BOOK
Oesophagogastric Surgery E-Book
S. Michael Griffin | Simon A. Raimes | Jonathan Shenfine
(2013)
Additional Information
Book Details
Abstract
Oesophagogastric Surgery meets the needs of surgeons in higher training and practising consultants for a contemporary and evidence-based account of this sub-specialty that is relevant to their general surgical practice. It is a practical reference source incorporating the most current information on recent developments, management issues and operative procedures. The text is thoroughly referenced and supported by evidence-based recommendations wherever possible, distinguishing between strong evidence to support a conclusion, and evidence suggesting that a recommendation can be reached on the balance of probabilities.
This is a title in the Companion to Specialist Surgical Practice series whose eight volumes are an established and highly regarded source of information for the specialist general surgeon.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within each major surgical sub-specialty.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
- An expanded authorship team across the series includes additional European and World experts with an increased emphasis on global practice.
- The contents of the series have been extensively revised in line with recently published evidence.
- This revised edition takes full account of the advances in the roles of endoscopic and laparoscopic investigation, management and the treatment of benign and malignant oesophagogastric disease.
- Key areas of evolving oesophagogastric practice are reflected in state of the art chapters from authors in the United States, Japan and Australia.
- Over half of the chapters have been updated to reflect the latest opinions on complicated and rapidly changing disciplines in endoscopic and open surgery
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Oesophagogastric Surgery: A Companion to Specialist Surgical Practice | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Contributors | vii | ||
| Series Editors' preface | ix | ||
| Editor's preface | xi | ||
| Acknowledgements | xi | ||
| Evidence-based practice in surgery | xiii | ||
| Chapter 1: Pathology of oesophageal and gastric tumours | 1 | ||
| Oesophagus | 1 | ||
| Introduction | 1 | ||
| Epithelial tumours of the oesophagus and the gastro-oesophageal junction | 1 | ||
| Benign tumours and tumour-like lesions | 1 | ||
| Malignant tumours | 1 | ||
| Squamous cell carcinoma | 1 | ||
| Precursor lesions of squamous cell carcinoma | 3 | ||
| Molecular pathology of squamous cell carcinoma | 4 | ||
| Adenocarcinoma | 4 | ||
| Adenocarcinoma associated with Barrett's oesophagus | 5 | ||
| Variants of oesophageal adenocarcinoma | 5 | ||
| Neuroendocrine tumours of the oesophagus | 6 | ||
| Mesenchymal tumours of the oesophagus | 6 | ||
| Leiomyoma | 6 | ||
| Granular cell tumour | 6 | ||
| Stomach | 6 | ||
| Gastric polyps | 6 | ||
| Fundic gland polyps | 6 | ||
| Polyposis syndromes | 7 | ||
| Gastric carcinoma | 7 | ||
| Epidemiology of gastric carcinoma | 7 | ||
| Aetiology and risk factors of gastric carcinoma | 7 | ||
| Lesions predisposing to gastric carcinoma | 9 | ||
| Chronic atrophic gastritis and intestinal metaplasia | 9 | ||
| Chronic gastric ulcer | 9 | ||
| Gastric dysplasia | 10 | ||
| Early and advanced gastric carcinoma | 10 | ||
| Morphological subtypes of gastric carcinoma | 12 | ||
| Molecular pathology of gastric carcinoma | 13 | ||
| Neuroendocrine tumours of the stomach | 13 | ||
| Mesenchymal tumours of the stomach | 15 | ||
| Lymphoma of the stomach | 16 | ||
| MALT lymphoma | 16 | ||
| Diffuse large B cell lymphoma | 17 | ||
| References | 18 | ||
| Chapter 2: Epidemiology, genetics and screening for oesophageal and gastric cancer | 22 | ||
| Introduction | 22 | ||
| Definitions | 22 | ||
| Epidemiology | 23 | ||
| Incidence | 23 | ||
| Oesophageal cancer | 23 | ||
| Oesophageal and oesophagogastric junctional adenocarcinoma | 23 | ||
| Gastric cancer | 23 | ||
| Aetiology | 23 | ||
