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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.
For this Sixth Edition the authorship team across the series has been expanded to include additional European and World experts, with an increased emphasis on global practice. Throughout all six volumes the contents have been extensively revised in line with recently published evidence. Detailed supportive key references are provided and are also included within the comprehensive list of references in the accompanying ebook. Links to recommended online videos have been added where appropriate.
- The Companion to Specialist Surgical Practice series provides a current and concise summary of the key topics within the major sub-specialties of general surgery.
- Each volume highlights evidence-based practice both in the text and within the extensive list of references at the end of every chapter.
This new Sixth Edition includes contributions from a number of world renowned authors which reflects the global nature of oesophagogastric surgery. In particular, to reflect the increasing role of bariatric surgery, there are three new chapters covering obesity, bariatric surgical procedures, and the follow up and outcomes of bariatric surgery. Other chapters have been extensively revised by world experts and include up to date evidence and advances in the assessment, management, and treatment of oesophagogastric disease.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Inside Front Cover | ES2 | ||
| Oesophagogastric Surgery | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Series Editors’ preface | vii | ||
| Editors’ preface | ix | ||
| Acknowledgements | ix | ||
| Evidence-based practice in surgery | xi | ||
| Contributors | xiii | ||
| 1 Pathology of oesophageal and gastric tumours | 1 | ||
| Oesophagus | 1 | ||
| Introduction | 1 | ||
| Benign tumours and tumour-like lesions of the oesophagus and the gastro-oesophageal junction | 1 | ||
| Malignant tumours of the oesophagus and the gastro-oesophageal junction | 2 | ||
| Squamous cell carcinoma | 2 | ||
| Precursor lesions of squamous cell carcinoma | 2 | ||
| Molecular pathology of squamous cell carcinoma | 5 | ||
| Adenocarcinoma | 5 | ||
| Precursor lesion of adenocarcinoma | 5 | ||
| Variants of oesophageal adenocarcinoma | 7 | ||
| Neuroendocrine tumours | 7 | ||
| Stomach | 8 | ||
| Benign tumours and tumour-like lesions of the stomach | 8 | ||
| Gastric polyps | 8 | ||
| Polyposis syndromes | 8 | ||
| Gastric carcinoma | 9 | ||
| Epidemiology | 9 | ||
| Aetiology and risk factors | 9 | ||
| Lesions predisposing to gastric carcinoma | 9 | ||
| Chronic atrophic gastritis and intestinal metaplasia | 10 | ||
| Chronic gastric ulcer | 10 | ||
| Gastric polyps | 11 | ||
| Gastric dysplasia | 11 | ||
| Early and advanced gastric carcinoma | 11 | ||
| Morphological subtypes of gastric carcinoma | 12 | ||
| Rare morphological variants of gastric carcinoma | 13 | ||
| Molecular pathology of gastric carcinoma | 14 | ||
| Macroscopy and microscopy of epithelial tumours of the oesophagus and stomach after neoadjuvant therapy | 14 | ||
| Neuroendocrine tumours of the stomach | 16 | ||
| Mesenchymal tumours of the stomach | 17 | ||
| Lymphoma of the stomach | 18 | ||
| MALT lymphoma | 18 | ||
| Diffuse large B-cell lymphoma | 18 | ||
| Key references | 20 | ||
| 2 Epidemiology, genetics and screening for oesophageal and gastric cancer | 21 | ||
| Introduction | 21 | ||
| Definitions | 21 | ||
| Epidemiology | 22 | ||
| Incidence | 22 | ||
| Oesophageal and oesophagogastric junctional adenocarcinoma | 22 | ||
| Gastric cancer | 22 | ||
| Aetiology | 23 | ||
| Associated conditions | 24 | ||
| Gastro-oesophageal reflux disease (GORD) | 24 | ||
| Obesity | 24 | ||
| Helicobacter pylori | 25 | ||
| Epstein–Barr virus (EBV) | 26 | ||
| Precancerous conditions | 26 | ||
| Prevention of oesophageal and gastric cancer | 26 | ||
| Genetics of oesophageal and gastric cancer | 27 | ||
| Family history and hereditary cancer syndromes | 27 | ||
| Oesophageal cancer | 27 | ||
| Gastric cancer | 27 | ||
| Hereditary diffuse gastric carcinoma (HDGC) | 28 | ||
| Molecular genetics of oesophageal and gastric cancer | 29 | ||
| Screening for oesophageal and gastric cancer | 29 | ||
| At-risk populations | 29 | ||
