By George Wu
Few scientific disciplines were reworked so dramatically by way of developments in technology and know-how as gastrointestinal surgical procedure. firstly, glossy ph- macology has nearly eradicated a few varieties of surgical procedure altogether. If one have been to take a peek at a customary working room time table in a hectic sanatorium of the Sixties, gastrectomies of 1 sort or one other might have constituted a wide block of the main surgical procedures. the appearance of powerful H2-histamine receptor antagonists and, extra + + lately, the H ,K -ATPase (proton pump) inhibitors resulted in a precipitous decline in these strategies such that they're hardly played at the present time. interesting new methods to treating inflammatory bowel ailments and their complications—such as fistulas— with anticytokine treatment could in the future have a equally profound influence on surgical procedure for this to boot. past pharmaceutics, advances in imaging concepts have drastically facilitated the id and characterization of pathology within the gastrointestinal tract in a fashion that may were unbelievable just a couple of years in the past. simply to visualize the pancreas not directly was once a horrendous job until eventually stomach ultrasound, magnetic resonance imaging, or computing device tomography made it basic. the truth that the intestine is a hole organ that may be accessed throughout the mouth, anus, or perhaps throughout the wall of the stomach has been totally exploited with fiberoptic endoscopes which could bend round corners very easily and allow surgical procedure to be carried out via them.
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Extra resources for An Internist's Illustrated Guide to Gastrointestinal Surgery
INDICATIONS All patients who can tolerate general anesthesia and laparoscopy should be candidates for surgery. In particular, patients under 40 yr of age have worse results with pneumatic dilation, whereas Heller myotomy offers a 90% long-term success rate (5). Patients who have failed other forms of therapy such as Botox injection or pneumatic dilation are surgical candidates. These patients may have scarring in the distal esophagus increasing the difficulty of the myotomy and increasing the mucosal perforation rate, but they have equivalent outcomes with little additional morbidity (6).
A transabdominal approach is used for patients with normal esophageal contractility and length. Patients who present with long-standing disease associated with poor esophageal function, a short esophagus, or stricture should undergo an open antireflux procedure tailored to their underlying anatomic and physiologic abnormalities. Those with weak esophageal contractions may be treated with a partial 270° fundoplication such as the transabdominal Toupet (Fig. 6) or transthoracic Belsey IV fundoplication in order to avoid the increased outflow resistance associated with a 360° Nissen fundoplication.
Type IV hiatal hernia: combination of type III with herniation of other viscus (colon). hernia may develop more gradually. Allen et al. followed 23 patients for a median of 78 mo and found only three cases of gastric strangulation in 735 patient years of follow-up (5). Although the true incidence of gastric volvulus presenting with strangulation is controversial (ranging from 3–30%), the elective repair of paraesophageal hernia is generally recommended because emergency surgery for acute complications carries a high mortality rate (5,6).
An Internist's Illustrated Guide to Gastrointestinal Surgery by George Wu