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 |