| Screening tests | 31 | ||
| Endoscopic techniques | 32 | ||
| Non-endoscopic techniques | 32 | ||
| Helicobacter pylori | 32 | ||
| Treatment and outcomes of screening strategies | 33 | ||
| Summary and future perspectives | 33 | ||
| Key references | 34 | ||
| 3 Staging of oesophageal and gastric cancer | 35 | ||
| Introduction | 35 | ||
| The multidisciplinary team (MDT) | 35 | ||
| Staging classifications | 35 | ||
| Gastric cancer staging | 36 | ||
| Oesophageal cancer staging | 38 | ||
| Clinical assessment | 40 | ||
| Endoscopy | 40 | ||
| Computed tomography | 40 | ||
| Gastric | 41 | ||
| Oesophageal | 43 | ||
| Positron emission tomography (PET) | 44 | ||
| Gastric cancer | 44 | ||
| Oesophageal cancer | 44 | ||
| Endoscopic ultrasound | 45 | ||
| Gastric cancer | 45 | ||
| Oesophageal cancer | 46 | ||
| Ultrasonography | 47 | ||
| Laparoscopy | 47 | ||
| Peritoneal cytology | 48 | ||
| Laparoscopic ultrasonography (lapUS) | 49 | ||
| Magnetic resonance imaging (MRI) | 49 | ||
| Restaging following neoadjuvant or radical therapy | 50 | ||
| Future developments | 51 | ||
| Acknowledgements | 52 | ||
| Key references | 52 | ||
| 4 Preoperative assessment and perioperative management in oesophageal and gastric surgery | 54 | ||
| Introduction | 54 | ||
| Physiological stress during the treatment of oesophagogastric malignancy | 54 | ||
| Diagnosis | 54 | ||
| Multidisciplinary team evaluation | 55 | ||
| Neoadjuvant therapy | 55 | ||
| Nutrition | 55 | ||
| Preoperative assessment | 56 | ||
| Cardiac assessment (Box 4.4) | 57 | ||
| History | 57 | ||
| Functional capacity | 57 | ||
| Investigations | 57 | ||
| Electrocardiogram (ECG) | 57 | ||
| Cardiopulmonary exercise testing (CPX) | 58 | ||
| Stress testing | 58 | ||
| Optimisation | 59 | ||
| Preoperative physical cardiopulmonary rehabilitation | 59 | ||
| Beta-blockade | 59 | ||
| Other relevant cardiac medication | 59 | ||
| Statins | 59 | ||
| Anticoagulants | 59 | ||
| Aspirin/clopidogrel | 59 | ||
| Warfarin | 59 | ||
| Pulmonary assessment | 60 | ||
| History | 60 | ||
| Investigations (Box 4.5) | 61 | ||
| Arterial blood gas (ABG) | 61 | ||
| Chest X-ray (CXR) | 61 | ||
| Pulmonary function testing (PFT) | 61 | ||
| Optimisation | 61 | ||
| Neurological assessment | 61 | ||
| History | 61 | ||
| 5 Surgery for cancer of the oesophagus | 70 | ||
| Introduction | 70 | ||
| Surgical pathology | 70 | ||
| Surgical anatomy | 70 | ||
| Hypopharynx and cervical oesophagus | 71 | ||
| Upper oesophagus | 71 | ||
| Middle oesophagus | 71 | ||
| Lower oesophagus | 71 | ||
| Blood supply and lymphatic drainage | 71 | ||
| Patient selection and assessment | 72 | ||
| Principles of oesophagectomy | 72 | ||
| Surgical objectives | 72 | ||
| Resection of primary tumour | 72 | ||
| Resection of lymph nodes | 73 | ||
| Nodal tiers | 73 | ||
| The rationale for lymphadenectomy | 73 | ||
| Optimal staging | 73 | ||
| Locoregional tumour control | 73 | ||
| Improved cure rate | 73 | ||
| Summary | 75 | ||
| Reconstruction of the oesophagus | 75 | ||
| Route of reconstruction | 75 | ||
| Posterior mediastinal | 75 | ||
| Retrosternal route (anterior mediastinal) | 75 | ||
| Presternal route | 75 | ||
| Organ of reconstruction | 75 | ||
| Reconstruction with stomach | 75 | ||
| Reconstruction with colon | 77 | ||
| Indications for colonic reconstruction | 77 | ||
| Surgical technique | 77 | ||
| Reconstruction with jejunum | 77 | ||
| Surgical approaches to oesophagectomy | 78 | ||
| Open surgical approaches | 78 | ||
| Two-phase subtotal oesophagectomy | 78 | ||
| Abdominal phase | 78 | ||
| Thoracic phase | 78 | ||
| Left thoracoabdominal oesophagectomy | 79 | ||
| Three-phase oesophagectomy | 79 | ||
| Transhiatal oesophagectomy | 79 | ||
| Pharyngolaryngo-oesophagectomy for carcinoma of the hypopharynx and cervical oesophagus | 80 | ||
| Minimally invasive oesophagectomy techniques | 80 | ||
| Minimally invasive oesophagectomy (three-phase) | 80 | ||
| Minimally invasive oesophagectomy (two-phase) | 81 | ||
| Hybrid procedures | 81 | ||
| Laparoscopically assisted oesophagectomy | 81 | ||
| Thoracoscopically assisted oesophagectomy | 81 | ||
| Overview of minimally invasive oesophagectomy techniques (MIOT) | 81 | ||
| Technique of anastomosis | 82 | ||
| Intrathoracic oesophagogastric anastomosis | 82 | ||
