共查询到20条相似文献,搜索用时 15 毫秒
1.
Laparoscopic treatment of gastric stromal tumors 总被引:9,自引:4,他引:5
Basso N Rosato P De Leo A Picconi T Trentino P Fantini A Silecchia G 《Surgical endoscopy》2000,14(6):524-526
Background: The laparoscopic resection of gastric stromal tumors (GST) is being performed with increased frequency.
Methods: Between November 1993 and October 1998, nine consecutive patients with benign and low-grade gastric stromal tumors underwent
laparoscopic resection using intraoperative endoscopy. For lesions located on the anterior wall (three cases), a direct approach
was utilized. Lesions located on the posterior wall were resected via a transgastric approach (four cases) or through a small
opening on the omentum or on the gastrocolic ligament (two cases). Excision of the lesions was performed manually by means
of electrocautery and scissors in eight cases; the gastric incisions were closed by manual running suture. An endoscopic stapler
device was used in one case only.
Results: All patients were successfully treated laparoscopically; there were no conversions to open surgery. Operative time ranged
from 75 to 120 min. There was one bleeding from the suture line of the gastric wall postoperatively that was treated conservatively.
The average postoperative hospital stay was 4 days (range, 2–6).
Conclusions: In light of the results reported in the literature and on the basis of the present work, it seems that laparoscopic resection
of GST should be considered as the treatment of choice. Wedge resection of anterior wall lesions is generally performed. The
treatment of posterior wall lesions is still controversial. In our opinion the direct approach should be reserved for lesions
located on the posterior wall of the body, which can be easily reached through the greater omentum, while the transgastric
approach should be preferred for lesions located on the fundus and antrum. Manual excision allows a tailored operation; hand-sewn
sutures are always feasible, and they are cheaper than stapled ones.
Received: 30 April 1999/Accepted: 7 October 1999/Online publication: 10 April 2000 相似文献
2.
Laparoscopy has added a new perspective to the diagnosis and treatment of abdominopelvic disease. A wide variety of gastric
procedures have been completed with laparoscopy in the past several years. The authors here present successful resection of
a submucosal gastric leiomyoma laparoscopically with the combined use of intraoperative gastroscopy for localization. A 2.5
× 2.0 cm submucosal gastric nodule is resected with ample margins laparoscopically. Intraoperative endoscopy is used for accurate
localization because the lesion was not visible to the laparoscope on the serosal surface of the organ. Laparoscopic surgery
can be applied to the traditional surgical principles with equal efficacy in selected patients.
Received: 15 December 1995/Accepted: 22 April 1996 相似文献
3.
Background: Percutaneous balloon-tipped laparoscopic cannulas designed for preperitoneal hernia repair can be readily used to treat gastric
bleeding laparoscopically.
Methods: Between 1995 and 1997, we successfully used balloon-tipped cannulas to visualize, biopsy, and suture acutely bleeding gastric
lesions in five patients. These case histories are reviewed for this study.
Results: Patients received an average of six units of blood preoperatively (range, 0–15). Operative time averaged 207 min (range,
149–270). At surgery, gastrotomies were made for cannula placement under laparoscopic visualization. Operative findings included:
lesser curve gastric ulcer, Mallory-Weiss tear, prepyloric ulcer, duodenal ulcer, and angiosarcoma. Three patients had successful
percutaneous suture of bleeding gastric lesions. One patient was converted to open surgery. One patient had local resection
of an angiosarcoma.
Conclusion: The laparoscopic use of balloon-tipped cannulas allows the expeditious diagnosis and treatment of acute gastric hemorrhage.
Received: 31 March 1998/Accepted: 26 February 1999 相似文献
4.
Laparoscopy in the management of gastric submucosal tumors 总被引:11,自引:3,他引:8
Background: Gastric tumors, including early gastric cancers, can be safely removed laparoscopically. They do not require an open laparotomy.
