Ferguson / Fennerty Managing Failed Anti-Reflux Therapy

1. Auflage 2006
ISBN: 978-1-84628-011-5
Verlag: Springer
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 196 Seiten

Comprehensive and up-to-date analysis of GERD Has focus on remedies to failed treatment of the disease

Autoren/Hrsg.

Ferguson, Mark K.

Fennerty, M. Brian

Inhaltsverzeichnis

1;Preface;6
2;Contents;8
3;Contributors;10
4;1 The Epidemiology and Pathophysiology of Gastroesophageal Reflux Disease --- Peter J. Kahrilas and John E. Pandolfino;12
4.1;GERD Pathophysiology;13
4.2;Functional Constituents of the EGJ;13
4.3;Mechanisms of EGJ Incompetence in GERD;16
4.4;Transient LES Relaxations;16
4.5;LES (Intrinsic Sphincter) Hypotension;17
4.6;The Diaphragmatic Sphincter and Hiatus Hernia;18
4.7;Gastroesophageal Flap Valve;18
4.8;Mechanical Properties of the Relaxed EGJ;18
4.9;Esophageal Acid Clearance;20
4.10;Impairments of Esophageal Emptying;21
4.11;Salivary Function;21
4.12;Summary;22
4.13;References;22
5;2 History of Medical and Surgical Anti-Reflux Therapy --- Mark K. Ferguson;26
5.1;Early Nonsurgical Therapy;27
5.2;Esophageal Dilation;27
5.3;Esophageal Stents;28
5.4;Palliative Surgical Therapy;29
5.5;Early Surgical Therapy;30
5.6;Physiologic Surgical Therapy;31
5.7;Pharmacologic Therapy;34
5.8;Endoscopic Therapy;35
5.9;References;36
6;3 Medical Management of GERD: Algorithms and Outcomes --- David A. Johnson;42
6.1;Background;42
6.2;Lifestyle/Diet Modifications;43
6.3;Antacids;43
6.4;Promotility Agents;44
6.5;H2-Receptor Antagonists;45
6.6;Proton Pump Inhibitors;45
6.7;Nocturnal Acid Breakthrough (PPI Plus H2RA);46
6.8;Maintenance of Remission;46
6.9;Barrett’s Esophagus;46
6.10;Extraesophageal GERD;47
6.11;Measuring Esophageal pH As an Outcome of Anti-Reflux Therapy;48
6.12;Measuring Esophageal Motility and LESP As an Outcome of Anti-Reflux Therapy;49
6.13;Endoscopic Assessment Endpoints As an Outcome of Anti-Reflux Therapy;49
6.14;Symptom Assessment As an Outcome of Anti-Reflux Therapy;50
6.15;Quality-of-Life Assessment As an Outcome of Anti-Reflux Therapy;51
6.16;Medication Use As an Outcome of Anti-Reflux Therapy;51
6.17;Conclusions;52
6.18;References;52
7;4 Complications of GERD: Esophagitis, Stricture, Barrett’s, and Cancer --- John A. Bonino and Prateek Sharma;56
7.1;Erosive Esophagitis;56
7.1.1;Prevalence;56
7.1.2;Pathogenesis and Risk Factors;57
7.1.3;Symptoms;58
7.1.4;Treatment;58
7.2;Esophageal (Peptic) Stricture;59
7.2.1;Pathogenesis and Prevalence;59
7.2.2;Risk Factors;59
7.2.3;Symptoms;59
7.2.4;Treatment;59
7.3;Barrett’s Esophagus;60
7.3.1;Prevalence;60
7.3.2;Pathogenesis and Risk Factors;60
7.3.3;Symptoms;61
7.3.4;Surveillance;61
7.3.5;Medical Therapy;62
7.3.6;Anti-reflux Surgery;62
7.3.7;Endoscopic Therapy;62
7.4;Esophageal Adenocarcinoma;63
7.4.1;Incidence;63
7.4.2;Pathogenesis;63
7.4.3;Risk Factors;63
7.4.4;Symptoms;64
7.4.5;Treatment;64
7.5;Summary;64
7.6;References;65
8;5 Principles of Successful Surgical Anti-Reflux Procedures --- Federico Cuenca-Abente, Brant K. Oelschlager, and Carlos A. Pellegrini;68
8.1;Indications;68
8.1.1;Averse to Lifestyle Changes;68
8.1.2;Poor Response to Proton Pump Inhibitors;68
8.1.3;Patients with Airway Manifestations of GERD;69
8.1.4;Patients with Barrett’s Esophagus;69
8.2;Contraindications;69
8.2.1;Morbid Obesity;69
8.2.2;Severe Comorbidities;69
8.3;Preoperative Evaluation;69
8.3.1;Flexible Endoscopy (EGD);69
8.3.2;Manometry;70