| Cervical oesophagogastric anastomosis | 82 | ||
| Postoperative management | 82 | ||
| Postoperative complications | 83 | ||
| General complications of oesophagectomy | 83 | ||
| Specific complications of oesophagectomy | 84 | ||
| Anastomotic leakage and gastric conduit necrosis | 84 | ||
| Chylothorax | 84 | ||
| Recurrent laryngeal palsy | 85 | ||
| Diaphragmatic herniation | 85 | ||
| Gastric outlet obstruction | 86 | ||
| Duodeno-gastro-oesophageal reflux | 86 | ||
| Benign anastomotic stricture | 86 | ||
| Overall results of single-modality surgical therapy | 86 | ||
| Short-term outcomes | 86 | ||
| Long-term outcomes | 87 | ||
| Summary and future research | 87 | ||
| Key references | 88 | ||
| 6 Treatment of early oesophageal cancer | 89 | ||
| Definition of early oesophageal cancer | 89 | ||
| Investigations/staging | 90 | ||
| Endoscopic assessment and local staging | 90 | ||
| Barrett’s neoplasia | 90 | ||
| Squamous neoplasia | 90 | ||
| Endoscopic mucosal resection (EMR) | 91 | ||
| Endoscopic submucosal dissection (ESD) | 91 | ||
| Endoscopic ultrasound | 91 | ||
| Management of early oesophageal cancer | 92 | ||
| Endoscopic therapy | 92 | ||
| Endoscopic mucosal resection | 92 | ||
| Endoscopic submucosal dissection | 92 | ||
| Mucosal ablation | 93 | ||
| Results from endoscopic therapy for early oesophageal cancer | 93 | ||
| Adenocarcinoma | 93 | ||
| Squamous cell carcinoma | 93 | ||
| Oesophageal resection | 94 | ||
| Endoscopic therapy compared with oesophagectomy | 95 | ||
| Definitive radiotherapy with or without chemotherapy | 96 | ||
| Role of a multidisciplinary team | 97 | ||
| Conclusion | 97 | ||
| Key references | 97 | ||
| 7 Surgery for cancer of the stomach | 100 | ||
| Introduction | 100 | ||
| Modes of spread and areas of potential failure after gastric cancer surgery | 100 | ||
| Metastatic pathway | 100 | ||
| Lymphatic spread | 100 | ||
| Peritoneal spread | 101 | ||
| Haematogenous spread | 102 | ||
| Metastasis by uncertain pathway | 102 | ||
| Direct extension | 102 | ||
| Intraoperative spillage | 102 | ||
| Summary | 102 | ||
| The concept of radical gastric cancer surgery | 102 | ||
| Gastric cancer surgery in Japan | 103 | ||
| Development of gastric cancer surgery in the West | 103 | ||
| Different staging systems | 103 | ||
| Different disease hypotheses | 103 | ||
| Proximal location | 103 | ||
| Patient factor | 104 | ||
| Role of radical surgery in Western practice | 104 | ||
| Outcomes after radical surgery for gastric cancer | 104 | ||
| Summary | 104 | ||
| Principles of radical gastric cancer surgery | 105 | ||
| Extent of gastric resection | 105 | ||
| Resection margins | 105 | ||
| Type of gastrectomy | 105 | ||
| Total gastrectomy | 105 | ||
| Distal (subtotal) gastrectomy | 105 | ||
| Proximal gastrectomy | 105 | ||
| Other resections for T1 tumours | 105 | ||
| Total gastrectomy ‘de principe’ for distal cancers | 106 | ||
| Lymphadenectomy | 106 | ||
| Lymph node groups in the former Japanese classifications | 106 | ||
| New definition of lymphadenectomy | 106 | ||
| D2 lymphadenectomy – evidence | 108 | ||
| Number of lymph nodes and extent of lymphadenectomy | 108 | ||
| Bursectomy | 109 | ||
| Splenectomy | 109 | ||
| Distal pancreatectomy | 109 | ||
| Extended resections | 110 | ||
| En bloc resection of involved adjacent organs | 110 | ||
| Extended lymphadenectomy | 110 | ||
| Resection of liver metastases | 110 | ||
| Laparoscopic gastrectomy | 110 | ||
| Summary | 111 | ||
| Technique of gastric resection with D2 lymphadenectomy | 111 | ||
| Incision | 111 | ||
| Intraoperative staging | 111 | ||
| Procedure of D2 lymphadenectomy | 111 | ||
| Distal gastrectomy | 111 | ||
| Kocherisation | 111 | ||
| Omentectomy | 111 | ||
| Division of left gastroepiploic vessels | 111 | ||
| Infrapyloric node dissection (no. 6) | 111 | ||
| Suprapyloric nodes dissection (no. 5) and transection of the duodenum | 112 | ||
| Exposure of the oesophageal hiatus | 113 | ||
| Dissection of the upper border of the pancreas (nos. 8a, 9, 11p and 12a) | 113 | ||
| Dissection of the upper lesser curvature nodes (nos. 1 and 3a) | 114 | ||
| Total gastrectomy | 114 | ||
| Dissection of the upper greater curvature nodes (nos. 2 and 4sa) | 114 | ||
| Dissection along the distal splenic artery (no. 11d) and splenic hilum (no. 10) | 114 | ||