Methods: From March 1995 to December 1998, we used laparoscopy to resect gastric submucosal lesions in 32 patients. There were 22
men and 10 women. The patients ranged in age from 23 to 67 years (median, 51.4 yr). The lesions were located in the upper
third in one patient, in the middle third in 20 patients, and in the lower third in 11 patients. The tumors ranged in size
from 2 to 6 cm in diameter. The operative procedures were wedge resection in 19 patients, wedge resection with gastrotomy
in two patients, intragastric surgery in nine patients, intragastric surgery with gastrotomy in one patient, and proximal
gastrectomy in one patient, using a four- or five-port technique. The exophytic mass was resected with an Endo-GIA, and the
tumors on the mucosal surface were exposed via a gastrotomy and excised. The gastrotomy was closed with an intracorporeal
suture. In all cases, the operation was finished after the confirmation of tumor-free margins on frozen-section biopsy specimens.
Results: The duration of the operation ranged from 80 to 180 mins. The final pathologic findings were leiomyoma in 24 patients, adenomyoma
in three patients, hyperplastic polyp in two patients, lipoma in one patient, hamartoma in one patient, and leiomyosarcoma
in one patient. One case (3.1%) was converted to a mini-laparotomy due to technical difficulty; in one other case, more margin
was resected laparoscopically due to the tumor-positive margin; and in one further patient, leakage was repaired by laparoscopic
suturing on the 1st postoperative day. There were no other major complications and no deaths. The hospital stay ranged from
6 to 7 days. The maximum follow-up to date in these patients, including a case of leiomyosarcoma, was 42 months. There has
been no evidence of tumor recurrence.
Conclusion: The application of laparoscopy to submucosal tumors of the stomach is technically feasible, safe, and useful. It should be
considered a viable alternative to open surgery and gastroscopic management because of its low invasiveness and good postoperative
results.
Received: 10 May 1999/Accepted: 22 November 1999/Online publication: 13 June 2000 相似文献
5.
Palliative bypass for neoplastic gastric outlet obstruction should be minimally invasive. We designed a laparoscopically
assisted approach that appears to meet the need. The proximal jejunum is exteriorized by laparoscopy via an epigastric trocar-site
incision. An EEA anvil is installed in the exteriorized jejunum, which is returned to the abdomen. Through this mini-incision,
the anterior wall of the stomach is opened for insertion of the EEA stapler, which penetrates the posterior gastric wall.
When snapped to the anvil and fired, an antecolic gastrojejunostomy is created. No mortality or anastomotic leak occurred
in two cases. The operation and recovery appeared to be faster than historic controls. This operation is minimally invasive
and expeditious, ideal for patients requiring palliative bypass.
Received: 28 June 1996/Accepted: 26 July 1996 相似文献
6.
Background: Between February 1995 and June 1998, 30 laparoscopic Duhamel pull-through procedures were performed in our department.
Methods: Our main aim was to prove the feasibility of the laparoscopic abdominal Duhamel procedure for different localizations of
Hirschsprung disease. We used one camera port and three working ports. The sigmoid colon and posterior rectum were mobilized
laparoscopically. A standard posterior colo-anal anastomosis was fashioned and a stapler was used for the anterior anastomosis.
The top of the rectum was then closed by endo stapler under laparoscopic vision.
Results: Thirty patients underwent laparoscopic surgery for this procedure. Three laparoscopic procedures were converted because of
technical difficulties. The operative time was 100–330 mn. Oral feeding was started at a mean postoperative time of 2.5 days.
Mean postoperative hospitalization was 9 days. Early postoperative complications included 1 anastomotic leak, 1 retrorectal
abscess, 2 urinary infections, and 1 evisceration (after conversion). No enterocolitis or enterocolitis-like symptoms were
noted. All patients now have daily spontaneous bowel movements.
Conclusion: The laparoscopic Duhamel procedure can be performed safely, giving good results.
Received: 6 November 1998/Accepted: 12 February 1999 相似文献
7.
Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas 总被引:11,自引:1,他引:10
Background: A substantial number of patients with unresectable pancreatic cancer eventually develop biliary or gastric outlet obstruction.
