1,721,029 research outputs found
Effectivenes of Antireflux Surgery(Fundoplication) for the cure of Chronic Cough with or without GERD Symptoms.
No full textBackground: The outcome of surgical therapy for atypical extra-esophageal symptoms allegedly secondary to GERD is controversial. Aim of this study was to assess the results of antirefl ux surgery in patients affected by 1) typical, 2) typical atypical, (chronic cough), in whom a dedicated preoperative work up was performed. Methods: Between 1995 and 2010, 151 patients with GERD-related typical and/or atypical symptoms were submitted to antirefl ux surgery. One hundred percent preoperatively underwent semi-quantitative evaluation of typical/atypical symptoms, chronic cough and esophagitis, barium swallow, endoscopy and histology and esophageal manometry (24 h pH-recording or intraluminal impedance/pH monitoring system in the absence of gross esophagitis). In addition, patients with chronic cough underwent chest HRCT scan, methacholine challenge test and spirometry. Surgery was performed exclusively on patients positive for GERD and negative for pulmonary diseases. Preoperative tests for GERD were repeated at follow-up. Results: Patients were ordered into two groups: A) 83 patients with typical symptoms only, B) 68 patients with typical symptoms and chronic cough. In both groups, antirefl ux surgery demonstrated to signifi cantly improve typical symptoms. The global score for outcome showed no signifi cant differences between group A and B. In group B, antirefl ux surgery signifi cantly improved chronic cough as well. Discussion: The preoperative work up was highly effective in selecting patients for antirefl ux surgery which achieved very satisfactory results in the treatment of GERD and GERD-related chronic cough. Disclosure: All authors have declared no confl icts of interest
Roux en Y Gastrojejunostomy for the treatment of complex Esophago-Gastric problems.
No full textBackground: Roux en Y gastrojejunostomy has been proposed for the treatment:
a) of complex benign esophageal problems generally in alternative to
distal esophagus resection; b) of complex redo antirefl ux surgery; c) of associated
gastric antrum and gastro-esophagel junction diseases, to avoid acidalkaline
esophageal refl ux, common after Billroth II gastrojejunostomy. The
Roux Stasis Syndrome (RSS) may impair results in 10% to 50% of cases. Aim
of the study is to evaluate the incidence of RSS after Roux en Y gastrojejunostomy
performed avoiding division of the jejunal mesentery, the gastrojejunal
terminolateral anastomosis being vertical to optimize emptying.
Methods: Of 38 patients, 27 were followed up in long term. Patients were
consecutively submitted to distal gastric resection for neoplastic or functional
disease of the esophageal and/or gastric tract and reconstruction with
Roux en Y jejunostomy. Patients were followed up with clinical interview,
barium swallow, endoscopy.
Results: Mortality was 2.6% and morbility was 16.2%. Median follow-up
was 113.6 months (range 6–192 months). RSS were found in 2 on 27 patients
(7.4%). Two patients (with caustic injury) were then subjected to esophagocolo-
gastroplasty for esophageal stenosis not otherwise treatable, one
patient (already undergone two redo surgery for esophageal achalasia) complained
of signifi cant dysphagia. In the remaining patients the functional
result is satisfactory.
Discussion: Roux en Y gastrojejunostomy is an effective option for the treatment
of complex esophago-gastric problems. The Roux Stasis Syndrome
may be minimized with few technical details.
Disclosure: All authors have declared no confl icts of interest
Surgical repair of Type II-IV Hiatal Hernia: frequency of True Short Esophagus and Results.
No full textBackground: The surgical management of type II-IV hiatal hernia is controversial.
Failure to recognize the condition of short esophagus may concur
to the high rate of hernia’s recurrence. We measured intraoperatively the
distance between the gastro-esophageal junction (GEJ) and the hiatus
(length of the abdominal esophagus) in patients undergoing surgery for type
II-IV hiatus hernias.