| Splenectomy | 114 | ||
| Summary | 115 | ||
| Reconstruction after gastric resection | 115 | ||
| Reconstruction after distal gastrectomy (Fig. 7.8) | 115 | ||
| 8 Endoscopic and surgical treatment of early gastric cancer | 122 | ||
| Introduction | 122 | ||
| Definition of early gastric cancer | 122 | ||
| Risk and development of early gastric cancer | 122 | ||
| Classification of early gastric cancer | 122 | ||
| Endoscopic appearance | 123 | ||
| Endosonography | 124 | ||
| Revised Vienna classification | 125 | ||
| Endoscopic treatment | 125 | ||
| Endoscopic treatment versus surgery | 125 | ||
| Endoscopic mucosal resection | 125 | ||
| Endoscopic submucosal dissection | 126 | ||
| Complete resections | 127 | ||
| Complications of endoscopic resections | 127 | ||
| Endoscopic mucosal resection versus ESD | 127 | ||
| Surgical resection | 128 | ||
| Proximal gastrectomy | 128 | ||
| Pylorus-preserving gastrectomy | 129 | ||
| Local (or wedge) segmental resection | 129 | ||
| Minimally invasive surgery | 130 | ||
| Lymphadenectomy | 131 | ||
| Sentinel node biopsy | 131 | ||
| Key references | 132 | ||
| 9 Radiotherapy and chemotherapy in treatment of oesophageal and gastric cancer | 134 | ||
| Introduction | 134 | ||
| Oesophageal cancer | 135 | ||
| Potentially curative treatment | 135 | ||
| Preoperative radiotherapy alone | 135 | ||
| Postoperative radiotherapy | 135 | ||
| Preoperative chemotherapy | 136 | ||
| Randomised trials of preoperative chemotherapy | 136 | ||
| Postoperative chemotherapy | 137 | ||
| Preoperative chemoradiotherapy | 137 | ||
| Which preoperative strategy: neoadjuvant chemoradiotherapy or chemotherapy? | 139 | ||
| Patient selection and future direction | 139 | ||
| Definitive radiotherapy and chemoradiotherapy | 140 | ||
| Definitive single agent radiotherapy | 140 | ||
| Definitive chemoradiotherapy | 140 | ||
| Future directions in definitive chemoradiation | 141 | ||
| Primary definitive CRT or surgery? | 142 | ||
| Small cell oesophageal cancer | 144 | ||
| Gastric cancer | 144 | ||
| Potentially curative treatment | 144 | ||
| Postoperative chemotherapy | 144 | ||
| Pre- and perioperative chemotherapy | 145 | ||
| Postoperative chemoradiotherapy | 145 | ||
| Chemotherapy or chemoradiotherapy? | 146 | ||
| Intraperitoneal chemotherapy | 146 | ||
| Future directions | 146 | ||
| Palliative chemotherapy | 147 | ||
| Squamous carcinoma of the oesophagus | 147 | ||
| Adenocarcinoma of the oesophagus and stomach | 147 | ||
| Single-agent therapy | 147 | ||
| Combination regimens | 148 | ||
| Monoclonal antibodies | 148 | ||
| Second-line treatments | 149 | ||
| Beyond second line therapy | 150 | ||
| Future directions of systemic therapy | 150 | ||
| Future strategies | 150 | ||
| Acknowledgements | 152 | ||
| Key references | 152 | ||
| 10 Palliative treatments of carcinoma of the oesophagus and stomach | 154 | ||
| Symptoms and signs of advanced oesophageal and gastric cancer | 154 | ||
| Tumours of the oesophagus and gastric cardia | 154 | ||
| Tumours of the gastric body and antrum | 154 | ||
| Patient selection and multidisciplinary teams | 155 | ||
| Fitness for treatment | 156 | ||
| Staging investigations | 156 | ||
| Patient preferences and information provision | 156 | ||
| Palliative treatments for cancer of the oesophagus and gastric cardia | 157 | ||
| Endoscopic methods of relieving luminal obstruction | 157 | ||
| Placement of oesophageal stents | 158 | ||
| Self-expanding metal stents (SEMS) | 158 | ||
| Method of insertion | 158 | ||
| Endoscopic insertion with fluoroscopy | 158 | ||
| Radiological insertion | 159 | ||
| Management after stent placement | 159 | ||
| Complications | 160 | ||
| Late complications | 160 | ||
| Endoscopic ablative and thermal techniques | 161 | ||
| Endoscopic technique | 161 | ||
| Early complications | 161 | ||
| Late complications | 162 | ||
| Chemically induced tumour necrosis | 162 | ||
| Endoscopic technique | 162 | ||
| Outcome | 162 | ||
| External beam or intracavitary radiotherapy | 162 | ||
| External beam radiotherapy | 162 | ||
| Brachytherapy (intracavitary irradiation) | 162 | ||
| Relief of dysphagia and patient-reported outcomes | 162 | ||
| Palliative chemotherapy, radiotherapy or combination chemoradiotherapy for oesophageal cancer | 163 | ||