In some cases, they present initially with both complications. These conditions contribute markedly to their discomfort and
certainly justify palliative intervention. The purpose of this study was to examine the feasibility and safety of simultaneous
laparoscopic biliary and gastric bypass in patients with unresectable carcinoma of the pancreas.
Methods: Between August 1995 and July 1998, simultaneous laparoscopic biliary and retrocolic gastric bypass was performed successfully
in 12 consecutive patients with unresectable carcinoma of the pancreas. There were eight men and four women. Their median
age was 72 years (range, 50–82). In all patients, the indications for gastrointestinal bypass were gastric outlet obstruction
and obstructive jaundice. The following parameters were evaluated for each patient: procedure-related morbidity and mortality,
operative time, length of hospital stay, overall survival, and ability to sustain oral nutrition during the survival period.
Results: All procedures were completed laparoscopically. The mean operative time was 89 ± 29.56 min. There were no intraoperative
complications. Postoperative morbidity consisted of wound infection in two patients and pneumonia in one patient. One patient
died of multiorgan failure on postoperative day 2. The mean hospital stay was 6.4 ± 1.5 days (range, 5–17). The mean survival
time until death from underlying disease was 85 ± 32.46 days (range, 31–260). None of the patients had recurrent jaundice,
and all of them were able to maintain oral nutrition.
Conclusion: Simultaneous laparoscopic biliary and retrocolic gastric bypass is a safe and effective technique for the treatment of biliary
and gastroduodenal obstruction in patients with unresectable pancreatic cancer.
Received: 17 December 1998/Accepted: 13 May 1999 相似文献
8.
Background: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic
gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared
to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal
cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery.
Methods: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy
was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach,
and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated
medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric
bypass was performed.
Results: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of
the stomach and surrounding upper abdominal organs.
Conclusions: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to
decrease operation time.
Received: 18 September 1996/Accepted: 26 December 1996 相似文献
9.
G. S. Ferzli J. B. Hurwitz M. A. Fiorillo N. E. Hayek F. A. Dysarz T. Kiel 《Surgical endoscopy》1997,11(8):850-851
Open surgery in a severely anemic patient may be complicated by a substantial blood loss from a large incision and subsequent
poor wound healing secondary to the anemia. We report our success in performing a splenectomy laparoscopically in a profoundly
anemic patient. A 50-year-old white male Jehovah's Witness who was HIV positive was referred for splenectomy after he developed
profound, worsening anemia secondary to hypersplenism that was refractory to medical management. His preoperative hemoglobin
and hematocrit levels were 2.7 g/dl and 8.8%, respectively, but his religious beliefs precluded transfusion. A laparoscopic
splenectomy by the posterior gastric approach was performed. The patient tolerated the surgery well and experienced no additional
morbidity. On postoperative day 7, his hemoglobin and hematocrit were 6.8 g/dl and 22%, respectively. We conclude that laparoscopic
splenectomy is an attractive procedure in a severely anemic patient who requires splenectomy and refuses blood transfusion.
Received: 29 March 1996/Accepted: 4 June 1996 相似文献
10.
Minimally invasive surgery for posterior gastric stromal tumors 总被引:9,自引:3,他引:6
Background: Because involvement is extremely rare, surgery for gastric stromal tumors consists of local excision with clear resection
margins. The aim of this study was to report the results of a consecutive series of nine patients with posterior gastric stromal
tumors that were excised using a minimally invasive method.
Methods: Patients received a general anesthetic before placement of three laparoscopic ports— a 10-mm (umbilical) port for the telescope
and two working ports, a 12-mm port (left upper quadrant) and a 10-mm port (right upper quadrant). Grasping forceps were placed
through an anteriorly placed gastrotomy to deliver the tumor through the gastrotomy into the abdominal cavity, thus allowing
an endoscopic linear cutter to excise the tumor with a cuff of normal gastric tissue.