| Squamous cell carcinoma of the oesophagus | 23 | ||
| Smoking and alcohol | 23 | ||
| Socio-economic and dietary influences | 24 | ||
| Associated conditions | 24 | ||
| Adenocarcinoma of the oesophagus and junctional cancers | 24 | ||
| Gastro-oesophageal reflux disease (GORD) | 24 | ||
| Obesity and dietary factors | 25 | ||
| Helicobacter pylori | 25 | ||
| Socio-economic factors | 25 | ||
| Gastric cancer | 26 | ||
| Socio-economic influences | 26 | ||
| Diet | 26 | ||
| Helicobacter pylori | 27 | ||
| Precancerous conditions | 27 | ||
| Prevention of oesophageal and gastric cancer | 27 | ||
| Genetics of oesophageal and gastric cancer | 28 | ||
| Oesophageal cancer | 28 | ||
| Gastric cancer | 28 | ||
| Hereditary diffuse gastric carcinoma (HDGC) | 28 | ||
| Hereditary cancer syndromes | 29 | ||
| Moderate cancer risk | 29 | ||
| Molecular genetics of oesophageal and gastric cancer | 30 | ||
| Screening for oesophageal and gastric cancer | 31 | ||
| Asymptomatic screening | 31 | ||
| Oesophageal cancer | 31 | ||
| Gastric cancer | 32 | ||
| Symptomatic screening and early detection | 32 | ||
| High-risk groups | 33 | ||
| GORD and Barrett's oesophagus | 33 | ||
| Helicobacter pylori | 34 | ||
| Gastric atrophy and intestinal metaplasia | 34 | ||
| Summary and future | 34 | ||
| References | 35 | ||
| Chapter 3: Staging of oesophageal and gastric cancer | 38 | ||
| Introduction | 38 | ||
| Staging classifications | 38 | ||
| Gastric cancer staging | 39 | ||
| Oesophageal cancer staging | 40 | ||
| Multidisciplinary team | 42 | ||
| Staging investigations | 42 | ||
| Clinical assessment | 42 | ||
| Contrast radiography | 42 | ||
| Endoscopy | 42 | ||
| Computed tomography (CT) | 43 | ||
| Gastric cancer | 43 | ||
| Oesophageal cancer | 45 | ||
| Positron emission tomography (PET) | 46 | ||
| Gastric cancer | 46 | ||
| Oesophageal cancer | 46 | ||
| Endoscopic ultrasonography (EUS) | 48 | ||
| Gastric cancer | 48 | ||
| Oesophageal cancer | 49 | ||
| Ultrasonography (US) | 50 | ||
| Laparoscopy | 51 | ||
| Peritoneal cytology | 51 | ||
| Laparoscopic ultrasonography (lapUS) | 52 | ||
| Magnetic resonance imaging (MRI) | 52 | ||
| Endobronchial ultrasonography (EBUS) | 53 | ||
| Restaging following neoadjuvant or radical therapy | 53 | ||
| Sentinel lymph nodes | 54 | ||
| Future developments | 54 | ||
| Acknowledgements | 55 | ||
| References | 55 | ||
| Chapter 4: Preoperative assessment and perioperative management in oesophageal and gastric surgery | 62 | ||
| Introduction | 62 | ||
| Physiological stress during the treatment of oesophagogastric malignancy | 62 | ||
| Diagnosis | 63 | ||
| Multidisciplinary team evaluation | 63 | ||
| Neoadjuvant therapy | 64 | ||
| Radiotherapy | 64 | ||
| Chemotherapy | 64 | ||
| Nutrition | 64 | ||
| Preoperative assessment | 65 | ||
| Cardiac assessment (Box 4.4) | 65 | ||
| History | 66 | ||
| Functional capacity | 66 | ||
| Investigations (Box 4.4) | 66 | ||
| Electrocardiogram (ECG) | 66 | ||
| Cardiopulmonary exercise testing (CPX) | 66 | ||
| Stress testing | 66 | ||
| Optimisation | 67 | ||
| Preoperative physical cardiopulmonary rehabilitation | 67 | ||
| Beta-blockade | 67 | ||
| Other relevant cardiac medication | 68 | ||
| Statins | 68 | ||
| Anticoagulants | 68 | ||
| Aspirin/clopidogrel | 68 | ||
| Warfarin | 68 | ||
| Pulmonary assessment | 68 | ||
| History | 68 | ||
| Investigations (Box 4.5) | 69 | ||
| Arterial blood gas (ABG) | 69 | ||
| Chest X-ray (CXR) | 69 | ||
| Pulmonary function testing (PFT) | 69 | ||
| Optimisation | 69 | ||
| Neurological assessment | 69 | ||
| History | 69 | ||
| Chapter 5: Surgery for cancer of the oesophagus | 81 | ||
| Introduction | 81 | ||
| Surgical pathology | 81 | ||
| Surgical anatomy | 82 | ||
| Hypopharynx and cervical oesophagus | 82 | ||
| Upper oesophagus | 82 | ||
| Middle oesophagus | 82 | ||
| Lower oesophagus | 82 | ||
| Blood supply and lymphatic drainage | 83 | ||
| Preoperative surgical preparation | 83 | ||
| Nutritional support | 83 | ||
| Preoperative nutritional support | 83 | ||
| Respiratory care | 84 | ||
