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Book Details
Abstract
For more than 60 years, Shackelford’s Surgery of the Alimentary Tract has served as the cornerstone reference in this fast-moving field. With comprehensive coverage of all aspects of GI surgery, the 8th Edition, by Drs. Charles J. Yeo, Steven R. DeMeester, David W. McFadden, Jeffrey B. Matthews, and James W. Fleshman, offers lavishly illustrated, authoritative guidance on endoscopic, robotic, and minimally invasive procedures, as well as current medical therapies. Each section is edited by a premier authority in GI surgery; chapters reflect key topics and are written by a "who’s who" of international experts in the field. It’s your one-stop resource for proven, systematic approaches to all relevant adult and pediatric GI disorders and operations
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| 9780323531771v1_WEB | 1 | ||
| Front Cover | 1 | ||
| IFC_Expert Consult | 2 | ||
| Shackelford’s SURGERY of the ALIMENTARY TRACT | 5 | ||
| Copyright Page | 6 | ||
| Dedication | 7 | ||
| Contributors | 8 | ||
| Preface | 23 | ||
| Brief History | 23 | ||
| The Eighth Edition | 23 | ||
| Acknowledgments | 24 | ||
| Table Of Contents | 25 | ||
| I Esophagus and Hernia | 35 | ||
| One Anatomy and Physiology of the Esophagus | 36 | ||
| 1 Esophageal Sphincters in Health and Disease | 36 | ||
| Abstract | 37 | ||
| Keywords | 37 | ||
| Upper Esophageal Sphincter in Health | 36 | ||
| Swallowing Process | 36 | ||
| Assessment of the Upper Esophageal Sphincter | 36 | ||
| Changes of the Upper Esophageal Sphincter in Disease | 39 | ||
| Lower Esophageal Sphincter in Health | 39 | ||
| Physiologic Function and Anatomic Structure | 39 | ||
| Functional Characteristics of the Lower Esophageal Sphincter and the Antireflux Barrier | 41 | ||
| Lower Esophageal Sphincter in Disease | 42 | ||
| Lower Esophageal Sphincter in Gastroesophageal Reflux Disease | 42 | ||
| Lower Esophageal Sphincter Function in Patients With Achalasia and Other Esophageal Motility Disorders | 43 | ||
| Hypertensive Lower Esophageal Sphincter | 44 | ||
| Conclusion | 44 | ||
| References | 45 | ||
| 2 Esophageal Body in Health and Disease | 46 | ||
| Abstract | 47 | ||
| Keywords | 47 | ||
| Esophageal Body in Health | 46 | ||
| Evaluation of the Esophagogastric Junction Morphology and Deglutitive Esophageal Contraction | 46 | ||
| Esophageal Body in Disease | 48 | ||
| Achalasia and Esophagogastric Junction Outflow Obstruction | 48 | ||
| Major Motility Disorders | 49 | ||
| Aperistalsis | 49 | ||
| Distal Esophageal Spasm | 49 | ||
| Hypercontractile (Jackhammer) Esophagus | 49 | ||
| Minor Motility Disorders | 49 | ||
| Ineffective Esophageal Motility | 49 | ||
| Fragmented Peristalsis | 50 | ||
| References | 50 | ||
| 3 Esophageal Mucosa in Health and Disease | 51 | ||
| Abstract | 52 | ||
| Keywords | 52 | ||
| Present Status of GastroEsophageal Reflux Disease | 51 | ||
| Progression of Gastroesophageal Reflux Disease With Empiric Proton Pump Inhibitor Therapy | 53 | ||
| Value of Pathology in the Diagnosis of Gastroesophageal Reflux Disease | 54 | ||
| A Proposed New Objective in the Management of Gastroesophageal Reflux Disease | 54 | ||
| Defining a Criterion of Irreversibility: Visible Columnar Lined Esophagus | 54 | ||
| Cause of Visible Columnar Lined Esophagus | 55 | ||
| Lower Esophageal Sphincter | 55 | ||
| Defining the Normal and Defective Lower Esophageal Sphincter by Manometry | 56 | ||
| Result of Abdominal Lower Esophageal Sphincter Damage: the Dilated Distal Esophagus | 58 | ||
| Mechanism of Abdominal Lower Esophageal Sphincter Damage | 58 | ||
| Relationship Between Abdominal Lower Esophageal Sphincter Length and Lower Esophageal Sphincter Failure | 59 | ||
| Histologic Measurement of Abdominal Lower Esophageal Sphincter Damage | 59 | ||