8.3.3;Twenty-four-hour pH Esophageal Monitoring;70
8.3.4;Upper Gastrointestinal Series;70
8.3.5;Twenty-four-hour Esophageal and Pharyngeal pH Monitoring;70
8.3.6;Laryngoscopy;70
8.3.7;Impedance;70
8.4;Surgical Technique—Nissen Fundoplication;71
8.4.1;Basic Tenants of Anti-Reflux Procedures;71
8.4.2;Relative Advantages of Different Fundoplications;71
8.4.3;Perioperative Considerations;72
8.4.4;Creation of Pneumoperitoneum and Port Placement;72
8.4.5;Dissection of the Cardia (“Left Crus Approach”);73
8.4.6;Division of the Short Gastric Vessels;73
8.4.7;Esophageal Mobilization;73
8.4.8;Hiatal Closure;74
8.4.9;Construction of the Wrap;74
8.4.10;Anchoring the Fundoplication;74
8.5;Conclusio;75
8.6;References;75
9;6 Acute Complications of Anti-Reflux Surgery --- Gianmattia del Genio and Jean-Marie Collard;78
9.1;Intraoperative Complications;79
9.1.1;Vascular Injury;79
9.1.2;Esophageal and Gastric Tear;80
9.1.3;Vagal Nerve Injury;81
9.1.4;Pneumomediastinum and Pneumothorax;81
9.2;Acute Postoperative Complications;82
9.2.1;Gastric and Esophageal Fistula;82
9.2.2;Bleeding;83
9.2.3;Herniation of the Wrap into the Chest;84
9.2.4;Acute Dysphagia;85
9.3;Summary;86
9.4;References;86
10;7 Persistent Symptoms after Anti-Reflux Surgery and their Management --- John G. Hunter and M. Brian Fennerty;90
10.1;Introduction;90
10.2;Evaluation of Patients with New or Recurrent Symptoms of GERD;90
10.2.1;Early Postoperative Symptoms;90
10.2.2;Recurrent GERD Symptoms;91
10.2.3;Persistent Postoperative Dysphagia;93
10.3;Anatomic Failure of Nissen Fundoplication;95
10.3.1;Fundoplication Herniation;95
10.3.2;Slipped Nissen Fundoplication;95
10.3.3;Disrupted Fundoplication, Twisted Fundoplication, and the Twocompartment Stomach;96
10.3.4;Bloating, Nausea, and Epigastric Pain;96
10.3.5;Reoperation for Fundoplication Failure;98
10.3.6;Exposure for Reoperative Laparoscopic Fundoplication;98
10.4;Conclusion;99
10.5;References;99
11;8 Technical Surgical Failures: Presentation, Etiology, and Evaluation --- Carrie A. Sims and David W. Rattner;102
11.1;Presenting Symptoms of Failed Anti-Reflux Operations;102
11.2;Methods of Evaluation;103
11.3;Potential Causes of Failure;105
11.4;Treatment Options;107
11.4.1;What Is the Best Surgical Approach to a Reoperation?;108
11.4.2;Choosing a Partial or a Total Fundoplication;109
11.4.3;Considerations for Esophageal Lengthening Procedures;109
11.4.4;Management of the Difficult Hiatus;110
11.4.5;Technical Tips for Laparoscopic Reoperations;111
11.5;Conclusion;112
11.6;References;112
12;9 Symptoms after Anti-Reflux Surgery: Everything is not always caused by Surgery --- Kenneth R. DeVault;114
12.1;Dysphagia;114
12.2;Gas Bloat and Upper Abdominal Discomfort;115
12.3;Flatulence, Diarrhea, and Irritable Bowel Syndrome;117
12.4;Recurrent Heartburn;118
12.5;Recurrent “Atypical” Symptoms;119
12.6;Summary;120
12.7;References;120
13;10 The Medical and Endoscopic Management of Failed Surgical Anti-Reflux Procedures --- M. Brian Fennerty and John G. Hunter;124
13.1;Magnitude of the Problem;124
13.2;Documentation of Recurrent Reflux after Surgical Anti-Reflux Therapy;124
13.3;Endoscopic Assessment of a Prior Surgical Anti-Reflux Procedure;126
13.4;Ambulatory Esophageal pH Monitoring in Patients with Prior Anti-Reflux Procedures;128
13.5;Other Tests of Gastrointestinal Physiology and Function;129
13.6;Endoscopic and Pharmacological Therapy after Failed Anti-Reflux Surgery;129