| Mental preparation/communication | 84 | ||
| Surgical objectives | 84 | ||
| Principles of oesophagectomy | 85 | ||
| Resection of primary tumour | 85 | ||
| Rules on resection margins | 85 | ||
| Resection of lymph nodes | 86 | ||
| Nodal tiers | 86 | ||
| The rationale for lymphadenectomy | 86 | ||
| Optimal staging | 86 | ||
| Locoregional tumour control | 86 | ||
| Improved cure rate | 86 | ||
| Summary | 89 | ||
| Method of reconstruction of the oesophagus | 89 | ||
| Route of reconstruction | 89 | ||
| Presternal route | 89 | ||
| Retrosternal route (anterior mediastinal) | 89 | ||
| Posterior mediastinal route | 89 | ||
| Organ of reconstruction | 89 | ||
| Reconstruction with stomach | 89 | ||
| Reconstruction with colon | 91 | ||
| Indications for colonic reconstruction (Box 5.3) | 91 | ||
| Surgical technique | 91 | ||
| Reconstruction with jejunum | 92 | ||
| Open surgical approaches to oesophagectomy | 92 | ||
| Pharyngolaryngo-oesophagectomy for carcinoma of the hypopharynx and cervical oesophagus | 92 | ||
| Two-phase subtotal oesophagectomy via a right thoracotomy for carcinomas of the middle and lower thirds of the oesophagus | 93 | ||
| Combined synchronous two-team oesophagectomy | 94 | ||
| Three-phase subtotal oesophagectomy for tumours of the upper middle third of the oesophagus | 94 | ||
| Left-sided subtotal oesophagectomy for lower-third oesophageal cancers | 94 | ||
| Transhiatal oesophagectomy for upper- and lower-third tumours of the oesophagus | 94 | ||
| Minimally invasive surgical approaches to oesophagectomy | 95 | ||
| Minimally invasive three-stage procedures | 95 | ||
| Minimally invasive two-stage procedures | 96 | ||
| Minimally invasive hybrid procedures | 96 | ||
| Overview of minimally invasive approaches | 96 | ||
| Current practice | 96 | ||
| Technique of anastomosis | 97 | ||
| Postoperative management | 97 | ||
| Postoperative complications | 98 | ||
| General complications | 98 | ||
| Specific complications | 98 | ||
| Anastomotic leakage and leakage from the gastric conduit | 98 | ||
| Chylothorax | 99 | ||
| Recurrent laryngeal palsy | 99 | ||
| Gastric outlet obstruction | 99 | ||
| Duodeno-gastro-oesophageal reflux | 100 | ||
| Benign anastomotic stricture | 100 | ||
| Overall results of single-modality resectional therapy | 100 | ||
| Hospital mortality | 100 | ||
| Survival figures | 100 | ||
| Summary and future research | 101 | ||
| References | 102 | ||
| Chapter 6: Treatment of early oesophageal cancer | 107 | ||
| Introduction | 107 | ||
| Definition of early oesophageal cancer and relevant pathology | 107 | ||
| Investigations | 108 | ||
| Endoscopic assessment | 108 | ||
| Barrett's neoplasia | 108 | ||
| Squamous neoplasia | 108 | ||
| Endoscopic mucosal resection (EMR) | 108 | ||
| Endoscopic submucosal dissection (ESD) | 109 | ||
| Imaging | 109 | ||
| Management of early oesophageal cancer | 109 | ||
| Oesophageal resection | 110 | ||
| Endoscopic therapy | 111 | ||
| Endoscopic mucosal resection | 111 | ||
| Endoscopic submucosal dissection (ESD) | 111 | ||
| Mucosal ablation | 111 | ||
| Results from endoscopic therapy for early oesophageal cancer | 112 | ||
| Adenocarcinoma | 112 | ||
| Squamous cell carcinoma | 112 | ||
| Definitive radiotherapy with or without chemotherapy | 113 | ||
| Role of a multidisciplinary team | 113 | ||
| Conclusion | 114 | ||
| References | 114 | ||
| Chapter 7: Surgery for cancer of the stomach | 118 | ||
| Introduction | 118 | ||
| Modes of spread and areas of potential failure after gastric cancer surgery | 118 | ||
| Metastatic pathway | 118 | ||
| Lymphatic spread | 118 | ||
| Peritoneal spread | 119 | ||
| Haematogenous spread | 120 | ||
| Metastasis by uncertain pathway | 120 | ||
| Direct extension | 120 | ||
| Intraoperative spillage | 120 | ||
| Summary | 120 | ||
| The concept of radical gastric cancer surgery | 120 | ||
| Gastric cancer surgery in Japan | 121 | ||
| Development of gastric cancer surgery in the West | 121 | ||
| Different staging systems | 121 | ||