| Definition of Normal Histology of the Esophagus and Stomach | 60 | ||
| Definition of the Gastroesophageal Junction | 60 | ||
| Measurement of the Length of the Dilated Distal Esophagus | 62 | ||
| Variation in the Length of the Dilated Distal Esophagus | 63 | ||
| New Pathologic Test of Lower Esophageal Sphincter Damage | 64 | ||
| Classification of Gastroesophageal Reflux Disease by the Results of the New Test | 64 | ||
| Evidence Base Supporting the New Diagnostic Method | 65 | ||
| Prediction of Progression of Lower Esophageal Sphincter Damage | 65 | ||
| Potential Value of the New Test in the Management of Gastroesophageal Reflux Disease | 65 | ||
| Exclusion of Gastroesophageal Reflux Disease as a Cause of Symptoms | 65 | ||
| Stratification of Gastroesophageal Reflux Disease Treatment According to Risk | 65 | ||
| What Needs to Happen for the New Test to Work | 65 | ||
| Need to Remove Errors in Interpretation | 65 | ||
| Need for a New Biopsy Device | 66 | ||
| Need for Data on Asymptomatic Persons and Gastroesophageal Reflux Disease Patients | 66 | ||
| Nonendoscopic Measurement of a-Lower Esophageal Sphincter Damage | 66 | ||
| New Effective Method for Preventing Progression of a-Lower Esophageal Sphincter Damage | 66 | ||
| Conclusion | 66 | ||
| References | 67 | ||
| 4 Relevant Anatomic Relations of the Esophagus | 68 | ||
| Abstract | 69 | ||
| Keywords | 69 | ||
| Cervical Esophagus | 68 | ||
| Upper Esophageal Sphincter | 68 | ||
| Trachea and Spine | 71 | ||
| Recurrent Laryngeal Nerves | 71 | ||
| Thoracic Esophagus | 71 | ||
| Vagus Nerves | 74 | ||
| Trachea | 74 | ||
| Azygos Vein | 75 | ||
| Lymphatic Drainage and Thoracic Duct | 76 | ||
| Abdominal Esophagus | 77 | ||
| Vagus Nerves | 77 | ||
| Diaphragm | 77 | ||
| Gastroesophageal Junction | 79 | ||
| Lower Esophageal Sphincter | 79 | ||
| Conclusion | 80 | ||
| References | 80 | ||
| Two Diagnostic Evaluation of the Esophagus | 82 | ||
| 5 Esophageal Symptoms and Selection of Diagnostic Tests | 82 | ||
| Abstract | 83 | ||
| Keywords | 83 | ||
| Origin of Esophageal Sensation | 82 | ||
| Symptoms | 84 | ||
| Typical Symptoms of Gastroesophageal Reflux Disease | 84 | ||
| Heartburn | 84 | ||
| Functional Heartburn | 84 | ||
| Regurgitation | 85 | ||
| Dysphagia | 85 | ||
| Atypical Symptoms of Gastroesophageal Reflux Disease | 85 | ||
| Noncardiac Chest Pain | 85 | ||
| Chronic Cough and Asthma | 86 | ||
| Hoarseness and Dental Caries | 87 | ||
| Nausea and Vomiting | 87 | ||
| Globus Sensation | 87 | ||
| Relevant Testing Before Consideration of Antireflux Surgery | 87 | ||
| pH Monitoring | 87 | ||
| Impedance Testing | 89 | ||
| Manometry | 89 | ||
| Impedance Manometry | 90 | ||
| Barium Esophagram | 90 | ||
| Endoscopy | 90 | ||
| Gastric Emptying Studies | 91 | ||
| Relevant Preoperative Testing for Specific Indications | 91 | ||
| Preoperative Testing for Barrett Esophagus | 91 | ||
| Preoperative Testing for Giant Hernias or Large Paraesophageal Hernias | 91 | ||
| Preoperative Testing for Myotomy for Achalasia or Diverticula | 91 | ||
| Preoperative Testing for End-Stage Lung Disease and Transplantation | 91 | ||
| Preoperative Testing for Reoperation After Failure of Previous Antireflux Surgery | 92 | ||
| Preoperative Testing for Esophageal Cancer | 93 | ||
| Conclusion | 93 | ||
| References | 93 | ||
| Suggested Readings | 93 | ||
| 6 Radiology of the Esophagus | 96 | ||
| Abstract | 97 | ||
| Keywords | 97 | ||
| Esophagram | 96 | ||
| Gastroesophageal Reflux Disease | 100 | ||
| Utility of Esophagram in Gastroesophageal Reflux Disease | 101 | ||
| Exclusion of Motility Disorder | 101 | ||
| Detection of Gastroesophageal Reflux | 101 | ||
| Detect Evidence of Esophageal Injury | 101 | ||
| Evaluation of Esophageal Clearance | 102 | ||
| Preoperative Planning | 102 | ||
| Esophageal Motility Disorders | 103 | ||
