Fig. 21.1 Various evaluation and treatment algorithms for patients presenting with (a) primarily GERD or (b) primarily gastroparesis symptoms There have been studies in the adult and pediatric populations that…
Fig. 10.1 Creation of Toupet fundoplication with key posterior gastropexy sutures and right fundoplication sutures to the esophagus. Left sided esophagopexy fundoplication sutures not shown Various types of partial fundoplications…
Open 1986a (%) Lap 1998b (%) Lap 2006c (%) Lap 2011d (%) Inability to belch 36 20 – – Inability to vomit (if tried) 63 25 – – Increased…
Indications Potential indications Abnormal pH testing (positive DeMeester score) Refractory GERD to surgical therapy (failed surgical treatment) PPI-responsive typical GERD symptoms Atypical GERD symptoms Small hiatal hernia (<2 cm) Mild…
Complication Early Late Death 0.09 0.001 Conversion to open 0–10 % Reoperation <0.1 % 3–10 % Side effects (dysphagia, bloating, nausea, etc.) 20–60 % 5–10 % The rate of conversion…
Fig. 17.1 Avoidance of dissection injury of the gastroesophageal junction requires careful retraction, identification of critical structures, precise dissection, and careful use of energy. An angled laparoscope allows dissection behind…
Fig. 7.1 The clasp and sling muscle fibers that make up the lower esophageal reflux barrier in the contracted and relaxed state Fig. 7.2 The EndoFlip (Crospon, Cork, Ireland) is…
Operation Antireflux barrier Decreased acid secretion Bile diversion Weight loss Fundoplication Yes No No No Gastric banding Yes No No Yes Sleeve gastrectomy No Yes No Yes Roux-en-Y gastric bypass…
Fig. 20.1 Example of ineffective esophageal motility, Swallow (Sw) 1–10: Hypotensive contraction (Swallow 1, 4, 6, 7, 8, 9); Failed peristalsis (Swallow 2, 3, 5, 10); Weak peristalsis with small…
Fig. 2.1 Anatomy and histology in normal and increasing severity of chronic reflux disease. (a) In the normal patient, the esophagus is lined by squamous epithelium (gray) and the stomach…