Results: Nine consecutive patients with a median age of 73 years (range, 47–83) were treated. In seven patients, laparoscopic removal
of the tumor was achieved. Two patients required conversion to an open operation because the tumor could not be delivered
into the abdominal cavity. The median length of postoperative stay for the seven patients in whom the procedure was completed
laparoscopically was 3 days (range, 2–6).
Conclusions: Posterior gastric stromal tumors can be removed safely using this minimally invasive method. Delivery of the tumor through
the gastrotomy is essential for success.
Received: 30 April 1999/Accepted: 12 July 1999 相似文献
11.
Transgastrostomal endoscopic surgery for early gastric carcinoma and submucosal tumor 总被引:3,自引:1,他引:2
Background: Laparoscopic intraluminal surgery of the stomach is now widely used for a lesion on the posterior wall. However, this procedure
has some technical limitation related to the intricate introduction of the surgical instruments into the gastric lumen. In
this article, we report our newly developed technique of transgastrostomal endoscopic surgery that overcomes this limitation
and is also suitable for full-thickness gastric wall resection of a lesion in the wall.
Methods: After making a 4-cm-long temporary gastrostomy, a Buess-type endoscope is inserted into the gastric lumen through the gastrostomy.
The operation is performed inside the gastric lumen under video camera guidance using electrocautery, scissors, and forceps.
After resection, the wound in the mucosa or the wound after full-thickness resection is endoluminally sutured. Mucosal resection
was performed in six cases of early gastric carcinoma, two cases of atypical epithelium, and one case of ectopic pancreas.
Full-thickness wall resection was performed in four cases of a leiomyoma.
Results: In all 13 cases, the lesion could be precisely located by the video camera. All lesions were then resected endoluminally.
The mean duration of the operation was 148 min. The postoperative course in all cases was uneventful.
Conclusions: Transgastrostomal endoscopic surgery is minimally invasive and an efficient tissue-preserving technique for the removal of
early gastric carcinoma or submucosal tumor.
Received: 7 September 1996/Accepted: 27 January 1997 相似文献
12.
We report two cases of laparoscopically performed transdiaphragmatic diagnostic pericardial window following diagnostic laparoscopy
for a penetrating wound to the central anterior thorax below the sixth intercostal space. In the hemodynamically stable patient,
this approach permits evaluation of the diaphragm, abdominal viscera, and pericardial space using a single, minimally invasive
surgical technique.
Received: 20 September 1995/Accepted: 24 April 1996 相似文献
13.
Mesenteric cysts are rare benign intraabdominal lesions without typical clinical findings. Treatment is indicated if they
become symptomatic due to enlargement of the cyst. We report 3 patients who were treated by laparoscopic surgery. In 3 patients
(3 women, ages 18, 18, 46 years) admitted to our hospital with uncharacteristic abdominal pain, a mesenteric cyst 4.5–18 cm
in diameter was diagnosed by ultrasonography and CT scan or MRI. One cyst was partially resected laparoscopically by unroofing
of the surface, and the other two were resected completely. There were no intra- or postoperative complications. During follow-up,
cyst recurrence was diagnosed in the patient with cyst unroofing 10 months after surgery, and complete cyst resection was
successfully performed laparoscopically. Mesenteric cysts can be successfully managed laparoscopically. In order to prevent
recurrence, complete resection should be performed.
Received: 16 June 1998/Accepted: 12 February 1999 相似文献
14.
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
15.
Shimizu S Uchiyama A Mizumoto K Morisaki T Nakamura K Shimura H Tanaka M 《Surgical endoscopy》2000,14(1):27-31
Background: The purpose of this study was to compare clinical outcomes between laparoscopically assisted and open distal gastrectomy
for early gastric cancer.
Methods: The records of 21 patients who underwent laparoscopically assisted distal gastrectomy (LG) for preoperative diagnosis of
intramucosal gastric carcinoma between January 1996 and August 1998 were reviewed and compared with those of 31 open distal
gastrectomy patients during the same period.