| Primary Motility Disorders | 103 | ||
| Secondary Motility Disorders | 105 | ||
| Esophageal Neoplasms | 105 | ||
| Carcinoma | 105 | ||
| Radiologic Appearance | 105 | ||
| Staging | 108 | ||
| Esophagram. | 108 | ||
| Computed Tomography. | 108 | ||
| Positron Emission Tomography | 108 | ||
| Staging of Esophageal Cancer. | 108 | ||
| Detection and Staging of Recurrent Esophageal Cancer. | 110 | ||
| Other Esophageal Malignancies | 110 | ||
| Benign Esophageal Neoplasms | 110 | ||
| Postoperative Esophagus | 112 | ||
| Techniques of Postoperative Esophageal Imaging | 112 | ||
| Imaging Modalities | 112 | ||
| Enteric Contrast Materials | 112 | ||
| Specific Postoperative Findings | 113 | ||
| Cricopharyngeal Myotomy | 113 | ||
| Cardiomyotomy | 113 | ||
| Antireflux Procedures | 113 | ||
| Esophageal Resection | 114 | ||
| Miscellaneous Conditions | 115 | ||
| Hiatal Hernias | 115 | ||
| Esophageal Rings and Webs | 116 | ||
| Less Common Types of Strictures | 118 | ||
| Caustic Injury | 119 | ||
| Esophageal Perforation | 120 | ||
| Diverticula | 120 | ||
| Varices | 121 | ||
| Summary | 122 | ||
| References | 123 | ||
| 7 Endoscopic Evaluation of the Esophagus and Endoscopic Ultrasonography of the Esophagus | 125 | ||
| Abstract | 126 | ||
| Keywords | 126 | ||
| Endoscopic Evaluation of the Gastroesophageal Junction | 125 | ||
| Conventional Endoscopic Diagnosis of Barrett Esophagus | 128 | ||
| Specialized Endoscopic Techniques for Barrett Esophagus | 130 | ||
| Endoscopic Diagnosis of Reflux Esophagitis | 131 | ||
| Endoscopic Evaluation of Patients Who Have Had Antireflux Surgery | 132 | ||
| Esophageal Cancer | 133 | ||
| Eosinophilic Esophagitis | 134 | ||
| Endoscopic Esophageal Ultrasonography | 135 | ||
| Fundamentals of Ultrasonography | 136 | ||
| Instruments and Techniques | 137 | ||
| Esophageal Wall and Ultrasound Anatomy | 138 | ||
| Esophageal Carcinoma | 139 | ||
| Clinical Stage (cTNM) | 143 | ||
| Determination of Computed Tomography Classification | 143 | ||
| Determination of N Classifications | 146 | ||
| Determination of M Classification | 148 | ||
| Posttherapy Stage (ycTNM) | 148 | ||
| Recurrence Stage (rTNM) | 148 | ||
| Benign Esophageal Diseases | 149 | ||
| Benign Esophageal Tumors | 149 | ||
| Tumors of the Mucosa | 149 | ||
| Tumors of the Submucosa | 149 | ||
| Tumors of the Muscularis Propria | 150 | ||
| Miscellaneous Esophageal Diseases | 150 | ||
| Esophageal Cysts | 150 | ||
| Esophageal Varices | 151 | ||
| Achalasia | 151 | ||
| Paraesophageal Diseases | 151 | ||
| Conclusion | 152 | ||
| References | 152 | ||
| 8 High-Resolution Esophageal Manometry | 156 | ||
| Abstract | 157 | ||
| Keywords | 157 | ||
| Techniques of Esophageal Manometry | 156 | ||
| Technical Aspects | 156 | ||
| Manometric Protocol | 158 | ||
| Esophageal Pressure Topography | 158 | ||
| Algorithm of Analysis Using Pressure Topography Parameters | 159 | ||
| Esophagogastric Junction Morphology | 160 | ||
| Esophagogastric Junction Relaxation | 161 | ||
| Contraction Vigor | 162 | ||
| Distal Contractile Latency | 163 | ||
| Contraction Pattern | 164 | ||
| Esophageal Pressurization | 164 | ||
| Esophageal Motor Disorders | 164 | ||
| Achalasia | 164 | ||
| Pharmacologic Therapy | 165 | ||
| Botulinum Toxin Injection | 165 | ||
| Pneumatic Dilation | 165 | ||
| Laparoscopic Heller Myotomy | 166 | ||
| Peroral Endoscopic Myotomy | 166 | ||
| Treatment Failure | 166 | ||
| Esophageal Spasm | 166 | ||
| Pharmacologic Treatment | 166 | ||
| Endoscopic Treatment | 166 | ||
| Surgical Treatment | 167 | ||
| Jackhammer Esophagus | 167 | ||
| Pharmacologic Treatment | 167 | ||
| Role of Manometry in Antireflux Surgery | 168 | ||
| Fundoplication Tailoring | 168 | ||
| Conclusion | 169 | ||
| Acknowledgments | 169 | ||
| References | 169 | ||
| 9 pH and Impedance Evaluation of the Esophagus | 171 | ||