| Different disease hypotheses | 121 | ||
| Proximal location | 121 | ||
| Patient factor | 122 | ||
| Role of radical surgery in Western practice | 122 | ||
| Summary | 122 | ||
| Principles of radical gastric cancer surgery | 122 | ||
| Extent of gastric resection | 122 | ||
| Resection margins | 122 | ||
| Type of gastrectomy | 123 | ||
| Total gastrectomy | 123 | ||
| Distal (subtotal) gastrectomy | 123 | ||
| Proximal gastrectomy | 123 | ||
| Other resections for T1 tumours | 123 | ||
| Total gastrectomy ‘de principe’ for distal cancers | 123 | ||
| Lymphadenectomy | 123 | ||
| Lymph node groups in the former Japanese classifications | 124 | ||
| New definition of lymphadenectomy | 126 | ||
| D2 lymphadenectomy – evidence | 127 | ||
| Number of lymph nodes and extent of lymphadenectomy | 127 | ||
| Bursectomy | 127 | ||
| Splenectomy | 128 | ||
| Distal pancreatectomy | 128 | ||
| Extended resections | 128 | ||
| En bloc resection of involved adjacent organs | 129 | ||
| Extended lymphadenectomy | 129 | ||
| Resection of liver metastases | 129 | ||
| Summary | 129 | ||
| Technique of gastric resection with D2 lymphadenectomy | 129 | ||
| Incision | 129 | ||
| Intraoperative staging | 129 | ||
| Procedure of D2 lymphadenectomy | 130 | ||
| Distal gastrectomy | 130 | ||
| Kocherisation | 130 | ||
| Omentectomy | 130 | ||
| Division of left gastroepiploic vessels | 130 | ||
| Infrapyloric node dissection (no. 6) | 130 | ||
| Suprapyloric nodes dissection (no. 5) and transection of the duodenum | 131 | ||
| Exposure of the oesophageal hiatus | 131 | ||
| Dissection of the upper border of the pancreas (nos. 8a, 9, 11p and 12a) | 131 | ||
| Dissection of the upper lesser curvature nodes (nos. 1 and 3a) | 132 | ||
| Total gastrectomy | 132 | ||
| Dissection of the upper greater curvature nodes (nos. 2 and 4sa) | 132 | ||
| Dissection along the distal splenic artery (no. 11d) and splenic hilum (no. 10) | 133 | ||
| Splenectomy | 133 | ||
| Summary | 133 | ||
| Modified surgery for early gastric cancer | 133 | ||
| Lymph node metastasis from early gastric cancer | 133 | ||
| Limited lymphadenectomy | 134 | ||
| Pylorus-preserving gastrectomy (PPG) (Fig. 7.8) | 134 | ||
| Local tumour resection based on sentinel lymph node diagnosis | 134 | ||
| Summary | 135 | ||
| Reconstruction after gastric resection | 135 | ||
| Reconstruction after distal gastrectomy (Fig. 7.9) | 135 | ||
| Chapter 8: Endoscopic and surgical treatment of early gastric cancer | 146 | ||
| Introduction | 146 | ||
| Definition of early gastric cancer | 146 | ||
| Risk and development of early gastric cancer | 146 | ||
| Classification of early gastric cancer | 146 | ||
| Endoscopic appearance | 147 | ||
| Lymph node metastasis | 148 | ||
| Endosonography | 148 | ||
| Revised Vienna classification | 149 | ||
| Endoscopic treatment | 149 | ||
| Endoscopic mucosal resection | 149 | ||
| Endoscopic submucosal dissection | 150 | ||
| Complete resections | 150 | ||
| Complications of endoscopic resections | 151 | ||
| Surgical resection | 151 | ||
| Proximal gastrectomy | 152 | ||
| Pylorus-preserving gastrectomy | 152 | ||
| Local (or wedge) segmental resection | 153 | ||
| Minimally invasive surgery | 154 | ||
| Lymphadenectomy | 154 | ||
| Sentinel node biopsy | 155 | ||
| References | 157 | ||
| Chapter 9: Radiotherapy and chemotherapy in treatment of oesophageal and gastric cancer | 160 | ||
| Introduction | 160 | ||
| Oesophageal cancer | 161 | ||
| Potentially curative treatment | 161 | ||
| Preoperative radiotherapy alone | 161 | ||
| Postoperative radiotherapy | 161 | ||
| Preoperative chemotherapy | 162 | ||
| Randomised trials of preoperative chemotherapy | 162 | ||
| Postoperative chemotherapy | 163 | ||
| Preoperative chemoradiotherapy | 164 | ||
| Neoadjuvant chemoradiotherapy or chemotherapy? | 167 | ||
| Definitive radiotherapy and chemoradiotherapy | 167 | ||
| Definitive radiotherapy | 168 | ||
| Definitive chemoradiotherapy | 168 | ||
| Future directions in definitive chemoradiation | 169 | ||
| Definitive CRT versus surgery | 170 | ||