Results: Age, gender, and size and histologic differentiation of the lesions were matched. Those located at the body of the stomach
(p= 0.011) and those macroscopically depressed (p= 0.049) were subjected more frequently to open surgery. Laparoscopically assisted gastrectomy required significantly longer
operative time (p < 0.001) with less extensive lymph node dissection (p < 0.001). However, time to start of walking (p= 0.032), time to flatus (p= 0.002), duration of postoperative fever (p= 0.027), and postoperative hospital stay (p= 0.001) were significantly shorter in the LG group, and this group had a lower white blood cell count on the first postoperative
day (p= 0.010). Blood loss and time to oral intake were comparable between the groups. Complications included one conversion to
open surgery, one leakage, and one stenosis in the LG group, and two leakages and an atelectasis in the OG group.
Conclusions: Although LG requires longer surgical time, this retrospective study suggests that it is superior to open surgery in terms
of faster postoperative recoveries, shorter hospital stays, and cosmetic outcomes.
Received: 25 December 1998/Accepted: 15 July 1999 相似文献
16.
A new technique for laparoscopic resection of a submucosal tumor on the posterior wall of the gastric fundus 总被引:8,自引:0,他引:8
M. Sekimoto S. Tamura Y. Hasuike M. Yano A. Murata M. Inoue H. Shiozaki M. Monden 《Surgical endoscopy》1999,13(1):71-74
Several reports have been published which describe the technique of using an Endo GIA to resect submucosal tumors on the
anterior wall of the stomach. Lesions on the posterior wall, however, especially near the esophagocardiac junction (ECJ),
are difficult to resect using these reported techniques. This is because the surgeon must divide the omentum and enter the
omental bursa in order to use a similar extraluminal technique. Furthermore, special care must be taken to ensure that resections
do not involve the ECJ and narrow the esophagus. In order to overcome these difficulties, we have proposed a new technique
for the laparoscopic excision of a submucosal tumor located on the posterior wall of the gastric fundus. The principle of
this procedure involves the intraluminal resection of the submucosal tumor, including the surrounding stomach wall, using
the Endo GIA. This technique is safe, simple, and effective. We believe that we are the first to address the excision of a
submucosal lesion by resecting the full thickness of the posterior gastric wall lesion intraluminally.
Received: 11 November 1996/Accepted: 2 April 1997 相似文献
17.
Background: The treatment of the morbidly obese patient is difficult because compliance with dietary regimens is poor. As a result, most
weight reduction programs fail very quickly. Surgical treatment, on the other hand, provides a reliable method for sustained
weight reduction. The most frequently performed procedure has been the vertical banded gastroplasty. Adaptation of the standard
open procedure to laparoscopic techniques has been technically difficult and imprecise. We have developed, in the laboratory,
an anterior wall banded gastroplasty that can be performed precisely and reproducibly using laparoscopic techniques.
Methods: Five Yorkshire pigs were used in attempt to laparoscopically perform the standard vertical banded gastroplasty. The procedure
was difficult and was associated with a risk of staple line leak and with bleeding along the lesser curvature of the stomach.
Furthermore, a reproducible pouch of proper dimension could not be created reliably. Fifteen animals were then used to develop
a new technique using a small gastric pouch based on the anterior gastric wall.
Results: A reproducible pouch, 4 cm in length, was created over an 18-Fr nasogastric tube. A standard polyproylene band of 5.2 cm
in length was utilized at the gastric pouch outlet.
Conclusions: This operation can be reproduced accurately and has not demonstrated any leaks on postmortem examination.
Received: 14 July 1997/Accepted: 4 February 1998 相似文献
18.
J. Buyske M. McDonald C. Fernandez J. L. Munson L. E. Sanders J. Tsao D. H. Birkett 《Surgical endoscopy》1997,11(11):1084-1087
Background: Benign gastric tumors and tumors of low-grade malignancy can be safely removed laparoscopically.