| Abstract | 172 | ||
| Keywords | 172 | ||
| History of Esophageal pH Monitoring | 171 | ||
| Indications for pH Testing | 171 | ||
| Electrochemical Properties of pH Electrodes | 171 | ||
| Catheter-Based pH Monitoring | 173 | ||
| Wireless pH Monitoring | 173 | ||
| Duration of pH Monitoring | 174 | ||
| pH Electrode Placement | 175 | ||
| Interpretation of Esophageal pH Studies | 175 | ||
| Symptoms Association | 177 | ||
| pH Testing on Versus Off Acid Suppressive Medication | 178 | ||
| Limitations of Esophageal pH Monitoring | 178 | ||
| Proximal Esophageal pH Assessment | 179 | ||
| Multichannel Intraluminal Impedance | 179 | ||
| Combined Multichannel Intraluminal Impedance and pH | 179 | ||
| Conclusion | 181 | ||
| References | 181 | ||
| 10 Novel Diagnostic Technologies | 184 | ||
| Abstract | 185 | ||
| Keywords | 185 | ||
| Mucosal Impedance | 184 | ||
| Eosinophilic Esophagitis | 187 | ||
| Optical Coherence Tomography | 188 | ||
| Surveillance of Treatment-Naive Barrett Esophagus | 191 | ||
| Postablation Surveillance of Barrett Esophagus | 193 | ||
| Volumetric Laser Endomicroscopy in Achalasia | 194 | ||
| Confocal Laser Endomicroscopy | 195 | ||
| Other Emerging Technologies | 197 | ||
| References | 198 | ||
| Three Esophageal Motility Disorders and Diverticula | 201 | ||
| 11 Cricopharyngeal Dysfunction and Zenker Diverticulum | 201 | ||
| Abstract | 202 | ||
| Keywords | 202 | ||
| Assessment of Oropharyngeal Dysphagia | 201 | ||
| Clinical Evaluation | 201 | ||
| Endoscopic Evaluation | 201 | ||
| Radiologic Studies | 203 | ||
| Fiberoptic Endoscopic Evaluation of Swallowing | 204 | ||
| Manometry | 204 | ||
| Functional Lumen Imaging Probe | 204 | ||
| Treatment | 205 | ||
| Endoscopic Dilations | 206 | ||
| Injection of Botulinum Toxin | 206 | ||
| Cricopharyngeal Myotomy | 207 | ||
| Zenker Diverticulum | 207 | ||
| Physiology and Pathophysiology of Zenker Diverticulum | 207 | ||
| Symptoms and Diagnosis | 209 | ||
| Therapy | 210 | ||
| Cricopharyngeal Myotomy With or Without Diverticulectomy | 210 | ||
| Endoscopic Stapling Diverticulostomy | 211 | ||
| Fiberoptic Endoscopic Treatment | 212 | ||
| Results and Discussion | 213 | ||
| Conclusion | 216 | ||
| References | 217 | ||
| 12 Surgical Management of Mid- and Distal Esophageal Diverticula | 218 | ||
| Abstract | 219 | ||
| Keywords | 219 | ||
| Distal Esophageal (Epiphrenic) Diverticulum | 218 | ||
| Pathophysiology | 218 | ||
| Symptoms and Diagnosis | 218 | ||
| Treatment | 221 | ||
| Surgical Approaches and Results | 221 | ||
| Transthoracic Approach | 221 | ||
| Video-Assisted Thoracic Approach ± Laparoscopic Myotomy/Fundoplication | 222 | ||
| Laparoscopic Approach | 223 | ||
| Endoscopic Approach | 224 | ||
| Current Controversies in Surgical Approach | 224 | ||
| Complications | 225 | ||
| Outcomes of Diverticulectomy and Myotomy | 226 | ||
| Middle Esophageal Diverticulum | 227 | ||
| Symptoms and Diagnosis | 227 | ||
| Treatment | 228 | ||
| Summary | 228 | ||
| References | 228 | ||
| 13 Epidemiology, Diagnosis, and Medical Management of Achalasia | 230 | ||
| Abstract | 231 | ||
| Keywords | 231 | ||
| Epidemiology | 230 | ||
| Diagnosis | 230 | ||
| Radiology | 230 | ||
| Manometry | 230 | ||
| Medical Management | 232 | ||
| Pharmacologic Therapy | 232 | ||
| Botulinum Toxin | 233 | ||
| Balloon Dilation | 234 | ||
| Esophageal Stents | 234 | ||
| References | 234 | ||
| 14 Endoscopic and Surgical Therapies for Achalasia | 236 | ||
| Abstract | 237 | ||
| Keywords | 237 | ||
| Preoperative Work-Up | 236 | ||
| Achalasia Manometric Subtypes | 236 | ||
| Treatment Options | 236 | ||
| Laparoscopic Heller Myotomy With Partial Fundoplication | 236 | ||
| Technique | 238 | ||
| Port Placement and Exposure. | 238 | ||
| Dissection of the Stomach and Hiatus. | 238 | ||