| Small-cell oesophageal cancer | 171 | ||
| Gastric cancer | 172 | ||
| Potentially curative treatment | 172 | ||
| Perioperative adjuvant chemotherapy | 172 | ||
| Intraperitoneal chemotherapy | 173 | ||
| Postoperative chemoradiotherapy | 173 | ||
| Palliative chemotherapy | 173 | ||
| Squamous carcinoma of the oesophagus | 173 | ||
| Adenocarcinoma of the oesophagus and stomach | 174 | ||
| Palliative radiotherapy | 175 | ||
| External beam radiotherapy | 175 | ||
| Brachytherapy | 176 | ||
| Future strategies | 176 | ||
| References | 178 | ||
| Chapter 10: Palliative treatments of carcinoma of the oesophagus and stomach | 183 | ||
| Epidemiology and survival | 183 | ||
| Patient selection and multidisciplinary teams | 184 | ||
| Fitness for treatment | 184 | ||
| Staging investigations | 185 | ||
| Patient preferences and information provision | 185 | ||
| Symptoms and signs of advanced oesophageal and gastric cancer | 186 | ||
| Tumours of the oesophagus and gastric cardia | 186 | ||
| Tumours of the gastric body and antrum | 186 | ||
| Palliative treatments for cancer of the oesophagus and gastric cardia | 186 | ||
| The endoscopic relief of luminal obstruction | 187 | ||
| Intubation | 187 | ||
| Self-expanding metal stents (SEMS) | 189 | ||
| Method of insertion | 190 | ||
| Preparation | 190 | ||
| Endoscopic insertion with fluoroscopy | 190 | ||
| Radiological insertion | 190 | ||
| Postoperative management | 190 | ||
| Complications | 190 | ||
| Early complications | 191 | ||
| Late complications | 191 | ||
| Laser treatment | 192 | ||
| Endoscopic technique | 192 | ||
| Early complications | 192 | ||
| Late complications | 193 | ||
| Combination laser treatment | 193 | ||
| Thermal recanalisation or stenting? | 193 | ||
| Argon-beam plasma coagulation | 193 | ||
| Photodynamic therapy | 194 | ||
| Clinical indications | 194 | ||
| Complications | 194 | ||
| Bipolar electrocoagulation | 194 | ||
| Chemically induced tumour necrosis | 194 | ||
| Endoscopic technique | 194 | ||
| Outcome | 194 | ||
| External beam and intracavity radiotherapy | 195 | ||
| External beam radiotherapy | 195 | ||
| Complications | 195 | ||
| Brachytherapy (intracavitary irradiation) | 195 | ||
| Relief of dysphagia and patient-reported outcomes | 195 | ||
| Palliative chemotherapy or combination chemoradiotherapy for oesophageal cancer | 196 | ||
| Epidermal growth factor receptor inhibitors in the palliation of oesophageal cancer | 196 | ||
| Aero-digestive fistulas | 196 | ||
| Recurrent laryngeal nerve palsy | 197 | ||
| Bleeding | 197 | ||
| Palliative treatments of tumours of the gastric body and antrum | 197 | ||
| Chemotherapy for advanced gastric and oesophagogastric cancer | 197 | ||
| Gastric outlet obstruction | 198 | ||
| Chronic bleeding | 199 | ||
| Summary | 199 | ||
| References | 200 | ||
| Chapter 11: Other oesophageal and gastric neoplasms | 204 | ||
| Introduction | 204 | ||
| Gastrointestinal stromal tumours (GISTs) | 204 | ||
| Pathophysiology | 204 | ||
| Incidence and malignant potential | 205 | ||
| Patient demographics and anatomical distribution | 205 | ||
| Presentation | 206 | ||
| Investigation | 206 | ||
| Endoscopic ultrasound (EUS) | 206 | ||
| CT scanning | 207 | ||
| Magnetic resonance imaging (MRI) | 207 | ||
| Positron emission tomography (PET) | 207 | ||
| GIST syndromes | 207 | ||
| Treatment and prognosis (Box 11.1) | 207 | ||
| Imatinib | 209 | ||
| Unresectable or metastatic disease | 210 | ||
| Adjuvant therapy post-resection | 210 | ||
| Gastric lymphoma | 210 | ||
| Staging | 210 | ||
| Classification | 211 | ||
| Neuroendocrine gastroenteropancreatic tumours (GEP-NETs) | 211 | ||
| Presentation, classification and treatment | 212 | ||
| Rarities | 213 | ||
| References | 213 | ||
| Chapter 12: Pathophysiology and investigation of gastro-oesophageal reflux disease | 218 | ||
| Introduction | 218 | ||
| Epidemiology | 218 | ||
| Symptoms | 219 | ||
| Normal oesophageal anatomy | 219 | ||
| Normal oesophageal physiology | 219 | ||
| Antireflux mechanisms | 220 | ||
