Laparoscopic Antireflux Surgery

Description

This book provides detailed, up-to-date information on gastroesophageal reflux disease (GERD) and all aspects of laparoscopic antireflux surgery. Clear descriptions of surgical techniques and important surgical tips are combined with state of the art research results to create a unique resource for general surgeons and other health care providers. The book opens by presenting the latest knowledge on the pathogenesis of GERD, identifying the target symptoms, and explaining diagnostic tests and their interpretation. The various techniques of fundoplication are then clearly described and illustrated, with provision of advice on the postoperative clinical pathway and the management of complications. Laparoscopic revision of failed antireflux surgery is fully covered, and the use of antireflux surgery in specific situations, such as achalasia and paraesophageal hernia, is discussed. The relationship between sleeve gastrectomy and GERD is also explored. Finally, guidance is provided on magnetic sphincter augmentation using the LINX Reflux Management System and on other emerging surgical options. Acknowledgements Contents 1: The Chronicle of Antireflux Surgery 1.1 Historical Trends of Antireflux Surgery 1.1.1 Initiation of Antireflux Surgery 1.2 Concept of His Angle 1.3 Esophageal Lengthening Procedure 1.4 The Advent of Fundoplication 1.5 Modern Alternative Efforts to Improve Antireflux Surgery 1.6 Conclusion References 2: GERD Pathogenesis and Essential Anatomic Knowledge for Antireflux Surgery 2.1 Definition of GERD 2.2 Anatomic Structure of the Gastroesophageal Junction and Pathogenesis of GERD 2.2.1 Lower Esophageal Sphincter 2.2.2 Esophageal Hiatus 2.2.3 Other Factors that May Aggravate GERD Symptoms 2.2.4 A Scenario in the Development of GERD: A Vicious Cycle 2.3 Role of Antireflux Surgery in Restoration of Normal Antireflux Valve Mechanism 2.3.1 Strengthening of LES: Fundoplication 2.3.2 Restoration of Normal GEJ Anatomy: Cruroplasty 2.3.3 Prevention of Recurrence of Hiatal Hernia 2.3.4 Prevention of Adverse Symptoms After ARS 2.3.5 Relationship Between TLESR and ARS References 3: Clinical Manifestations and Surgical Indications of Gastroesophageal Reflux Disease 3.1 Clinical Manifestation of Gastroesophageal Reflux Disease 3.1.1 Esophageal Syndromes 3.1.1.1 Typical Reflux Syndrome 3.1.1.2 Reflux Chest Pain Syndrome 3.1.1.3 Syndromes with Esophageal Injury 3.1.2 Extraesophageal Syndromes 3.2 Surgical Indications and Predisposing Factors to Predict the Outcome of ARS References 4: Anti-reflux Surgery to Extra-esophageal Manifestations of GERD 4.1 Extra-esophageal Manifestation of GERD 4.2 Laryngopharyngeal Reflux 4.3 Pathophysiology 4.4 Diagnosis 4.5 Hypopharyngeal Multichannel Intraluminal Impedance 4.6 Anti-reflux Surgery to Extra-esophageal Manifestations References 5: Diagnostic Tests and Interpretations Before Anti-reflux Surgery 5.1 Introduction 5.2 Endoscopic Findings 5.3 24-Hour Esophageal pH Test 5.3.1 Equipment 5.3.1.1 pH Electrodes 5.3.1.2 Data Recorder 5.3.2 Technique 5.3.2.1 Preparation 5.3.2.2 Calibration of Electrodes 5.3.2.3 Location of Electrodes 5.3.3 Interpretation 5.3.3.1 Variables 5.3.3.2 Association with Symptoms 5.3.4 Clinical Application 5.3.5 Limitations 5.4 Esophageal Impedance Test 5.4.1 Fundamental Principles of Impedance Test 5.5 Esophageal Impedance-pH Test 5.5.1 Equipment and Technique 5.5.2 Data Analysis 5.5.2.1 Normal Value of Impedance-pH Test 5.5.2.2 Interpretation 5.5.3 Clinical Application 5.6 Esophageal Manometry 5.6.1 Indication 5.6.2 Equipment 5.6.3 Technique 5.6.3.1 Preparation Before