Methods: Seven patients were considered candidates for laparoscopic resection of gastric tumors. Inclusion criteria included small
tumor size (less than 6 cm), exophytic or endophytic tumor morphology, and benign characteristics. Indications for surgical
intervention included bleeding, weight loss, and need for tissue diagnosis. Patients ranged in age from 38 to 70. There were
five female and two male patients. All patients underwent preoperative upper GI endoscopy. The procedures were performed using
a four- or five-port technique. An Endo-GIA (US Surgical Company, Norwalk, Connecticut) was used to amputate those tumors
located on the serosal surface of the stomach. Tumors on the mucosal surface were exposed via a gastrotomy, then likewise
amputated using an Endo-GIA. The gastrotomy closure was then either hand sewn or stapled. Operating time ranged from 95 to
225 min.
Results: Final pathologic diagnoses included lipoma, lymphoma, leiomyoma, and leiomyosarcoma. There was a 28% conversion rate. There
were no complications. Length of postoperative stay ranged from 4 to 7 days. There have been no tumor recurrences in 6–38-month
follow-up.
Conclusions: Minimally invasive management of benign and low-grade gastric tumors can be performed safely with excellent short- and long-term
results.
Received: 17 March 1997/Accepted: 28 May 1997 相似文献
19.
Pouch dilatation with stoma obstruction is a well-known late complication after adjustable gastric banding operations for
morbid obesity. Surgical treatment of this problem usually results in removal of the band, with or without replacement by
another, or in repositioning of the band via laparotomy. We present the case of a patient with late pouch dilatation and stoma
obstruction after placement of a Laparoscopic Adjustable Gastric Banding system (LAGB—Bioenterics) and in whom the adjustable
band was laparoscopically opened, disconnected from the access port, and repositioned more proximally on the stomach. The
postoperative course was uneventful. A postoperative radiographic contrast examination showed a correct repositioning of the
band. The case demonstrates that the LAGB can be successfully opened and repositioned by a minimal invasive procedure. This
is the first time to our knowledge that such a procedure has been reported.
Received: 25 May 1996/Accepted: 26 November 1996 相似文献
20.
Background: The antireflux capacity of various gastric fundoplications combines the creation of a valve (flapper or nipple) with recreation
of a sharp cardioesophageal angle. Experimental comparison of valve competency and appropriate valve geometry is incomplete
despite wide application of these techniques. Our primary aim was to compare the competency of several antireflux valves in
explanted cadaver stomachs. Our secondary aim was to understand better the geometry of the gastric fundus in empty and full
stomachs.
Methods: Stomachs with 6–8 cm of distal esophagus were harvested from 18 fresh cadavers. With the stomach empty, the greater and lesser
curvature length and the transverse dimensions of the anterior and posterior surface of the stomach in the fundus, body, and
antrum were measured. The pylorus was tied off over a catheter; the stomachs were inflated with water; and reflux occurred.
Intragastric pressure was measured during inflation with a needle inserted in the side of the stomach. A clamp was then placed
on the esophagus, and the stomach was inflated to a pressure of 10 mmHg. Gastric measurements were recalculated in the distended
stomach. The stomachs were deflated, the clamp removed, and a 2-cm Nissen fundoplication as well as 270° and 180° posterior
fundoplications were performed over a 60 Fr dilator. The stomachs were reinflated while the pressure was transduced. The inflation
was stopped when reflux occurred or when the fundoplication disrupted.
Results: The stomachs expanded symmetrically when filled with water except for the fundus in which the anterior gastric wall lengthened
by more than 100% and the posterior gastric wall lengthened by about 50%. In the untreated stomachs, reflux occurred at a
pressure of 3.0 ± 1.0 mmHg. After fundoplication, reflux never occurred, but the sutures pulled out of the stomach or esophagus
at 28.6 ± 16.8 mmHg. Posterior fundoplications refluxed water in several stomachs.
Conclusions: When filled, the anterior fundus expands to a greater degree than the posterior fundus, offering more tissue for creation
of floppy fundoplication. The ``floppy' Nissen fundoplication is completely competent, suffering a degradation before allowing
reflux. The posterior partial fundoplication is unpredictable in its competency.
Received: 3 April 1997/Accepted: 22 May 1998 相似文献