| Lower oesophageal sphincter | 221 | ||
| Diaphragmatic sphincter | 222 | ||
| Distal oesophageal compression | 222 | ||
| Other mechanical barriers | 223 | ||
| Oesophageal mucosal acid defence mechanisms | 223 | ||
| Risk factors for reflux | 223 | ||
| Inherited factors | 223 | ||
| Demographic factors | 224 | ||
| Lifestyle factors | 224 | ||
| Medical factors | 224 | ||
| Hiatus hernia | 224 | ||
| Oesophageal dysmotility and GORD: cause or effect? | 225 | ||
| Role of duodenogastric reflux | 226 | ||
| Investigation and diagnosis | 226 | ||
| Symptomatic diagnosis | 226 | ||
| Endoscopy | 227 | ||
| Contrast radiology | 227 | ||
| pH studies | 227 | ||
| Wireless pH monitoring | 229 | ||
| Oesophageal impedance monitoring | 230 | ||
| Manometry | 231 | ||
| Standard static manometry | 231 | ||
| High-resolution manometry (HRM) | 232 | ||
| References | 235 | ||
| Chapter 13: Treatment of gastro-oesophageal reflux disease | 241 | ||
| Introduction | 241 | ||
| Medical treatment | 241 | ||
| Simple measures | 241 | ||
| H2-receptor antagonists | 242 | ||
| Proton-pump inhibitors | 242 | ||
| Prokinetic agents | 242 | ||
| Surgical treatment | 242 | ||
| Selection criteria for surgery | 242 | ||
| Patients with complicated reflux disease | 243 | ||
| Reflux with stricture formation | 243 | ||
| Reflux with respiratory complications | 243 | ||
| Reflux with throat symptoms | 243 | ||
| Columnar-lined (Barrett's) oesophagus | 243 | ||
| Patients with uncomplicated reflux disease | 243 | ||
| Medical versus surgical therapy | 244 | ||
| Pros and cons of antireflux surgery | 245 | ||
| Advantages | 245 | ||
| Disadvantages | 245 | ||
| Preoperative investigations | 245 | ||
| Endoscopy | 245 | ||
| Manometry | 245 | ||
| Oesophageal pH monitoring | 245 | ||
| Other investigations | 245 | ||
| Antireflux surgery | 246 | ||
| Mechanisms of action of antireflux surgery | 246 | ||
| Techniques of antireflux surgery | 246 | ||
| Nissen fundoplication (Figs 13.1 and 13.2) | 246 | ||
| Posterior partial fundoplication (Fig. 13.3) | 247 | ||
| Anterior partial fundoplication | 248 | ||
| Other antireflux procedures | 248 | ||
| Hill procedure | 248 | ||
| Collis procedure (Fig. 13.7) | 249 | ||
| Augmentation of the lower oesophageal sphincter | 249 | ||
| LINX® | 249 | ||
| EndoStim® | 250 | ||
| Controversies and comparisons | 250 | ||
| Complete or partial fundoplication? | 250 | ||
| Nissen versus posterior fundoplication | 250 | ||
| Nissen versus anterior fundoplication | 251 | ||
| Anterior versus posterior partial fundoplication | 251 | ||
| Division/no division of short gastric vessels | 252 | ||
| Laparoscopic antireflux surgery | 253 | ||
| Laparoscopic versus open antireflux surgery | 253 | ||
| Complications of laparoscopic antireflux surgery | 254 | ||
| Complications that are more common following laparoscopic antireflux surgery | 255 | ||
| Paraoesophageal hiatus hernia | 255 | ||
| Dysphagia | 255 | ||
| Pulmonary embolism | 256 | ||
| Complications unique to laparoscopic antireflux surgery | 256 | ||
| Bilobed stomach | 256 | ||
| Pneumothorax | 256 | ||
| Vascular injury | 257 | ||
| Perforation of the upper gastrointestinal tract | 257 | ||
| Mortality | 257 | ||
| Avoiding complications following laparoscopic antireflux surgery and minimising their impact | 257 | ||
| Synthesis of the results from prospective randomised trials | 258 | ||
| Endoscopic therapies for reflux | 258 | ||
| Radiofrequency | 259 | ||
| Polymer injection | 259 | ||
| Endoscopic suturing | 259 | ||
| EndoCinch | 259 | ||
| NDO Plicator | 259 | ||
| Endoscopic fundoplication | 260 | ||
| Overview of endoscopic antireflux surgery | 260 | ||
| References | 262 | ||
| Chapter 14: Treatment of the complications of gastro-oesophageal reflux disease and failed gastro-oesophageal surgery | 269 | ||
| Introduction | 269 | ||
| Complications of GORD | 269 | ||
| Short oesophagus | 270 | ||
| Gastrointestinal haemorrhage | 270 | ||
| Peptic oesophageal stricture | 270 | ||
| Failed antireflux surgery | 271 | ||