| Management of aero-digestive fistulas | 163 | ||
| Recurrent laryngeal nerve palsy | 163 | ||
| Bleeding | 163 | ||
| Palliative treatments for gastric cancer | 163 | ||
| Gastric outlet obstruction | 164 | ||
| Summary | 165 | ||
| Key references | 166 | ||
| 11 Other oesophageal and gastric neoplasms | 168 | ||
| Introduction | 168 | ||
| Gastrointestinal stromal tumours (GISTs) | 168 | ||
| Pathophysiology | 168 | ||
| Incidence and malignant potential | 169 | ||
| Patient demographics and anatomical distribution | 169 | ||
| Presentation | 169 | ||
| Investigation | 169 | ||
| Endoscopic ultrasound | 169 | ||
| Computed tomography | 170 | ||
| Magnetic resonance imaging | 170 | ||
| Positron emission tomography | 171 | ||
| GIST syndromes | 171 | ||
| Treatment and prognosis (Box 11.1) | 171 | ||
| Imatinib | 173 | ||
| Unresectable, metastatic or recurrent disease | 173 | ||
| Adjuvant therapy post resection | 174 | ||
| Gastric lymphoma | 174 | ||
| Staging | 174 | ||
| Classification | 174 | ||
| Neuroendocrine gastroenteropancreatic tumours (GEP-NETs) | 175 | ||
| Presentation, classification and treatment | 175 | ||
| Rarities | 176 | ||
| Key references | 177 | ||
| 12 Pathophysiology and investigation of gastro-oesophageal reflux disease | 179 | ||
| Introduction | 179 | ||
| Definition | 179 | ||
| Epidemiology | 179 | ||
| Symptoms | 181 | ||
| Normal oesophageal anatomy | 181 | ||
| Normal oesophageal physiology | 182 | ||
| Antireflux mechanisms | 183 | ||
| Lower oesophageal sphincter | 183 | ||
| Diaphragmatic sphincter | 184 | ||
| Distal oesophageal compression | 184 | ||
| Other mechanical barriers | 184 | ||
| Oesophageal muscosal defence mechanisms | 185 | ||
| Inflammatory mediators | 185 | ||
| Risk factors for reflux | 185 | ||
| Genetic factors | 185 | ||
| Demographic factors | 186 | ||
| Dietary and lifestyle factors | 186 | ||
| Medical factors | 186 | ||
| Gastric factors | 186 | ||
| Oesophageal dysmotility and GORD: cause or effect? | 187 | ||
| Role of duodeno-gastro-oesophageal reflux | 187 | ||
| Symptoms: mechanisms and variability | 188 | ||
| Investigation and diagnosis | 188 | ||
| Symptomatic diagnosis | 188 | ||
| Endoscopy | 189 | ||
| Contrast radiology | 189 | ||
| pH studies | 189 | ||
| Wireless pH monitoring | 191 | ||
| Oesophageal impedance monitoring | 192 | ||
| Bilirubin monitoring | 192 | ||
| Manometry | 192 | ||
| Suggested diagnostic pathway | 193 | ||
| Reviewing PPI therapy | 195 | ||
| Endoscopy and speciality referral | 195 | ||
| Reflux monitoring | 195 | ||
| Key references | 197 | ||
| 13 Treatment of gastro-oesophageal reflux disease | 199 | ||
| Introduction | 199 | ||
| Medical treatment | 199 | ||
| Simple measures | 199 | ||
| H2-receptor antagonists | 200 | ||
| Proton pump inhibitors | 200 | ||
| Surgical treatment | 200 | ||
| Selection criteria for surgery | 200 | ||
| Patients with complicated reflux disease | 201 | ||
| Reflux with stricture formation | 201 | ||
| Reflux with respiratory complications | 201 | ||
| Reflux with throat symptoms | 201 | ||
| Columnar-lined (Barrett’s) oesophagus | 201 | ||
| Patients with uncomplicated reflux disease | 201 | ||
| Medical versus surgical therapy | 202 | ||
| Pros and cons of antireflux surgery | 203 | ||
| Advantages | 203 | ||
| Disadvantages | 203 | ||
| Operations available | 203 | ||
| Mechanisms of action of antireflux operations | 203 | ||
| Techniques of antireflux surgery | 204 | ||
| Nissen fundoplication (Figs 13.1 and 13.2) | 204 | ||
| Posterior partial fundoplication (Fig. 13.3) | 205 | ||
| Anterior partial fundoplication | 205 | ||
| Other antireflux procedures | 206 | ||
| Hill procedure | 206 | ||
| Collis procedure (Fig. 13.7) | 206 | ||
| Augmentation of the lower oesophageal sphincter | 207 | ||
| Electrical stimulation of the lower oesophageal sphincter | 207 | ||
| Complete or partial fundoplication? | 207 | ||
| Nissen versus posterior fundoplication | 207 | ||
| Nissen versus anterior fundoplication | 208 | ||
| Anterior versus posterior partial fundoplication | 209 | ||
| The controversy of division/no division of short gastric vessels | 209 | ||
| Laparoscopic antireflux surgery | 210 | ||
| Results and complications following laparoscopic fundoplication | 210 | ||
