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Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication.
No full textFrom 1976 to 1989, 206 patients referred for primary treatment of esophageal
achalasia underwent transabdominal Heller's myotomy and anterior fundoplication
according to the Dor technique. In the majority of the patients, the cardia was
not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on
the esophagus and 2 cm on the stomach). There was no operative mortality. Two
patients (0.9%) required reoperation due to bleeding from the myotomy site in one
and leakage from the gastrotomy site in the other. One hundred ninety-three
patients entered the follow-up study and were followed up from 12 to 144 months
(median, 64.5 months). Five patients died during the follow-up of unrelated
diseases, and in one patient, an esophageal cancer infiltrating the trachea was
discovered 26 months after the operation. Clinical results were excellent or good
in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven
patients (3.6%), six of whom required pneumatic dilation for relief and one
patient who underwent reoperation because of a paraesophageal hiatal hernia.
Postoperative roentgenographic studies showed a significant reduction in the mean
value of the maximal esophageal diameter. Esophageal manometry showed a
significant reduction of lower esophageal sphincter pressure and length over
preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal
acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had
erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in
11 patients, showed a significant improvement of transit time in the erect
position compared with preoperative values. We concluded that transabdominal
esophagomyotomy combined with Dor fundoplication is a safe, effective, and
durable procedure in the treatment of esophageal achalasia
Surgical treatment of reflux stricture of the oesophagus.
No full textThe choice of surgery in patients with reflux-induced oesophageal stricture
remains controversial. From 1976 to 1990, a total of 65 patients underwent
fundoplication (36 patients), Collis gastroplasty plus fundoplication (ten),
total duodenal diversion (four) and oesophageal resection (15). The postoperative
mortality rate was 5 per cent (three patients): necrosis of the colon transplant
in two patients and acute pancreatitis in one. The median follow-up was 25 (range
6-120) months. After conservative surgery, the median number of dilatations per
patient per year significantly decreased (P < 0.001). Nine patients (25 per cent)
complained of persistent or recurrent symptoms after standard fundoplication and
six required reoperation. Clinical results were satisfactory in patients who
underwent Collis fundoplication, total duodenal diversion and oesophageal
resection. It is concluded that the causes of failed fundoplication are
irreversible stricture or persistent gastro-oesophageal reflux; the latter may be
caused by inefficacy or deterioration of the partial fundoplication wrap. A
subtle degree of oesophageal shortening is probably underestimated in such
patients and this may explain the better results obtained with the Collis
fundoplication. Total duodenal diversion is a good therapeutic option in patients
who have undergone previous oesophagogastric surgery. Oesophageal resection
should be reserved for patients with tight strictures unresponsive to dilatation
or those with scleroderma, multiple previous operations or severe dysplasia in
Barrett's oesophagus
L'ENDOSCOPIA OPERATIVA NELLA LITIASI DELLE VIE BILIARI E DELLE SUE COMPLICANZE: NOSTRA ESPERIENZA
No full text
DIAGNOSI FISIOPATOLOGICA NELLA RECIDIVA DOPO TRATTAMENTO CHIRURGICO DELLA MALATTIA DA REFLUSSO GASTRO-ESOFAGEO
No full textGoing Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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