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51.
Gastrobronchial fistula is a rare complication of antireflux surgery. Presentation can be subacute, with only productive cough. Endoscopy often fails to visualize these fistulae. Barium in the bronchial tree during postoperative upper gastrointestinal series is diagnostic, but can be confused with that appearing due to aspiration. Every case reported after antireflux surgery has followed intrathoracic Nissen fundoplication. 相似文献
52.
Background/Purpose
Gastroesophageal reflux is common in children with severe neurological impairment. Fundoplication may produce symptomatic improvement but has a high failure rate. Esophagogastric dissociation (EGD) is an alternative procedure for treatment of gastroesophageal reflux. The aim of this study is to evaluate the results of EGD in our institution and compare them with a neurologically matched group of children who had Nissen fundoplication.Methods
Twenty consecutive patients who had EGD were retrospectively evaluated and the results were compared with a neurologically matched group of 20 consecutive patients who had Nissen fundoplication.Results
Twenty patients had EGD, 17 as a primary procedure. There was no operative mortality but 5 have died of other causes. Resolution of reflux-associated symptoms occurred in all patients. Of the 15 survivors, 5 remain on antireflux medication.Twenty patients had fundoplication. There was no operative mortality, but 8 patients have died of other causes. Failure occurred in 5 patients necessitating further surgery. Of the 10 unreoperated survivors, 6 remain on antireflux medication.Conclusions
Esophagogastric dissociation is an effective antireflux procedure when compared with fundoplication. It has a lower failure rate. We recommend EGD as a primary procedure in selected children with severe neurological impairment. 相似文献53.
Background This study aimed to evaluate the development and outcomes of laparoscopic antireflux surgery in Germany using a nationwide
representative survey.
Methods A written questionnaire including 34 detailed questions and 288 structured items about diagnostic and therapeutic approaches,
number of procedures, complications, and mortality was sent to 546 randomly selected German surgeons (33% of the registered
general surgeons) at the end of 2000.
Results The response rate was 72%, and a total of 2,540 antireflux procedures were reported. According to the survey, 81% of all procedures
were performed laparoscopically, and 0.1% were performed thoracoscopically. As reported, 65% were total fundoplications, 31%
were partial fundoplications, and 4% were other procedures. Of the surgeons who had experience with laparoscopic antireflux
techniques (29%), 71% preferred a 5-trocar technique, and 91% used the Harmonic Scalpel for dissection. There were significant
technical variations among the surgical procedures (e.g., use and size of the bougie, length of the wrap, additional gastropexy,
fixation of the wrap). The overall complication rate for laparoscopic fundoplication was 7.7% (5.7% surgical and 2% nonsurgical
complications), including rates of 0.6% for esophageal perforations and 0.6% for splenic lesions. The conversion rate was
2.9%; the reoperation rate was 1.6%; and the overall hospital mortality rate was 0.13%. The authors observed a striking learning
curve difference in complication rates between hospitals performing fewer than 10 laparoscopic antireflux techniques annually
and those performing more than 10 fundoplications per year (14% vs 5.1%, p < 0.001). Long-term dysphagia and interventions occasioned by dysphagia occurred significantly more often after total fundoplications
than after partial fundoplications (6.6% vs 2.4%; p < 0.001). Similar findings were reported for Nissen versus floppy Nissen procedures. The overall failure rate, however, was
similar for both groups (Nissen 8.7%; partial 9%, difference not significant).
Conclusions Until now, no unique laparoscopic antireflux technique has been accepted, and a number of different antireflux procedures
with numerous modifications have been reported. The morbidity and mortality rates reported in this article compare very well
with those in the literature, and 1-year-follow-up results are promising. 相似文献
54.
Heller‘s术附加抗返流术治疗贲门失弛缓症86例疗效观察 总被引:1,自引:0,他引:1
目的:探讨Heller's术及其附加抗返流术治疗贲门失弛缓症的疗效。方法:对86例贲门失弛缓症行Heller's术附加抗返流术为观察组,50例贲门失弛缓症单纯行Heller's术为对照组,将两组进行比较,观察远期疗效及返流性食管炎的发生率,结果:Heller's手术组远期有效率70%,返流性食管炎发生率30%,Heller's术附加抗返流手术组远期有效率93.02%,返流性食管炎发生率5.81%,两组远期疗效和返流性食管炎发生率均有显著统计学意义(P<0.001),结论:Heller's术附加抗返流术远期疗效较单纯Heller's术好,而返流性食管炎发生率较单纯Heller's术低。 相似文献
55.
Guy-Bernard Cadière Nathalie Van Sante Jaime E. Graves Anna K. Gawlicka Amin Rajan 《Surgical endoscopy》2009,23(5):957-964
Background A feasibility study (n = 19) evaluated the safety and initial efficacy of transoral incisionless fundoplication (TIF) for the treatment of gastroesophageal
disease (GERD). The results at 1 year (n = 17) indicated that TIF was safe and had a significant effect on reducing GERD symptoms, proton pump inhibitor (PPI) usage,
acid exposure, and small hiatal hernia. This study was designed to evaluate the long-term safety and durability of TIF.
Methods Fourteen patients (50% female; median age, 34 years) completed the 2-year follow-up assessment tests. Three patients were
excluded from the study after 1 year because two of them underwent retreatment and one was lost to follow-up.