| Investigation of the failed antireflux operation | 271 | ||
| Endoscopy | 271 | ||
| Barium studies | 271 | ||
| Computerised tomography | 272 | ||
| Oesophageal physiology tests | 272 | ||
| Management of failure after antireflux surgery | 273 | ||
| Recurrence of reflux symptoms | 273 | ||
| Persistence of preoperative symptoms | 273 | ||
| Dysphagia | 273 | ||
| Other symptoms | 274 | ||
| Revisional surgery following failed antireflux surgery | 274 | ||
| Complex revisional surgery | 276 | ||
| Summary | 277 | ||
| References | 278 | ||
| Chapter 15: Barrett's oesophagus | 280 | ||
| Definition | 280 | ||
| Epidemiology | 280 | ||
| Endoscopic assessment | 281 | ||
| Pathophysiology of Barrett's oesophagus and progression to adenocarcinoma | 281 | ||
| Risk of cancer and mortality in Barrett's oesophagus | 283 | ||
| Natural history of dysplasia in Barrett's oesophagus | 284 | ||
| Low-grade dysplasia | 285 | ||
| High-grade dysplasia | 285 | ||
| Risk factors for progression to cancer | 286 | ||
| Screening for Barrett's oesophagus and adenocarcinoma using molecular markers | 287 | ||
| Surveillance of non-dysplastic disease | 288 | ||
| Effect of medical therapy and antireflux surgery | 288 | ||
| Endotherapy | 289 | ||
| Endoscopic resection | 289 | ||
| Endoscopic ablation | 289 | ||
| Management of LGD | 290 | ||
| Management of HGD | 290 | ||
| Conclusion | 291 | ||
| References | 292 | ||
| Chapter 16: The management of achalasia and other motility disorders of the oesophagus | 298 | ||
| Introduction | 298 | ||
| Achalasia | 298 | ||
| Background | 298 | ||
| Primary achalasia | 298 | ||
| Clinical features | 299 | ||
| Investigations | 299 | ||
| Treatment | 300 | ||
| Botulinum toxin injection | 300 | ||
| Pneumatic dilatation | 300 | ||
| Cardiomyotomy | 301 | ||
| Revisional procedures and oesophagectomy | 301 | ||
| Secondary achalasia | 302 | ||
| Diffuse oesophageal spasm | 302 | ||
| Oesophagogastric junction outflow obstruction and non-specific oesophageal motor disorders | 303 | ||
| Oesophageal motor disturbances and autoimmune disease | 304 | ||
| Systemic sclerosis | 304 | ||
| Polymyositis and dermatomyositis | 304 | ||
| Systemic lupus erythematosus | 304 | ||
| Polyarteritis nodosa and rheumatoid disease | 304 | ||
| Oesophageal diverticula | 304 | ||
| Clinical features | 304 | ||
| Diagnosis | 304 | ||
| Treatment | 305 | ||
| Acknowledgements | 305 | ||
| References | 305 | ||
| Chapter 17: Paraoesophageal hernia and gastric volvulus | 308 | ||
| Introduction | 308 | ||
| Epidemiology | 308 | ||
| Anatomy and natural history | 308 | ||
| Presentation and diagnosis | 309 | ||
| Operative indications | 310 | ||
| Operative approaches | 310 | ||
| Principles of paraoesophageal hernia repair | 310 | ||
| Transthoracic repair | 310 | ||
| Transabdominal repair | 310 | ||
| Laparoscopic repair | 310 | ||
| Set-up and port placement | 311 | ||
| Reduction of hernia sac and fundic mobilisation | 311 | ||
| Assessment of oesophageal length | 311 | ||
| Crural dissection and repair | 312 | ||
| Fundoplication | 312 | ||
| Current controversies in paraoesophageal hernia management | 312 | ||
| Recurrence rate | 312 | ||
| Oesophageal lengthening procedures | 312 | ||
| Prosthetic crural reinforcement | 313 | ||
| Acute gastric volvulus | 313 | ||
| Frequency and mechanism | 313 | ||
| Presentation and diagnosis | 314 | ||
| Management | 314 | ||
| References | 315 | ||
| Chapter 18: Benign ulceration of the stomach and duodenum and the complications of previous ulcer surgery | 317 | ||
| Introduction | 317 | ||
| Management of refractory peptic ulceration | 317 | ||
| Endoscopic confirmation | 317 | ||
| Confirmation of persistent Helicobacter infection | 317 | ||
| Non-HP-related refractory ulceration | 318 | ||
| Elective surgery for peptic ulceration | 318 | ||
| Operations for refractory duodenal ulcers | 318 | ||
| Operations for refractory gastric ulcers | 319 | ||
| Laparoscopic peptic ulcer surgery | 319 | ||
| Zollinger–Ellison syndrome (ZES) | 319 | ||
| Pathology | 319 | ||