| Laparoscopic versus open antireflux surgery | 210 | ||
| Synthesis of the results from prospective randomised trials | 211 | ||
| Complications of laparoscopic antireflux surgery | 212 | ||
| Complications that are more common following laparoscopic antireflux surgery95 | 212 | ||
| Paraoesophageal hiatus hernia | 212 | ||
| Dysphagia | 213 | ||
| Pulmonary embolism | 213 | ||
| Complications unique to laparoscopic antireflux surgery | 214 | ||
| Bilobed stomach | 214 | ||
| Pneumothorax | 214 | ||
| Vascular injury | 214 | ||
| Perforation of the upper gastrointestinal tract | 214 | ||
| Mortality | 215 | ||
| Avoiding complications following laparoscopic antireflux surgery and minimising their impact | 215 | ||
| Endoscopic therapies for reflux | 215 | ||
| Radiofrequency | 216 | ||
| Polymer injection | 216 | ||
| Endoscopic suturing | 216 | ||
| EndoCinch | 216 | ||
| NDO Plicator | 216 | ||
| Endoscopic fundoplication | 216 | ||
| Overview of endoscopic antireflux surgery | 217 | ||
| Conclusion | 218 | ||
| Key references | 219 | ||
| 14 Revisional oesophagogastric surgery | 221 | ||
| Introduction | 221 | ||
| Revisional antireflux surgery | 221 | ||
| Problems in the early postoperative period | 222 | ||
| Recurrent reflux | 222 | ||
| Revisional surgery for recurrent reflux | 223 | ||
| Dysphagia | 223 | ||
| Revisional surgery for dysphagia | 224 | ||
| Surgery for gas bloat | 225 | ||
| Surgery after two or more failed operations | 225 | ||
| Revisional surgery for recurrent para-oesophageal herniation | 225 | ||
| Revisional surgery for other benign diseases of the oesophagus | 226 | ||
| Replacement of the oesophagus | 226 | ||
| Colon as an oesophageal substitute | 226 | ||
| Jejunum as an oesophageal substitute | 227 | ||
| Revisional surgery for benign and malignant diseases of the stomach | 228 | ||
| Revisional surgery following distal resection | 228 | ||
| Enterogastric reflux | 228 | ||
| Afferent loop syndrome | 229 | ||
| Dumping and diarrhoea | 229 | ||
| Small stomach syndrome and revisional surgery after total gastrectomy | 229 | ||
| Conclusion | 229 | ||
| Key references | 230 | ||
| 15 Barrett’s oesophagus | 231 | ||
| A note on current guidelines | 231 | ||
| Definition | 231 | ||
| Endoscopic evaluation | 231 | ||
| Biopsy protocol | 234 | ||
| Histology | 235 | ||
| Prevalence | 236 | ||
| Risk factors and screening | 236 | ||
| Advances in molecular and genetic understanding, and prospect of biomarkers | 237 | ||
| Dysplasia | 239 | ||
| Definition | 239 | ||
| Advanced imaging technologies | 240 | ||
| Risk of progression | 242 | ||
| Surveillance | 242 | ||
| Management | 243 | ||
| Medication | 243 | ||
| Fundoplication in Barrett’s oesophagus | 243 | ||
| Ablation for non-dysplastic Barrett’s epithelium | 243 | ||
| Indefinite for dysplasia | 244 | ||
| Low-grade dysplasia | 244 | ||
| High-grade dysplasia and intramucosal carcinoma | 245 | ||
| Radiofrequency ablation | 246 | ||
| RFA protocol | 246 | ||
| Efficacy: eradication of BE and prevention of progression | 247 | ||
| Complications | 247 | ||
| Duration of eradication | 247 | ||
| Ongoing surveillance | 248 | ||
| Photodynamic therapy | 248 | ||
| Organisational issues | 248 | ||
| Key references | 249 | ||
| 16 The management of achalasia and other motility disorders of the oesophagus | 251 | ||
| Introduction | 251 | ||
| Achalasia | 251 | ||
| Clinical features | 251 | ||
| Natural history | 252 | ||
| Investigations | 252 | ||
| Manometry | 253 | ||
| Classification | 253 | ||
| Treatments | 253 | ||
| Medical and botulinum toxin | 253 | ||
| Pneumatic dilatation | 255 | ||
| Heller cardiomyotomy | 255 | ||
| Heller cardiomyotomy vs pneumatic dilatation | 256 | ||
| Peroral endoscopic myotomy | 256 | ||
| Revisional surgery and oesophagectomy | 256 | ||
| Secondary achalasia | 257 | ||
| Distal oesophageal spasm and nutcracker oesophagus | 257 | ||
| Non-specific oesophageal motility disorders | 258 | ||
| Oesophageal diverticula | 258 | ||
| Acknowledgement | 258 | ||
| Key references | 259 | ||
| 17 Paraoesophageal hernia and gastric volvulus | 261 | ||
| Introduction | 261 | ||
| Epidemiology | 261 | ||
| Anatomy and natural history | 261 | ||
| Presentation and diagnosis | 262 | ||
| Operative indications | 263 | ||
| Operative approaches | 263 | ||
