An Internist's Illustrated Guide to Gastrointestinal Surgery by George Y. Wu

By George Y. Wu

Textual content describes the entire surgical and laparoscopic approaches now used for the gastrointestinal tract. comprises transparent, halftone illustrations and discussions of anatomical and physiological adjustments. additionally deals suggestion at the scientific administration of the postsurgical sufferer. For physicians. DNLM: Digestive process Surgical Procedures--methods.

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LNF was initially performed only at referral centers. As experience with this procedure has grown, surgeons who perform advanced laparoscopy are routinely performing LNF in community hospitals. As with many laparoscopic procedures, there is a learning curve of 30 to 50 operations. When this curve is surmounted, operative times and complications decrease and long-term successful antireflux repair is achieved (2). This chapter will discuss the pathophysiology of GERD, treatment options, indications for surgery, necessary preoperative evaluations, a description of LNF, alternative antireflux procedures, and LNF’s results, complications, and costs.

Wu, Khalid Aziz, and Giles F. , Totowa, NJ 17 18 Holm and Lafreniere Fig. 1. (A) Normal anatomy. (B) Anatomical relationships of Zenker’s diverticulum. EVALUATION Dysphagia is the presenting symptom for a large number of ailments of the upper aerodigestive tract. Diligent history taking and examination are required to elicit the correct diagnosis. Tumors of the hypopharynx, larynx, and esophagus may present with a similar spectrum of symptoms. Careful history-taking regarding the exact nature of symptoms, associated symptoms, comorbid conditions, and risk factors for carcinoma are vital.

Several excellent series have been published. Dysphagia was relieved in more than 90% of patients with a follow-up of 2 yr (8). The largest published series of 133 patients by Patti et al. reported excellent results in 90% of patients with a mean follow-up of 28 mo (9). SUMMARY 1. Achalasia is a neurological disease of the esophagus characterized by an aperistaltic body and poor relaxation of LES. 2. Dysphagia and regurgitation with eventual weight loss are usual presenting complaints. 3. The diagnosis may be made with a barium swallow, but should be followed with upper endoscopy and manometric studies.

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