By George Y. Wu
Textual content describes the entire surgical and laparoscopic systems now used for the gastrointestinal tract. contains transparent, halftone illustrations and discussions of anatomical and physiological alterations. additionally deals recommendation at the clinical administration of the postsurgical sufferer. For physicians. DNLM: Digestive process Surgical Procedures--methods.
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Additional info for An Internist's Illustrated Guide to Gastrointestinal Surgery (Clinical Gastroenterology)
The muscle is Chapter 3 / Esophagectomy for Achalasia 29 Fig. 4. Postoperative barium swallow. dissected from the mucosa allowing the mucosa to protrude. Intraoperative flexible endoscopy is then performed to be certain there is no further distal obstruction. The myotomy can be easily extended if necessary until the lower esophageal sphincter is ablated. Air is insufflated into the esophagus and the distended mucosa is assessed for evidence of perforation. Once the myotomy is completed, an antireflux procedure is added.
The relationship of the distal esophagus to the gastric fundus (which compresses the distal esophagus when the stomach is distended) also contributes to this high-pressure zone (4). The relationship of the distal esophagus to the diaphragm stops reflux (Figs. 1–3). Normally, the distal esophagus rests within the abdomen. As the esophagus traverses the hiatus, the crura of the diaphragm compress the esophagus, increasing LES pressure. This compression is maximal during inspiration, when intrathoracic pressure decreases and risk of reflux is greatest.
The absence of acid reflux or poor correlation between symptoms and reflux is a predictor of poor outcome of surgery (2,5,6). Esophageal motility testing is essential to rule out esophageal motility disorder as causing symptoms. An LNF done in the presence of a motility disorder can lead to severe dysphagia. Patients with poor motility may benefit from a partial fundoplication (2,5,6). Upper GI endoscopy should be performed to document the presence of esophagitis or Barrett’s esophagus both visually and through biopsies.