s p o n s o r e d l i n k s
Surgical Diseases of the Esophagus
Anatomy
- Blood supply
- Lymphatic drainage
- Esophageal wall
Physiology and Physiologic Tests
Evaluation of Esophageal function
- 24- hour pH monitoring
- Manometry
- Barium Swallow
- Endoscopy
Gastroesophageal Reflux Disease
Etiology
Symptoms:
Typical:
- Heartburn
- Dysphagia
- Regurgitation
Atypical:
- Chest Pain
- Cough
- Hoarseness
- Asthma
Esophagitis
Barrett’s esophagus
Behavioral Modification:
- Elevate head of bed
- Avoid late meals
- Avoid foods that precipitate symptoms
Medical Therapy:
H2 blockers
Proton Pump Inhibitors
Indications for surgical treatment
- Depends on objective assessment of the severity and intractability of complications
- Essential to correlate occurrence of complications with presence of gastroesophageal reflux.
- Failure of medical management
- GERD controlled with medications, however patient wishes to stop taking the medications due to cost, quality of life, etc.
Evaluation of Esophageal function
- 24- hour pH monitoring
- Manometry
- Barium Swallow
- Endoscopy
- Solid Phase Gastric Emptying studies in case of symptoms of bloating or vomiting
Types of Anti-Reflux Procedures
- Laparoscopic Nissen fundoplication
- Laparoscopic Toupet fundoplication
- Additional Collis’Gastroplasty for short esophagus
- Additional Pyloroplasty for severe delayed gastric emptying
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