.5 mm of esophageal length gain compared with a median of 6.25 mm with division of both vagal trunks. Maximal esophageal lengthening (median 18.5 mm) occurred with a combination of esophageal mobilization and bilateral vagal trunk division. CONCLUSIONS: Esophageal length gain after transthoracic mobilization in normal pigs is significant, and would likely be even greater in patients with gastroesophageal reflux disease with concomitant mediastinal inflammation. Transthoracic mobilization alone likely will allow successful reduction of the gastroesophageal junction below the diaphragm in many patients who might otherwise require a Collis gastroplasty. 相似文献
18.
W. O. Richards R. H. Clements P. C. Wang C. D. Lind H. Mertz J. K. Ladipo M. D. Holzman K. W. Sharp 《Surgical endoscopy》1999,13(10):1010-1014
Background: There is still some controversy over the need for antireflux procedures with Heller myotomy in the treatment of achalasia.
This study was undertaken in an effort to clarify this question.
Methods: To determine whether Heller myotomy alone would cause significant gastroesophageal reflux (GER), we studied 16 patients who
had undergone laparoscopic Heller myotomy without concomitant antireflux procedures. Patients were asked to return for esophageal
manometry and 24-h pH studies after giving informed consent for the Institutional Review Board (IRB)-approved study at a median
follow-up time of 8.3 months (range, 3–51). Results are expressed as the mean ± SEM.
Results: Fourteen of the 16 patients reported good to excellent relief of dysphagia after myotomy. They were subsequently studied
with a 24-h pH probe and esophageal manometry. These 14 patients had a significant fall in lower esophageal sphincter (LES)
pressure from 41.4 ± 4.2 mmHg to 14.2 ± 1.3 mmHg, after the myotomy (p < 0.01, Student's t-test). The two patients who reported more dysphagia postoperatively had LES pressures of 20 and 25 mmHg, respectively. Two
of 14 patients had DeMeester scores of >22 (scores = 61.8, 29.4), while only one patient had a pathologic total time of reflux
(percent time of reflux, 8%). The mean percent time of reflux in the other 13 patients was 1.9 ± 0.6% (range, 0.1–4%), and
the mean DeMeester score was 11.7 ± 4.6 (range, 0.48–19.7).
Conclusions: Laparoscopic Heller myotomy is effective for the relief of dysphagia in achalasia if the myotomy lowers the LES pressure
to <17 mmHg. If performed without dissection of the entire esophagus, the laparoscopic Heller myotomy does not create significant
GER in the postoperative period. Clearance of acid refluxate from the aperistaltic esophagus is an important component of
the pathologic gastroesophageal reflux disease (GERD) seen after Heller myotomy for achalasia. Furthermore, GERD symptoms
do not correlate with objective measurement of GE reflux in patients with achalasia. Objective measurement of GERD with 24
h pH probes may be indicated to identify those patients with pathologic acid reflux who need additional medical treatment.
Received: 12 May 1998/Accepted: 15 December 1998 相似文献
19.
Laparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated 总被引:4,自引:1,他引:3
M. G. Patti C. V. Feo U. Diener A. Tamburini M. Arcerito B. Safadi L. W. Way 《Surgical endoscopy》1999,13(9):843-847
Background: It has been said that a Heller myotomy cannot improve dysphagia in achalasia when the esophagus is markedly dilated or sigmoid
shaped. Those who hold this belief recommend esophagectomy as the primary treatment in such cases. This study aimed to compare
the results of laparoscopic Heller myotomy combined with Dor fundoplication in 66 patients with and without esophageal dilatation,
all of whom had achalasia.
Methods: On the basis of the maximal diameter of the esophageal lumen and the shape of the esophagus, the patients were placed into
four groups: group A (esophageal diameter <4.0 cm; 26 patients), group B (diameter 4.0–6.0 cm; 21 patients), group C1 (diameter
>6.0 cm and straight esophageal axis; 12 patients), and group C2 (diameter >6.0 cm and sigmoid-shaped esophagus; 7 patients).
All patients underwent a laparoscopic Heller myotomy and Dor fundoplication.
Results: The duration of the operation and the length of hospital stay were similar among the four groups. Excellent or good results
were obtained in 88% of group A, 100% of group B, 83% of group C1, and 100% of group C2. No patient in this consecutive series
ultimately required an esophagectomy.
Conclusions: In patients with achalasia who have esophageal dilation, a laparoscopic Heller myotomy and Dor fundoplication (a) took no
longer and was no more difficult, (b) was associated with no more postoperative complications, and (c) gave just as good relief
of dysphagia. We conclude that esophageal dilation by itself should rarely serve as an indication for esophagectomy rather
than myotomy as the initial surgical treatment.
Received: 1 March 1999/Accepted: 21 June 1999 相似文献
20.
Prosthetic reinforcement of posterior cruroplasty during laparoscopic hiatal herniorrhaphy 总被引:1,自引:2,他引:1
Symptomatic gastroesophageal reflux after Nissen fundoplication may occur if the wrap herniates into the thorax. In an attempt
to prevent recurrent hiatal hernia we employed polytetrafluoroethylene (PTFE) mesh reinforcement of posterior cruroplasty
during laparoscopic Nissen fundoplication and hiatal herniorrhaphy. Three patients with symptomatic gastroesophageal reflux
and a large (≥8 cm) hiatal defect underwent laparoscopic posterior cruroplasty and Nissen fundoplication. The cruroplasty
was reinforced with a PTFE onlay. No perioperative complications occurred, and in follow-up (≤11 months) the patients are
doing well. When repairing a large defect of the esophageal hiatus during fundoplication, the surgeon may consider reinforcement
of the repair with PTFE mesh.
Received: 5 March 1996/Accepted: 3 June 1996 相似文献