By George Wu
Few medical disciplines were remodeled so dramatically by way of developments in technology and know-how as gastrointestinal surgical procedure. firstly, smooth ph- macology has nearly eradicated a few forms of surgical procedure altogether. If one have been to take a peek at a regular working room agenda in a hectic medical institution of the Sixties, gastrectomies of 1 variety or one other could 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 ended in a precipitous decline in these methods such that they're infrequently played at the present time. intriguing new techniques to treating inflammatory bowel ailments and their complications—such as fistulas— with anticytokine treatment may possibly someday have a equally profound impression on surgical procedure for this in addition. past pharmaceutics, advances in imaging strategies have significantly facilitated the identity and characterization of pathology within the gastrointestinal tract in a fashion that will were incredible just a couple of years in the past. simply to visualize the pancreas indirectly was once a horrendous job until eventually belly ultrasound, magnetic resonance imaging, or computing device tomography made it uncomplicated. the truth that the intestine is a hole organ that may be accessed during the mouth, anus, or perhaps throughout the wall of the stomach has been totally exploited with fiberoptic endoscopes that may bend round corners conveniently and allow surgical procedure to be carried out via them.
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Additional resources for An Internist's Illustrated Guide to Gastrointestinal Surgery
SURGICAL MANAGEMENT Heller esophagomyotomy is the optimal treatment of achalasia. This procedure allows for the precise division of the longitudinal and circular muscles of the lower esophagus, thus relieving the functional obstruction of distal esophagus. Although the Heller myotomy was first performed transthoracically, the development of video-assisted minimally invasive techniques has led to the development of a laparoscopic approach that is equally effective but with minimal morbidity. INDICATIONS All patients who can tolerate general anesthesia and laparoscopy should be candidates for surgery.
The muscle is Chapter 3 / Esophagectomy for Achalasia 29 Fig. 4. Postoperative barium swallow. dissected from the mucosa allowing the mucosa to protrude. Intraoperative flexible endoscopy is then performed to be certain there is no further distal obstruction. The myotomy can be easily extended if necessary until the lower esophageal sphincter is ablated. Air is insufflated into the esophagus and the distended mucosa is assessed for evidence of perforation. Once the myotomy is completed, an antireflux procedure is added.
These include: a) a head back position in the upright position associated with a Valsalva maneuver; b) drinking carbonated beverages; c) belching; d) drinking alcoholic or warmed beverages; e) and smoking marijuana. Regurgitation is the second most common complaint and occurs in approx 70% of cases. The regurgitated food is described as undigested, nonbilious and nonacidic, and frequently awakens the patient from sleep (1). Other symptoms include chest pain and heartburn occurring in approx 40% of patients.