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

By Lee L. Swanstrom, Christy M. Dunst

This quantity presents a entire, cutting-edge evaluation of the key concerns particular to the sector of antireflux surgical procedure. It offers remarkable tutorial element relating to functionality of antireflux surgical procedure from prime esophageal surgeons all over the world. This quantity represents the single source of its sort devoted particularly to the problems specified to antireflux surgical procedure. it truly is wealthy intimately and invaluable illustrations that coach surgeons in right strategy in addition to offering the reasoning in the back of a number of concepts. Written by means of specialists within the box, Antireflux surgical procedure is of significant price to working towards surgeons who practice gastrointestinal surgical procedure, clinical scholars, surgical citizens, and fellows.

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Example text

At the present time, cancer risk is defined by the presence of intestinal metaplasia in the columnar lined esophagus. No effort is made to stratify risk in the patients with intestinal metaplasia by mapping the extent of intestinal metaplasia and the proximity of intestinal metaplasia to the distal esophagus. , a longer squamo-oxyntic gap) with its attendant higher carcinogen exposure, more intestinal metaplasia and extension of intestinal metaplasia to the more distal esophagus where carcinogen concentration is highest are at the greatest risk for cancer.

The most common operation is a Nissen fundoplication, which is a complete wrap of the gastric fundus around the distal esophagus, commonly with a crural repair. 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.

This is false. The resolution of endoscopes, even with narrow band imaging and magnification, is too low to see the microscopic columnar epithelium that is present in all patients with chronic reflux disease. What the eye does not behold at endoscopy exists in the patient under the microscope [2]. To not recognize this is a fundamental error. Effect of Acid Suppressive Drug Therapy on Squamous Epithelium Acid in gastric contents is responsible for most if not all of the reflux-induced damage produced in the squamous epithelium of the esophagus.

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