Methods: 34 patients underwent minimally invasive surgery. After isolation
of the GEJ and resection of the sac, the position of the gastric folds was
localized endoscopically and two clips were applied. The distance between
the clips and the diaphragm (abdominal esophagus) was measured with a
dedicated ruler after mediastinal dissection. In case of abdominal esophagus
1.5 cm a Collis-Nissen was performed.
Results: 17 (50%) fl oppy Nissen and 17 (50%) thoracoscopic Collislaparotomic
Nissen were performed. In the latter group, (all type III-IV
hernia), after mediastinal mobilization the length of the abdominal esophagus
was ≤1.5 cm. Post-operative mortality was 5.8% and morbility 17.6%.
Global results (median follow up 48 months) were excellent in 43.8%, good
in 50%, fair in 3.1%, and poor in 3.1%. Hiatal hernia relapse occurred in
3.1% of patients.
Discussion: True short esophagus is present in 50% of type III-IV and in
none of type II hiatus hernia. The intraoperative measurement of the length
of the abdominal esophagus is an objective method for recognizing these
patients.
Disclosure: All authors have declared no confl icts of interest
The gastro-esophageal prolapse in GERD : clinical patterns and surgical outcome.
No full textthe gastro-esophageal prolapse in GERD : clinical patterns and surgical outcome
PN Status in adenocarcinoma of the distal oesophagus and cardia (ADOC).
No full textpN status in adenocarcinoma of the distal oesophagus and cardia (ADOC).Objectives Adenocarcinoma of the distal oesophagus and cardia (ADOC) are grouped among the thoracic tumors according to the TNM 7~ ed., however controversy is pending on the unique or dual pathogenesis (GORD or gastric-like cancerogenesis). We investigated the pathways of Iymphatic spreading in two cohorts of ADOC with or without Barrett's metaplasia. Methods ADOC + Barrett's (group 1) was diagnosed in 54 (subtotal oesophagectomy and oesophagogastrostomy at the neck or chest dome); no Barrett's was detected in 140 ADOC (group 2), (oesophagectomy at the azygos vein + total gastrectomy with Roux oesphagojejunostomy). A11 194 cases, were approached through a right thoracotomy and upper laparotomy. Radical Iymphadenectomy (stations 4L/R-34-7-10-8-9-15-16-17-18-19-20 TNM 7th ed. + pancreatic and pyloric nodes) was identical in both procedures except for the greater curvature stations. Results Histology confirmed the preop. Barrett-non Barrett grouping. Groups I and 2 were not different (p>0,05) for sex, age, mortality, morbidity, R0 resection rate and grading. They were different (p<0,05) for the number of patients with positive nodes (27/54 50% in group I and 98/140 70% in group 2), stage I (13/54 24% in group I and 4/140 3% in group 2), stage 3a4 (5/54 9°/O in group I and 44/140 31% in group 2). Median number (IQR) of resected nodes was 29 (15-36.5) in I and 30 (20-40) in 2 (p=.5 1). Distribution of pN+ and site of recurrence are reported in table 1. Survival of group I and 2 at Syrs is 42%, at 10yrs is 41% for group 1 and 36% for group 2 (log-rank p=0,679). Conclusions ADOC with Barrett's spreads preferentially to the thoracic stations opposite to ADOC without Barrett's which involves mostly perigastric nodes comprising the greater curvature's in 16.5%. The role of total gastrectomy should be questioned. These data deserve further investigation to improve surgery but possibly also surveillance programs. Disclosure: All authors have declared no conflicts of interest
Total Lymphadenectomy and Nodes-Based Prognostic Factors in Surgical Intervention for Esophageal Adenocarcinoma
No full textAbstract
BACKGROUND:
To evaluate prognostic factors based on the number of resected lymph nodes, we considered 202 patients who underwent radical resection and "total lymphadenectomy" for esophageal adenocarcinoma according to a prospective protocol.