| Myotomy. | 238 | ||
| Fundoplication. | 238 | ||
| Postoperative Care | 239 | ||
| Complications | 239 | ||
| Results | 239 | ||
| Peroral Endoscopic Myotomy | 240 | ||
| Technique | 240 | ||
| Endoscopic Measurements. | 240 | ||
| Saline Lift and Mucosotomy. | 240 | ||
| Submucosal Tunnel. | 240 | ||
| Circular Myotomy. | 241 | ||
| Mucosotomy Closure. | 241 | ||
| Other Considerations | 241 | ||
| Postprocedure Care | 242 | ||
| Results | 242 | ||
| Complications | 242 | ||
| Gastroesophageal Reflux Disease | 242 | ||
| Peroral Endoscopic Myotomy Compared to Heller Myotomy | 242 | ||
| Conclusion | 242 | ||
| References | 242 | ||
| Four Gastroesophageal Refl ux Disease | 245 | ||
| 15 Gastroesophageal Reflux Disease | 245 | ||
| Abstract | 246 | ||
| Keywords | 246 | ||
| Definition | 245 | ||
| Scope | 245 | ||
| Complications | 249 | ||
| Strictures | 249 | ||
| Barrett Esophagus | 249 | ||
| Quality of Life | 249 | ||
| Economic Burden | 249 | ||
| Conclusion | 250 | ||
| Acknowledgments | 250 | ||
| References | 250 | ||
| 16 Etiology and Natural History of Gastroesophageal Reflux Disease and Predictors of Progressive Disease | 253 | ||
| Abstract | 254 | ||
| Keywords | 254 | ||
| Progression of Gastroesophageal Reflux Disease Under Therapy | 253 | ||
| Pathophysiology of Gastroesophageal Reflux Disease | 256 | ||
| Histopathology of Gastroesophageal Reflux Disease | 262 | ||
| Prevention of Progressive Disease | 265 | ||
| References | 268 | ||
| 17 Respiratory Complications of Gastroesophageal Reflux Disease | 271 | ||
| Abstract | 272 | ||
| Keywords | 272 | ||
| Role of Gastroesophageal Reflux Disease in Chronic Cough | 271 | ||
| Laryngopharyngeal Reflux | 273 | ||
| Role of Gastroesophageal Reflux Disease in Asthma and Chronic Obstructive Pulmonary Disease | 274 | ||
| Role of Gastroesophageal Reflux Disease in Bronchiectasis | 275 | ||
| Role of Gastroesophageal Reflux Disease in Interstitial Lung Disease | 276 | ||
| Role of Gastroesophageal Reflux Disease in Patients Under Consideration for Lung Transplantation | 276 | ||
| References | 277 | ||
| 18 Acid-Suppression Therapy for Gastroesophageal Reflux Disease and the Therapeutic Gap | 279 | ||
| Abstract | 280 | ||
| Keywords | 280 | ||
| Pathophysiologic Mechanisms Underlying Gastroesophageal Reflux Disease | 279 | ||
| Management of Gastroesophageal Reflux Disease With Acid-Suppression Therapy | 279 | ||
| Alternative Pharmacologic and Lifestyle Interventions for Gastroesophageal Reflux Disease | 281 | ||
| Nonpharmacologic Treatments for Gastroesophageal Reflux Disease: Bridging the Therapeutic Gap? | 282 | ||
| Radiofrequency Ablation Therapy: Stretta | 282 | ||
| Transoral Incisionless Fundoplication: Esophyx and Medigus Ultrasonic Surgical Endostapler | 282 | ||
| Magnetic Sphincter Augmentation Device: Linx | 283 | ||
| Conclusion | 283 | ||
| Acknowledgments | 283 | ||
| References | 283 | ||
| 19 Fundoplication for Gastroesophageal Reflux Disease | 286 | ||
| Abstract | 287 | ||
| Keywords | 287 | ||
| Clinical Features | 286 | ||
| Preoperative Evaluation | 286 | ||
| Indications for Surgery | 288 | ||
| Open Versus Laparoscopic Nissen Fundoplication | 289 | ||
| Principles of Nissen Fundoplication | 289 | ||
| Laparoscopic Nissen Fundoplication | 289 | ||
| Position and Port Placement | 289 | ||
| Exposure | 291 | ||
| Dissection | 291 | ||
| Exposure of the Hiatus. | 291 | ||
| Complete Mobilization of the Gastric Fundus. | 291 | ||
| Mediastinal and Posterior Esophagus. | 292 | ||
| Reconstruction | 294 | ||
| Crural Closure. | 294 | ||
| Fundoplication. | 294 | ||
| Open Nissen Fundoplication | 295 | ||
| Exploration and Exposure | 295 | ||
| Lesser Curve. | 296 | ||
| Crus. | 296 | ||
| Mediastinal and Posterior Esophagus. | 296 | ||
| Fundus and Greater Curve. | 296 | ||
| Repair and Fundoplication. | 296 | ||