| Principles of paraoesophageal hernia repair | 263 | ||
| Transthoracic repair | 263 | ||
| Transabdominal repair | 263 | ||
| Laparoscopic repair | 264 | ||
| Set-up and port placement | 264 | ||
| Reduction of hernia sac and fundic mobilisation | 264 | ||
| Assessment of oesophageal length | 265 | ||
| Crural dissection and repair | 265 | ||
| Fundoplication | 265 | ||
| Current controversies in paraoesophageal hernia management | 266 | ||
| Recurrence rate | 266 | ||
| Oesophageal lengthening procedures | 266 | ||
| Prosthetic crural reinforcement | 266 | ||
| Acute gastric volvulus | 267 | ||
| Frequency and mechanism | 267 | ||
| Presentation and diagnosis | 267 | ||
| Management | 267 | ||
| Key references | 268 | ||
| 18 Oesophageal emergencies | 270 | ||
| Introduction | 270 | ||
| Perforation of the oesophagus | 270 | ||
| Aetiology and pathophysiology | 271 | ||
| Iatrogenic perforation of the oesophagus | 271 | ||
| Spontaneous perforation of the oesophagus | 271 | ||
| Penetrating injuries | 272 | ||
| Blunt trauma | 272 | ||
| Clinical presentation | 272 | ||
| Investigations | 273 | ||
| Plain radiography | 273 | ||
| Computed tomography | 273 | ||
| Contrast radiography | 274 | ||
| Upper gastrointestinal endoscopy | 274 | ||
| Other investigations | 275 | ||
| Management | 275 | ||
| Non-operative management | 276 | ||
| Adjuncts to non-operative management | 276 | ||
| Closure: clips and sealants | 277 | ||
| Diversion: stents | 277 | ||
| Drainage: repeated endoscopy | 277 | ||
| Operative management | 278 | ||
| Open surgery | 278 | ||
| Primary repair with or without reinforcement | 278 | ||
| T-tube repair | 278 | ||
| Resection | 279 | ||
| Other approaches | 280 | ||
| Minimally invasive surgery: laparoscopic/thoracoscopic | 280 | ||
| Surgical repair over a stent | 280 | ||
| Management of penetrating injuries | 280 | ||
| Cervical | 280 | ||
| Thoracic | 280 | ||
| Management of underlying pathology | 280 | ||
| Paraoesophageal surgery and procedural injuries | 280 | ||
| Management algorithm | 281 | ||
| Non-perforated spontaneous injuries of the oesophagus | 282 | ||
| Caustic injuries | 282 | ||
| Clinical presentation | 282 | ||
| Investigation and management | 283 | ||
| Long-term complications and outcomes | 285 | ||
| Cancer risk | 285 | ||
| Management algorithm | 285 | ||
| Ingestion of foreign bodies | 285 | ||
| Clinical presentation | 286 | ||
| Diagnosis | 286 | ||
| Management | 287 | ||
| Conclusion | 288 | ||
| Key references | 289 | ||
| 19 Obesity and assessment for metabolic surgery | 290 | ||
| Introduction | 290 | ||
| Pathophysiology of obesity and obesity-related diseases | 290 | ||
| The mechanisms of action of bariatric procedures and the rationale for metabolic surgery | 292 | ||
| Weight loss post bariatric surgery | 292 | ||
| Food intake | 292 | ||
| Gut hormones | 292 | ||
| Neural mechanisms | 292 | ||
| Vagus signalling | 292 | ||
| Hypothalamic signalling and bariatric surgery | 292 | ||
| Gut microbiota | 293 | ||
| Bile acids (BAs) | 293 | ||
| Changes in food preference and food reward | 293 | ||
| Energy expenditure | 293 | ||
| Comorbidity improvement/resolution | 293 | ||
| Changes in eating behaviour and weight loss | 293 | ||
| Gut hormones | 293 | ||
| Bile acid kinetics | 293 | ||
| Adipocyte-derived factors | 294 | ||
| Anatomical factors | 294 | ||
| Rationale for metabolic surgery | 294 | ||
| Indications for bariatric surgery | 294 | ||
| The ‘specialist bariatric unit’ | 296 | ||
| The multidisciplinary team | 297 | ||
| The role of weight management programmes | 298 | ||
| Multidisciplinary assessment of patient suitability for metabolic surgery | 300 | ||
| Risk assessment | 300 | ||
| Identifying and optimising obesity-related comorbidities | 302 | ||
| Dietetic assessment | 302 | ||
| Respiratory assessment: OSA, asthma and pulmonary assessment | 302 | ||
| Metabolic and endocrine assessment | 303 | ||
| Type 2 diabetes (T2DM) | 303 | ||
| Thyroid function | 303 | ||
| Psychological assessment | 303 | ||
| Cardiovascular assessment | 304 | ||
| Gastrointestinal (GI) assessment | 304 | ||
| Gynaecology assessment | 304 | ||
| Conclusion | 304 | ||
| Key references | 305 | ||
| 20 Bariatric operations and perioperative care | 307 | ||
| Selection of procedure | 307 | ||