METHODS:
Fifty-eight tumors surrounded by Barrett's epithelium underwent esophagectomy and esophagogastrostomy, and 144 tumors without Barrett's epithelium underwent esophageal resection at the azygos vein level, total gastrectomy, and Roux-en-Y esophagojejunostomy. All nodes and fat tissue were resected at the following stations: chest 4L and R3, R4, R7, R8, and R9 (TNM seventh edition) and abdomen 1-12 according to the Japanese Classification of Gastric Carcinoma (1998). The nodes were counted, excluding fragments. The correlations between the number of nodes yielded and the ratio of the metastatic lymph nodes/lymph nodes yielded with pT stage, grading measurements, and cancer-specific survival (CSS) were calculated.
RESULTS:
A total of 6,270 nodes were yielded (interquartile range per patient, 22-38; minimum, 4 nodes; maximum, 61 nodes). In 3 of 21 (14%) stage pT1 cases, less than 10 nodes were counted, in 2 of 27 (8%) stage pT2 cases, less than 20 were counted, and in 73 of 154 (47%) stage pT3-4 cases, less than 30 nodes were counted. The lymph node yield (LNY) and T stage were not correlated (r = 0 .048; p = 0.5). The metastatic lymph nodes to lymph nodes yielded ratio was correlated with pT stage (r = 0.272; p = 0.0001), and G (r = 0.385; p = 0.0001). CSS positively correlated with pT stage (p = 0.02), G (p = 0.001), and metastatic lymph nodes/lymph nodes yielded ratio (p = 0.01) (multivariate analysis).
CONCLUSIONS:
The total number of lymph nodes to be removed in total and within each T stage indicated as thresholds could not be reached in up to 38.6% of patients. The metastatic lymph nodes/lymph nodes yield ratio not the total LNY, did correlate with cancer-specific survival
The Gastroesophageal Prolapse in GERD: Clinical Patterns and Surgical Outcome.
No full textAims. To assess the clinical profile of patients with gastro-esophageal prolapse and GERD and the outcome of surgical therapy.
Methods. Since 1983 to 2006, 50 patients, mean age 48.84, r. 27-73 were observed. The severity of symptoms and Reflux esophagitis were graded from 0 to 3. The anatomy of the gejunction was assessed by barium swallow.
Results. Median symptoms duration was 51 months (r. 2~300). Epigastric pain was in 98% of pts. Belching or gagging in 70% (35/50), Sl=38, 76%; S2=11, 22%, SR3=31, 62%; SR2=19, 38%. Reflux esophagitis in 94% (47/50; El=15, 30%; E2= 21, 42%; E3=11, 22%). At barium swallow 18 pts (36%) had normal anatomy, 11 (22%) had Sliding Hiatus Ernia, while in 21 pts (42%) the oral migration of the g-e junction. NissenFundoplication was performed in 28 (56%) with 2 Collis techniques. No mortality, morbility (7,1%), (Median FU 15 months, r 6-192 ). 22 patients underwent medical therapy (Median FU 60 months, r 24-120). Postoperative symptoms and reflux esophagitis improved statistically after surgery and after medical treatment (Preoperative versus Postoperative p = 0.000).
In the comparison between surgical versus medical patients statistically significant differences were observed with regard to severity of pre-treatment reflux symptoms (p = 0.034) and with regard to post-treatment clinical evaluation of symptoms and esophagitis (p = 0.000).
Conclusions. Epigastric pain, belching and gagging seem to be related to the g-e prolapse because they are reduced more by surgery than by antacid therapy. In g-e prolapse+GERD, surgery is more effective than medical therapy
One hundred percent follow up of a case series of patients operated upon for type II-IV hiatus hernia (II-IV HH) in the arch of 30 years.
No full textOne hundred percent follow up of a case series of patients operated upon for type II-IV hiatus hernia (II-IV HH) in the arch of 30 years
Going 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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