Download Antireflux Surgery by Lee L. Swanstrom, Christy M. Dunst PDF

By Lee L. Swanstrom, Christy M. Dunst

This quantity presents a accomplished, state of the art evaluate of the most important concerns particular to the sector of antireflux surgical procedure. It offers unheard of tutorial aspect concerning functionality of antireflux surgical procedure from best esophageal surgeons around the globe. This quantity represents the single source of its style committed in particular to the problems particular to antireflux surgical procedure. it truly is wealthy intimately and worthwhile illustrations that tutor surgeons in right method in addition to providing the reasoning in the back of a number of suggestions. Written by means of specialists within the box, Antireflux surgical procedure is of significant price to practising surgeons who practice gastrointestinal surgical procedure, scientific scholars, surgical citizens, and fellows.

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San Diego: Academic; 2006. p. 201–40. 62. Thiesen J, Stein HJ, Feith M, Kauer WK, Dittler HJ, Pirchi D, Siewert JR. Preferred location for the development of esophageal adenocarcinoma within a segment of intestinal metaplasia. Surg Endosc. 2006;20:235–8. 63. Oberg S, Johansson J, Wenner J, Johnsson F, Zilling T, von Holstein CS, Nilsson J, Walther B. Endoscopic surveillance of columnar-lined esophagus: frequency of intestinal metaplasia detection and impact of antireflux surgery. Ann Surg. 2001;234: 619–26.

Columnar metaplasia first occurs in the most distal esophagus where the damage to the esophagus is highest in reflux disease. This metaplastic columnar epithelium separates the esophageal squamous epithelium from the normal oxyntic mucosa that lines the proximal stomach, creating a histologic squamo-oxyntic gap [1]. The presence of this metaplastic columnar epithelium and the gap is an absolutely specific and an extremely sensitive marker for reflux disease. With increasing reflux-induced damage of esophageal squamous epithelium, the amount of columnar metaplasia progressively increases and the squamo-oxyntic gap increases in length as the squamo-columnar junction (Z-line) moves cephalad.

Partial fundoplications that produce a lesser sphincter augmentation than a Nissen are also used. Lesser procedures than surgical fundoplication are available as anti-reflux procedures. Endoscopic fundoplication has been attempted but not with sustained success. The only procedure presently being used is the transoral incisionless fundoplication which has had limited success in a small number of patients. A newer technique is LINX, a magnetic ring placed laparoscopically around the distal esophagus to augment sphincter function.

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