| Acquired Short Esophagus | 296 | ||
| Postoperative Care | 298 | ||
| Specific Intraoperative and Postoperative Complications | 298 | ||
| Short-Term Results | 298 | ||
| Long-Term Results | 298 | ||
| Conclusion | 299 | ||
| References | 299 | ||
| 20 Magnetic Sphincter Augmentation for Gastroesophageal Reflux Disease | 301 | ||
| Abstract | 302 | ||
| Keywords | 302 | ||
| Magnetic Sphincter Augmentation | 301 | ||
| Surgical Technique | 301 | ||
| Summary of Clinical Experience | 303 | ||
| Conclusion | 305 | ||
| References | 305 | ||
| 21 Endoscopic Management of Gastroesophageal Reflux Disease | 307 | ||
| Abstract | 308 | ||
| Keywords | 308 | ||
| Indications for Endoscopic Therapy of Gastroesophageal Reflux Disease | 307 | ||
| Techniques | 307 | ||
| Endoscopic Plication | 307 | ||
| Medigus Ultrasonic Endostapling System (MUSE) Method | 309 | ||
| EsophyX Transoral Incisionless Fundoplication | 310 | ||
| Radiofrequency Ablation | 310 | ||
| Endoscopic Bulking Techniques | 313 | ||
| Antireflux Mucosectomy | 313 | ||
| Conclusion | 314 | ||
| References | 314 | ||
| 22 Options to Address Delayed Gastric Emptying in Gastroesophageal Reflux Disease | 317 | ||
| Abstract | 318 | ||
| Keywords | 318 | ||
| Diagnosis of Delayed Gastric Emptying | 317 | ||
| Delayed Gastric Emptying in Gastroesophageal Reflux Disease | 317 | ||
| Treatment Options | 319 | ||
| Medical Management | 320 | ||
| Endoscopic Botulinum Toxin Injection | 320 | ||
| Radiofrequency Ablation | 320 | ||
| Gastric Electrical Stimulation | 320 | ||
| Pyloromyotomy and Pyloroplasty | 321 | ||
| Gastric Fundoplication | 322 | ||
| Partial and Total Gastrectomy | 323 | ||
| Bariatric Surgery for Gastroesophageal Reflux Disease and Delayed Gastric Emptying | 323 | ||
| Conclusion | 323 | ||
| References | 324 | ||
| 23 Management of Failed Fundoplications, End-Stage Gastroesophageal Reflux Disease, and Scleroderma | 325 | ||
| Abstract | 326 | ||
| Keywords | 326 | ||
| Outcomes After Fundoplication | 325 | ||
| Why Do Fundoplications Fail? | 325 | ||
| Approach to the Patient With a Failed Fundoplication | 327 | ||
| Contrast Imaging | 327 | ||
| Manometry | 328 | ||
| Esophageal pH Testing | 328 | ||
| Multichannel Intraluminal Impedance Testing | 328 | ||
| Endoscopy | 328 | ||
| Other Studies | 328 | ||
| Choice of Operation | 328 | ||
| Redo Fundoplication | 329 | ||
| Gastrectomy With Roux-en-Y Reconstruction | 330 | ||
| Esophageal Replacement | 330 | ||
| Approach to the Patient With End-Stage Gastroesophageal Reflux Disease | 331 | ||
| Approach to the Patient With Scleroderma | 331 | ||
| Fundoplication | 332 | ||
| Gastrectomy With Roux-en-Y Reconstruction | 332 | ||
| Esophageal Replacement | 332 | ||
| Conclusion | 332 | ||
| References | 332 | ||
| 24 Esophageal Complications of Bariatric Procedures | 334 | ||
| Abstract | 335 | ||
| Keywords | 335 | ||
| Complications | 334 | ||
| Esophageal Dilation | 334 | ||
| Motility Disorders | 334 | ||
| Pseudoachalasia | 334 | ||
| Reflux Esophagitis | 334 | ||
| Ulcers and Stenosis | 336 | ||
| Esophageal Perforation | 336 | ||
| Summary | 336 | ||
| Suggested Readings | 336 | ||
| Five Paraesophageal Hernia | 337 | ||
| 25 Paraesophageal Hernia | 337 | ||
| Abstract | 338 | ||
| Keywords | 338 | ||
| Etiology | 337 | ||
| Classification | 337 | ||
| Prevalence | 337 | ||
| Presentation | 339 | ||
| Incarceration and Strangulation | 339 | ||
| Compression of the Esophagus or Stomach | 339 | ||
| Anemia | 339 | ||
| Respiratory Symptoms | 340 | ||
| Diagnostic Approach | 340 | ||
| Radiographic Studies | 340 | ||
| Contrast Esophagography | 340 | ||
| Upper Endoscopy | 341 | ||
| Esophageal Manometry and pH Monitoring | 341 | ||
| Indications for Repair | 341 | ||
| References | 342 | ||
| 26 Laparoscopic Paraesophageal Hernia Repair | 343 | ||
| Abstract | 344 | ||