13.6.1;Endoscopic Anti-Reflux Procedures in General;129
13.6.2;Food and Drug Administration Status of Endoscopic Anti-Reflux Procedures;130
13.6.3;Reimbursement Status of Endoscopic Anti-Reflux Procedures;130
13.6.4;Short- and Long-term Outcomes of Endoscopic Anti-Reflux Procedures;130
13.6.5;Use of Endoscopic Anti-Reflux Procedures in This Clinical Situation;131
13.6.6;Pharmacological Therapy for Failed Anti-Reflux Surgery;132
13.6.7;Use in This Clinical Situation;133
13.7;Conclusions;134
13.8;References;134
14;11 Reoperation for Failed Anti-Reflux Surgery --- Jennefer A. Kieran and Myriam J. Curet;138
14.1;Preoperative Evaluation;138
14.2;Operative Techniques;139
14.2.1;Open Laparotomy for Reoperative Fundoplication;139
14.2.2;Laparoscopic Revision of Fundoplication;141
14.2.3;Comparison of Open Versus Laparoscopic Refundoplication;144
14.2.4;Laparoscopic Gastric Bypass for Recurrent Reflux;145
14.2.5;Thoracotomy;146
14.3;Postoperative Management;147
14.4;Summary;147
14.5;References;147
15;12 Management of Alkaline Reflux --- Jose M. Clavero, Philippe Topart, and Claude Deschamps;150
15.1;Pathogenesis;150
15.2;Diagnosis;151
15.2.1;Endoscopy;151
15.2.2;Scintigraphy;151
15.2.3;Aspiration Studies;151
15.2.4;Twenty-four-hour pH Monitoring;152
15.2.5;Bilirubin Monitoring;153
15.3;Treatment;153
15.3.1;Bile Diversion Operations;153
15.3.2;Total Duodenal Diversion;153
15.3.3;Duodenal Switch;155
15.3.4;Biliary Diversion;156
15.4;Technical Aspects;156
15.4.1;Long-limb Roux-Y Jejunal Reconstruction after Total or Proximal Gastrectomy;156
15.5;Conclusion;158
15.6;References;158
16;13 Management of the Short Esophagus --- Éric Fréchette and André Duranceau;162
16.1;Evolution of Hiatal Hernia and Anti-Reflux Surgery;162
16.2;Definition;163
16.3;Etiology;163
16.4;nvestigation;164
16.4.1;Radiology;164
16.4.2;Endoscopy and Esophageal Biopsies;165
16.4.3;Motility Studies;165
16.4.4;Monitoring Acid and Bile Reflux;166
16.5;Medical Management;166
16.6;Surgical Treatment;166
16.6.1;Standard Anti-Reflux Repairs;166
16.6.2;Lengthening Gastroplasties;167
16.6.3;Stricturoplasty and Intrathoracic Fundoplication;170
16.6.4;Vagotomy, Antrectomy, and Roux-en-Y Diversion;171
16.6.5;Treatment of the Short Esophagus by Minimally Invasive Surgery;171
16.7;Conclusion;171
16.8;References;172
17;14 Esophagectomy: Indications, Techniques, and Outcomes --- Mark K. Ferguson;174
17.1;History;174
17.2;Indications;175
17.2.1;Peptic Stricture;175
17.2.2;Gastrointestinal Bleeding;175
17.2.3;Multiple Failed Anti-Reflux Operations;176
17.2.4;Complications of Barrett’s Esophagus;176
17.3;Techniques;176
17.3.1;Patient Preparation;176
17.3.2;Approach;177
17.3.3;Extent of Resection;178
17.3.4;Procedure;179
17.4;Outcomes;182
17.5;Conclusions;183
17.6;References;183
18;15 Vagal Sparing Esophagectomy --- Steven R. DeMeester;186
18.1;Evaluation;187
18.2;Indications for Vagal-sparing Esophagectomy;187
18.3;Surgical Approach;188
18.4;Results;189
18.5;Summary;191
18.6;References;191
19;16 Future Directions of Therapy for GERD --- M. Brian Fennerty and Mark K. Ferguson;192
19.1;Physiologic Evaluation of Suspected GERD;192
19.2;Medical Therapy for GERD;192
19.3;Endoscopic Anti-Reflux Procedures;193
19.4;Newer Indications for Surgical Therapy;193
19.5;Centers of Surgical Excellence;194
19.6;Evaluation of the Failed Anti-Reflux Procedure;194
19.7;Endoscopic and Pharmacologic Therapy after a Failed Anti-Reflux Surgery;195
19.8;References;196
20;Index;198