Results At 2 years, no adverse events related to TIF were reported. A ≥50% improvement in GERD-HRQL scores compared with those at
baseline on PPIs was sustained by 64% of patients. TIF was effective in eliminating heartburn in 93% of patients and daily
PPI therapy in 71% of patients. Significantly (p < 0.05) more patients were able to consume reflux-causing foods and maintain lifestyle activities without GERD symptoms compared
with baseline on PPIs. Fundoplications were durable and maintained their geometric dimensions. TIF was effective in eliminating
hiatal hernia in 60% of patients and esophagitis in 55% of patients. Global assessment of all outcomes in each patient revealed
that 79% of patients experienced complete cure (29%) or remission (50%) of GERD at 2 years after TIF.
Conclusion The results at 2 years supported the long-term safety and durability of TIF and its sustained effect on the elimination of
heartburn, esophagitis, ≤2 cm hiatal hernia, and daily dependence on PPIs. 相似文献
56.
Ten-year Outcome of Laparoscopic Antireflux Surgery 总被引:1,自引:0,他引:1
M. Fein M. Bueter A. Thalheimer V. Pachmayr J. Heimbucher S. M. Freys K.-H. Fuchs 《Journal of gastrointestinal surgery》2008,12(11):1893-1899
Background Reflux recurrence is the most common long-term complication of fundoplication. Its frequency was independent from the type
of fundoplication in randomized studies. Results for different techniques of laparoscopic antireflux surgery were retrospectively
evaluated after 10 years.
Methods From 1992 to 1997, 120 patients had primary laparoscopic fundoplication with a “tailored approach” (type of wrap chosen according
to esophageal peristalsis): 88 received a Nissen, 22 an anterior, and 10 a Toupet fundoplication. Follow-up of 87% of the
patients included disease-related questions and the gastrointestinal quality-of-life index (GIQLI).
Results Of the patients, 89% would select surgery again. Heartburn was reported by 30% of the patients. Regurgitations were noted
from 15% of patients after a Nissen, 44% after anterior fundoplication, and 10% after a Toupet (p = 0.04). Twenty-eight percent were on acid-suppressive drugs again. Following Nissen fundoplication, proton pump inhibitors
were less frequently used (p = 0.01) and on postoperative pH-metry reflux recurrence rate was lower (p = 0.04). The GIQLI was 110 ± 24 without significant differences for the type of fundoplication.
Discussion Ten years after laparoscopic fundoplication, overall outcome is good. A quarter of the patients are on acid-suppressive drugs.
Nissen fundoplication appears to control reflux better than a partial fundoplication.
The results of the questionnaire have already been published in German in the journal ‘Der Chirurg’. 相似文献
57.
Esophageal adenocarcinoma has the fastest growing incidence rate of any cancer in the United States, and currently carries a very poor prognosis with 5 years relative survival rates of less than 15%. Current curative treatment options are limited to esophagectomy, a procedure that suffers from high complication rates and high mortality rates. Metaplasia of the esophageal epithelium, a condition known as Barrett's esophagus(BE), is widely accepted as the precursor lesion for adenocarcinoma of the esophagus. Recently, radiofrequency ablation has been shown to be an effective method to treat BE, although there is disagreement as to whether radio-frequency ablation should be used to treat all patients with BE or whether treatment should be reserved for those at high risk for progressing to esophageal adenocarcinoma while continuing to endoscopically survey those with low risk. Recent research has been targeted towards identifying those at greater risk for progression to esophageal adenocarcinoma so that radio-frequency ablation therapy can be used in a more targeted manner, decreasing the total health care cost as well as improving patient outcomes. This review discusses the current state of the literature regarding risk factors for progression from BE through dysplasia to esophageal adenocarcinoma, as well as the current need for an integrated scoring tool or risk stratification system capable of differentiating those patients at highest risk of progression in order to target these endoluminal therapies. 相似文献
58.
59.
Background A new endoluminal fundoplication (ELF) technique performed transorally using the EsophyX™ device was evaluated for the treatment
of gastroesophageal reflux disease (GERD) in a prospective, feasibility clinical trial.
Methods Nineteen patients were enrolled into the study. Inclusion criteria were chronic and symptomatic GERD, proton pump inhibitor
(PPI) dependence, and the absence of esophageal motility disorder. Two patients were excluded due to esophageal stricture
and a 6 cm hiatal hernia. The median duration of GERD symptoms and PPI use in the remaining 17 patients was 10 and 6 years,
respectively. The ELF procedure was designed to partially reconstruct the antireflux barrier through the creation of a valve
at the gastroesophageal junction.
Results The ELF-created valves had a median length of 4 cm (range 3–5 cm) and circumference of 210° (180–270°). Adherence of the valves
to the endoscope was tight (n = 14) or moderate (n = 3). Hiatal hernias present in 13 patients (76%) were all reduced. Adverse events were limited to mild or moderate pharyngeal
irritation and epigastric pain, which resolved spontaneously. After 12 months, the ELF valves (n = 16) had a median length of 3 cm (1–4 cm) and a circumference of 200° (150–210°). Eighty-one percent of valves retained
their tightness. The hiatal hernias present at the baseline remained reduced in 62% of patients. The median GERD-HRQL scores
improved by 67% (17–6), and nine patients (53%) improved their scores by ≥50%. Eighty-two percent of patients were satisfied
with the outcome of the procedure, 82% remained completely off PPIs, and 63% had normal pH.
Conclusion The study demonstrated technical feasibility and safety of the ELF procedure using the EsophyX™ device. The study also demonstrated
maintenance of the anatomical integrity of the ELF valves for 12 months and provided preliminary data on ELF efficacy in reducing
the symptoms and medication use associated with GERD. 相似文献
60.