| Keywords | 344 | ||
| Pathophysiology, Incidence, and Clinical Presentation | 343 | ||
| Indications/Contraindications | 343 | ||
| Preoperative Assessment | 346 | ||
| Surgical Technique | 346 | ||
| Reducing the Hernia Sac | 347 | ||
| Establishing Adequate Intraabdominal Esophageal Length | 348 | ||
| Repairing the Diaphragmatic Defect | 348 | ||
| Reestablishing the Antireflux Barrier | 349 | ||
| Mesh Use at the Hiatus | 349 | ||
| Complications and Outcomes | 349 | ||
| Summary | 350 | ||
| References | 350 | ||
| 27 Open Paraesophageal Hernia Repair | 351 | ||
| Abstract | 352 | ||
| Keywords | 352 | ||
| Indication for Surgical Repair | 351 | ||
| Preoperative Evaluation | 351 | ||
| Operative Approaches | 353 | ||
| Transabdominal Repair | 354 | ||
| Dissection of Hiatus | 354 | ||
| Esophageal Mobilization | 354 | ||
| Closure of Hiatus | 354 | ||
| Fundoplication | 355 | ||
| Postoperative Management | 356 | ||
| Transthoracic Repair | 357 | ||
| Transthoracic Approach | 357 | ||
| Esophageal Mobilization | 357 | ||
| Fundoplication | 357 | ||
| Hiatus Repair | 359 | ||
| Postoperative Management | 359 | ||
| Patient Outcomes | 359 | ||
| Morbidity and Mortality | 359 | ||
| Efficacy | 359 | ||
| Recurrence | 359 | ||
| Reoperation | 360 | ||
| Conclusion | 360 | ||
| References | 360 | ||
| 28 Diaphragmatic Relaxing Incisions for Crural Tension During Hiatal Hernia Repair | 362 | ||
| Abstract | 363 | ||
| Keywords | 363 | ||
| Important Initial Maneuvers | 362 | ||
| Technique for Right-Sided Relaxing Incision | 362 | ||
| Technique for Left-Sided Relaxing Incision | 364 | ||
| Outcomes With Crural Relaxing Incisions | 365 | ||
| Conclusion | 366 | ||
| Disclosures | 366 | ||
| References | 366 | ||
| 29 Collis Gastroplasty for a Foreshortened Esophagus | 367 | ||
| Abstract | 368 | ||
| Keywords | 368 | ||
| Identifying the Short Esophagus | 367 | ||
| Management of the Short Esophagus | 367 | ||
| Outcome With a Collis Gastroplasty | 369 | ||
| Conclusion | 370 | ||
| References | 370 | ||
| 30 Mesh at the Hiatus | 371 | ||
| Abstract | 372 | ||
| Keywords | 372 | ||
| Hiatal Hernia: Recurrence and Outcomes | 371 | ||
| Recurrence Rates With Primary Closure in the Early Laparoscopic Era | 371 | ||
| Recurrence Rates With Primary Closure in the Modern Laparoscopic Era | 371 | ||
| Recurrence Rates With Mesh-Reinforced Crus Closure | 373 | ||
| Mesh Configurations and Materials | 373 | ||
| Mesh-Related Complications | 374 | ||
| Mesh Versus No Mesh | 375 | ||
| Comparative Studies | 375 | ||
| Randomized Controlled Trials | 376 | ||
| Conclusion | 376 | ||
| References | 376 | ||
| Six Barrett Esophagus | 378 | ||
| 31 Controversies in the Definition of Barrett Esophagus | 378 | ||
| Abstract | 379 | ||
| Keywords | 379 | ||
| Current Definitions of Barrett Esophagus | 378 | ||
| Historical Perspective | 380 | ||
| Histologic Determination of the Gastroesophageal Junction | 381 | ||
| Implications of the Location of the Gastroesophageal Junction | 383 | ||
| Definition of the Cardia | 383 | ||
| Screening and Surveillance Biopsy Protocols for Barrett Esophagus | 383 | ||
| Risk of Neoplastic Progression in Subtypes of Esophageal Columnar Metaplasia | 384 | ||
| Limitations of Using Goblet Cells to Determine the Presence of Intestinal Metaplasia | 384 | ||
| Steps in the Development of Intestinal Metaplasia | 384 | ||
| Risk of Neoplastic Progression in Columnar-Lined Esophagus With or Without Goblet Cells | 385 | ||
| Conclusion | 385 | ||
| References | 386 | ||
| 32 Epidemiology of Barrett Esophagus and Risk Factors for Progression | 388 | ||
| Abstract | 389 | ||
| Keywords | 389 | ||
| Prevalence and Incidence of Barrett Esophagus | 388 | ||
| Risk Factors for Barrett Esophagus | 388 | ||
| Factors Associated With Increased Risk of Barrett Esophagus | 388 | ||