| Patient choice | 307 | ||
| Surgical factors influencing selection | 307 | ||
| Open vs laparoscopic? | 308 | ||
| General preoperative care | 308 | ||
| Familiarity with the ‘patient pathway’ and preoperative expectation setting | 308 | ||
| Nutritional repletion | 308 | ||
| Consent for surgery | 308 | ||
| Stabilisation of comorbidities | 308 | ||
| Enhanced recovery after bariatric surgery (ERABS) | 309 | ||
| Day of surgery | 309 | ||
| Requirement for HDU/HiCare | 309 | ||
| General considerations for surgery | 309 | ||
| Equipping the service | 309 | ||
| Staff | 309 | ||
| Furniture | 309 | ||
| Surgical kit | 309 | ||
| Availability of ‘open’ kit | 309 | ||
| Patient handling and positioning | 309 | ||
| Surgical approach | 309 | ||
| Anaesthetic considerations | 310 | ||
| Preoperative | 310 | ||
| Perioperative | 310 | ||
| Postoperative | 310 | ||
| Postoperative management of significant comorbidities | 310 | ||
| Type-2 diabetes mellitus | 310 | ||
| Hypertension | 310 | ||
| Obstructive sleep apnoea | 310 | ||
| The operations | 310 | ||
| General principles | 311 | ||
| Adjustable gastric banding | 311 | ||
| Vertical sleeve gastrectomy (VSG)10 | 312 | ||
| Roux-en-Y gastric bypass | 313 | ||
| Principles | 313 | ||
| Access | 313 | ||
| Pouch-first approach | 314 | ||
| Roux-first approach | 314 | ||
| One anastomosis (‘mini’) gastric bypass (OAGB)18 | 314 | ||
| Access | 314 | ||
| True malabsorptive options | 315 | ||
| Biliopancreatic diversion (BPD)21 | 315 | ||
| Duodenal switch22 | 315 | ||
| Sleeve and duodenal ileostomy (SADI)23 | 316 | ||
| Ileal interposition24 | 316 | ||
| Gastric plication25 | 316 | ||
| Endoscopic approaches26 | 316 | ||
| Intragastric balloon27 | 316 | ||
| Endobarrier28 | 317 | ||
| Endoscopic plication29 | 317 | ||
| Aspiration gastrostomy30 | 317 | ||
| Management of early postoperative complications | 317 | ||
| Bleeding | 318 | ||
| Leak | 318 | ||
| Intestinal obstruction35 | 318 | ||
| Early acute gastric band slippage | 318 | ||
| Outcomes of bariatric surgery | 318 | ||
| 21 Follow-up and late complications of bariatric surgery | 321 | ||
| Follow-up and long-term outcomes after bariatric surgery | 321 | ||
| Introduction | 321 | ||
| Follow-up after bariatric surgery | 321 | ||
| Quality of available follow-up data | 321 | ||
| Framework for follow-up | 322 | ||
| Guidelines for follow-up | 323 | ||
| A pragmatic solution | 323 | ||
| Outcomes after bariatric surgery | 323 | ||
| Long-term complications after bariatric surgery | 324 | ||
| Long-term complications after gastric band | 324 | ||
| Gastric band slippage | 325 | ||
| Enlarged gastric pouch | 325 | ||
| Gastric band erosion | 325 | ||
| Pouch and tubing complications | 325 | ||
| Gastro-oesophageal reflux disease (GORD) | 325 | ||
| Long-term complications after sleeve gastrectomy | 326 | ||
| Gastro-oesophageal reflux disease (GORD) | 326 | ||
| Stricture | 326 | ||
| Twist or kink | 326 | ||
| Long-term complications after RYGB | 326 | ||
| Internal hernia | 326 | ||
| Anastomotic stricture | 326 | ||
| Reactive hypoglycaemia | 326 | ||
| Marginal ulcer | 327 | ||
| Nutritional complications after bariatric surgery | 327 | ||
| Supplementation and monitoring after gastric banding | 329 | ||
| Supplementation and monitoring after sleeve gastrectomy | 329 | ||
| Supplementation and monitoring after RYGB | 329 | ||
| Supplementation and monitoring after BPD/DS | 329 | ||
| Commonly encountered nutritional problems | 330 | ||
| Protein-calorie malnutrition (PCM) | 330 | ||
| Neurological complications | 330 | ||
| Anaemia | 330 | ||
| Hair loss and dermatological complications | 330 | ||
| Bone health | 330 | ||
| Weight regain | 330 | ||
| Definitions | 331 | ||
| Causes of weight regain | 331 | ||
| Management of weight regain | 331 | ||
| Revisional bariatric surgery | 332 | ||
| Definition | 332 | ||
| Justification | 332 | ||
| Patient selection and indications | 332 | ||
| Revisions after gastric band | 332 | ||
| Revisions after sleeve gastrectomy | 333 | ||
| Revisions after RYGB | 333 | ||
| Outcomes of revisional bariatric surgery | 333 | ||
| Cost-effectiveness and economic benefits of bariatric surgery | 333 | ||
| Future role of bariatric surgery | 334 | ||
| Key references | 336 | ||
| Index | 339 |