| Diagnosis | 320 | ||
| Tumour localisation | 320 | ||
| Surgery for ZES | 320 | ||
| Emergency management of complicated peptic ulcer disease | 321 | ||
| Perforation | 321 | ||
| Conservative management | 321 | ||
| Surgery | 321 | ||
| Bleeding | 322 | ||
| Medical therapy | 322 | ||
| Endoscopic therapy | 322 | ||
| Surgery | 323 | ||
| Bleeding duodenal ulcer | 323 | ||
| Bleeding gastric ulcer | 325 | ||
| Interventional radiology | 325 | ||
| Pyloric stenosis | 326 | ||
| Resuscitation and medical therapy | 326 | ||
| Endoscopic treatment | 326 | ||
| Surgery | 326 | ||
| Complications of previous ulcer surgery | 326 | ||
| Preoperative evaluation | 327 | ||
| Endoscopy | 327 | ||
| Radiology | 327 | ||
| Gastric-emptying studies | 327 | ||
| Other tests | 327 | ||
| Enterogastric reflux | 327 | ||
| Medical treatment | 327 | ||
| Surgical treatment | 327 | ||
| Chronic afferent loop syndrome | 329 | ||
| Dumping | 329 | ||
| Medical treatment | 330 | ||
| Surgical treatment | 330 | ||
| Diarrhoea | 331 | ||
| Medical treatment | 331 | ||
| Surgical treatment | 331 | ||
| Small stomach syndrome | 331 | ||
| References | 332 | ||
| Chapter 19: Oesophageal emergencies | 336 | ||
| Introduction | 336 | ||
| Perforation of the oesophagus | 336 | ||
| Aetiology and pathophysiology | 336 | ||
| Iatrogenic perforation of the oesophagus | 336 | ||
| Spontaneous perforation of the oesophagus | 337 | ||
| Penetrating injuries | 337 | ||
| Blunt trauma | 337 | ||
| Clinical presentation | 338 | ||
| Investigations | 338 | ||
| Plain radiography | 338 | ||
| Contrast radiography | 338 | ||
| Upper gastrointestinal endoscopy | 339 | ||
| Computed tomography (CT) | 339 | ||
| Other investigations | 341 | ||
| Management | 341 | ||
| Non-operative management | 341 | ||
| Adjuncts to non-operative management | 342 | ||
| Closure: clips and sealants | 342 | ||
| Diversion: stents | 342 | ||
| Drainage: repeated endoscopy | 342 | ||
| Operative management | 343 | ||
| Open surgery | 343 | ||
| Primary repair with or without reinforcement | 343 | ||
| T-tube repair | 343 | ||
| Resection | 344 | ||
| Other approaches | 344 | ||
| Minimally invasive surgery: laparoscopic/thoracoscopic | 344 | ||
| Surgical repair over a stent | 344 | ||
| Management of penetrating injuries | 344 | ||
| Cervical | 344 | ||
| Thoracic | 344 | ||
| Management of underlying pathology | 345 | ||
| Paraoesophageal surgery and procedural injuries | 346 | ||
| Management algorithm | 346 | ||
| Non-perforated spontaneous injuries of the oesophagus | 346 | ||
| Caustic injuries | 346 | ||
| Clinical presentation | 348 | ||
| Investigation and management | 348 | ||
| Long-term complications and outcomes | 350 | ||
| Cancer risk | 351 | ||
| Management algorithm | 351 | ||
| Ingestion of foreign bodies | 352 | ||
| Clinical presentation | 352 | ||
| Diagnosis | 352 | ||
| Management | 353 | ||
| Summary | 354 | ||
| References | 355 | ||
| Chapter 20: Bariatric surgery | 358 | ||
| Introduction | 358 | ||
| Obesity as a public health problem | 358 | ||
| Diabetes risk with obesity | 359 | ||
| Cancer risk with obesity | 359 | ||
| Psychosocial morbidity and prejudice | 360 | ||
| Baseline obesity-related disease | 360 | ||
| Data from the NBSR | 360 | ||
| Multidisciplinary work-up | 360 | ||
| Optimisation of patients | 361 | ||
| Obesity Surgery–Mortality Risk score (OS-MRS) | 361 | ||
| Current bariatric operations and surgical techniques | 361 | ||
| Gastric bypass | 361 | ||
| Gastric banding | 362 | ||
| Sleeve gastrectomy | 363 | ||
| Biliopancreatic diversion/duodenal switch | 363 | ||
| Mechanisms of bypass and banding | 364 | ||
| Weight loss outcomes | 364 | ||
| Band versus bypass RCTs | 364 | ||
| Band versus sleeve gastrectomy RCT | 366 | ||
| Banded versus non-banded gastric bypass RCT | 366 | ||
| Sleeve versus bypass RCTs | 366 | ||
| Bypass versus duodenal switch RCT | 366 | ||
| Complications of surgery | 367 | ||
| Operative mortality | 367 | ||
| Gastric bypass | 367 | ||
| Early | 367 | ||
| Index | 381 |