By George Y. Wu
Textual content describes the entire surgical and laparoscopic tactics now used for the gastrointestinal tract. comprises transparent, halftone illustrations and discussions of anatomical and physiological adjustments. additionally deals recommendation at the scientific administration of the postsurgical sufferer. For physicians. DNLM: Digestive approach Surgical Procedures--methods.
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Additional info for An Internist's Illustrated Guide to Gastrointestinal Surgery (Clinical Gastroenterology)
4. Laparoscopic Heller myotomy with partial fundoplication is the optimal treatment for patients with acceptable surgical risk. Ninety percent of patients report excellent results with this minimally invasive procedure. Chapter 3 / Esophagectomy for Achalasia 31 5. Pneumatic dilation and botulinum toxin injection are alternatives for patients who have unacceptable surgical risk factors. In patients who are surgical candidates, these nonsurgical interventions should be avoided as first-line therapies because they increase the risk of esophageal perforation if surgery is performed.
Large meals late at night often results in nocturnal reflux symptoms. Their elimination will often improve GERD. Obesity increases intrabdominal pressure. Weight loss will often effectively decrease reflux. H2-blockers and proton pump inhibitors potently neutralize gastric secretions stopping heartburn and healing esophagitis (1). When lifestyle modifications and medications are ineffective or poorly tolerated, surgery should be considered. In addition, in patients who are good surgical risks, LNF is an excellent alternative to lifelong medication (6).
Adequate visualization can be limited by patient anatomy including presence of teeth, a large neck, macroglossia, an anteriorly situated larynx, and redundant hypopharyngeal tissue. If adequate visualization is not possible, an attempt at endoscopic repair should be aborted and the open procedure performed. Preoperative counseling and informed consent should reflect this algorithm. The incidence of complications with the procedure increases significantly if visualization is difficult. Patients with cervical spine disorders or TMJ joint problems may not be suitable for the endoscopic approach.
An Internist's Illustrated Guide to Gastrointestinal Surgery (Clinical Gastroenterology) by George Y. Wu