Examination 5.6.3.2 Equipment 5.6.3.3 Examination 5.6.3.4 Recording Test Results General Information Lower Esophageal Sphincter Esophageal Body Upper esophageal Sphincter Interpretation of Results 5.6.4 Interpretation 5.6.4.1 Manometric Finding of Normal Esophagus 5.6.4.2 Upper Esophageal Sphincter 5.6.4.3 Esophageal Body 5.6.4.4 Lower Esophageal Sphincter Classic Achalasia Atypical Disorders of LES Relaxation Diffuse Esophageal Spasm Nutcracker Esophagus Isolated Hypotensive LES Esophageal Hypocontraction 5.7 Esophageal Impedance-Manometry Test 5.7.1 Equipment and Technique 5.7.2 Analyzing and Interpretation 5.7.2.1 Definition of Impedance Indicator 5.7.2.2 Interpretation 5.7.3 Clinical Applications and Limits 5.8 Conclusion References 6: Various Techniques of Anti-reflux Treatment 6.1 Introduction 6.2 Epidemiology 6.3 Clinical Features 6.4 Pathogenesis 6.5 Diagnosis 6.6 Investigational Tests 6.7 Treatment 6.7.1 Lifestyle Modification 6.7.2 Medical Treatment 6.7.3 Endoscopic Options 6.7.4 Surgical Options 6.7.5 Operative Techniques 6.8 Complete Fundoplication 6.9 Partial Fundoplication 6.9.1 Long-Term Efficacy 6.10 Conclusions References 7: Postoperative Clinical Pathway After Anti-reflux Surgery 7.1 Definition of a Clinical Pathway 7.2 Clinical Pathway for Anti-reflux Surgery 7.3 Example of a CP After ARS 7.4 Pre-operation Day 7.5 Operation Day 7.6 Post-operation Day 1–2 7.7 Post-operation Day Three (Discharge Date) References 8: Complications After Antireflux Surgery (ARS) and Managements 8.1 Introduction 8.2 Acute Technical Complications After Antireflux Surgery 8.3 Functional Complications Following Antireflux Surgery 8.4 Summary References 9: Long-Term Outcomes and Cost-Effectiveness of Anti-reflux Surgery 9.1 Long-Term Outcomes of Laparoscopic Anti-reflux Surgery 9.1.1 Clinical Outcomes of Laparoscopic Anti-reflux Surgery 9.1.2 Comparison of Total Versus Partial Fundoplication 9.1.2.1 Total Versus Toupet 9.1.2.2 Total Versus Dor 9.2 Cost-Effectiveness of Laparoscopic Fundoplication Versus Medical Treatment 9.2.1 Cost-Effectiveness Analysis in the Field of Medicine 9.2.2 Cost-Effectiveness Study of Anti-reflux Surgery References 10: Failure and Revision of Antireflux Surgery 10.1 Introduction 10.2 Failure of ARS 10.3 Risk Factors for Failure of ARS 10.4 Evaluation of Patients with Persistent or Recurrent Symptoms After ARS 10.4.1 Upper Endoscopy 10.4.2 Barium Esophogram 10.4.3 pH Monitoring 10.4.4 Esophageal Manometry 10.5 Revisional Surgery 10.5.1 Operative Technique 10.5.2 Challenging Hiatal Closure Strategies 10.5.3 Adjunctive Procedure: EndoFLIP 10.5.4 Complications and Outcomes 10.5.5 Roux-En-Y Reconstruction 10.6 Summary References 11: Anti-reflux Surgery During Specific Situations: Achalasia, Para-esophageal Large Hiatal Hernia 11.1 Anti-reflux Surgery for Achalasia 11.2 Anti-reflux Surgery for Large Paraesophageal Hernia References 12: Reflux After Bariatric Surgery 12.1 GERD and Obesity 12.2 Reflux After Sleeve Gastrectomy 12.3 Reflux After Gastric Bypass 12.4 Reflux After Adjustable Gastric Band 12.5 Reflux After Mini-gastric Bypass/One-Anastomosis Gastric Bypass 12.6 Conclusions References 13: Emerging Surgical Options 13.1 Introduction 13.2 LINX® Reflux Management System 13.2.1 Cross Section of the LINX Device in Open and Closed Positions 13.2.2 Safety and Efficacy 13.3 Stretta® Procedure 13.3.1 Remodeling of the Musculature by Stretta Therapy 13.3.1.1 Safety and Efficacy 13.4 Transoral Incisionless Fundoplication 13.4.1 Safety and Efficacy 13.5 Electrical Stimulation of Lower Esophageal Sphincter 13.6 EndoFlip Impedance Planimetry System 13.7 Summary References