| Sex and Age | 388 | ||
| Gastroesophageal Reflux | 388 | ||
| Obesity | 394 | ||
| Smoking and Alcohol Consumption | 394 | ||
| Family History and Genetic Predisposition | 394 | ||
| Factors Associated With Decreased Risk of Barrett Esophagus | 395 | ||
| Patient Height | 395 | ||
| Helicobacter pylori Infection | 395 | ||
| Nonsteroidal Antiinflammatory Drugs and Statins | 395 | ||
| Acid Suppressive Medical Therapy and Antireflux Surgery | 395 | ||
| Nutrition | 396 | ||
| Risk Factors for the Neoplastic Progression of Barrett Esophagus | 396 | ||
| Overall Risk of Neoplastic Barrett Progression | 396 | ||
| Clinical Risk Factors for the Progression of Barrett Esophagus | 397 | ||
| Age and Sex | 397 | ||
| Obesity and Smoking | 397 | ||
| Recurrent Gastroesophageal Reflux Disease | 397 | ||
| Barrett Segment Length | 397 | ||
| Dysplasia | 398 | ||
| Molecular Risk Factors for the Progression of Barrett Esophagus | 398 | ||
| References | 399 | ||
| 33 Medical and Surgical Therapy for Gastroesophageal Reflux Disease and Barrett Esophagus | 405 | ||
| Keywords | 406 | ||
| Clinical Features of Barrett Esophagus | 405 | ||
| Surveillance | 407 | ||
| Treatment of Nondysplastic Barrett Esophagus | 407 | ||
| Medical Treatment | 407 | ||
| Chemoprophylaxis | 407 | ||
| Acid Suppression | 408 | ||
| Surgical Treatment | 408 | ||
| Subjective and Objective Outcomes | 409 | ||
| Impact of Antireflux Surgery on the Metaplasia-Dysplasia-Neoplasia Continuum | 410 | ||
| Treatment of Dysplasia and Early Cancer | 411 | ||
| Endoscopic Therapy for Dysplastic Barrett Esophagus | 411 | ||
| Low-Grade Dysplasia | 411 | ||
| High-Grade Dysplasia and Intramucosal Adenocarcinoma | 413 | ||
| Resection for Dysplastic Barrett Esophagus | 413 | ||
| Conclusion | 414 | ||
| References | 414 | ||
| 34 Ablation for Patients With Barrett or Dysplasia | 417 | ||
| Abstract | 418 | ||
| Keywords | 418 | ||
| Which Patients With Barrett Should Have Ablation? | 417 | ||
| Issues Relating to Nondysplastic Barrett Esophagus and Ablation | 419 | ||
| Ablative Techniques: Methods, Outcomes, and Complications | 419 | ||
| Endoscopic Resection | 420 | ||
| Endoscopic Mucosal Resection | 420 | ||
| Endoscopic Mucosal Resection Technique | 420 | ||
| Stepwise Radical Endoscopic Resection | 420 | ||
| Endoscopic Submucosal Dissection | 420 | ||
| Mucosal Ablation | 421 | ||
| Radiofrequency Ablation | 421 | ||
| Photodynamic Therapy | 423 | ||
| Argon Plasma Coagulation | 424 | ||
| Cryotherapy Ablation | 424 | ||
| Subsquamous Barrett Glands (Buried Barrett) | 425 | ||
| Summary of Ablative Therapies | 425 | ||
| Role of Acid Control Before and After Ablation Treatment | 426 | ||
| Surveillance | 426 | ||
| Role of Biomarkers | 427 | ||
| Conclusion | 427 | ||
| References | 427 | ||
| Seven Esophageal Cancer | 430 | ||
| 35 Epidemiology, Risk Factors, and Clinical Manifestations of Esophageal Cancer | 430 | ||
| Abstract | 431 | ||
| Keywords | 431 | ||
| Epidemiology | 430 | ||
| Incidence | 430 | ||
| Mortality and Prognosis of Patients With Esophageal Cancer | 430 | ||
| Age, Sex, and Race Distribution | 430 | ||
| Anatomic Distribution of Esophageal Cancer | 432 | ||
| Risk Factors for Esophageal Cancer | 432 | ||
| Tobacco/Alcohol | 432 | ||
| Achalasia | 432 | ||
| Diet and Nutrition | 433 | ||
| Nonsteroidal Antiinflammatory Drugs | 433 | ||
| Risk Factors Specific to Esophageal Adenocarcinoma | 433 | ||
| Obesity | 433 | ||
| Gastroesophageal Reflux Disease | 433 | ||
| Barrett Esophagus | 433 | ||
| Proton Pump Inhibitors | 434 | ||
| Lower-Sphincter Relaxing Medications | 434 | ||
| Helicobacter pylori | 434 | ||
| Why Is the Epidemiology Changing? | 434 | ||
| Clinical Manifestations | 434 | ||
| References | 435 | ||
| 36 Esophageal Cancer Diagnosis and Staging | 437 | ||
| Abstract | 438 | ||
| Keywords | 438 | ||
| Epidemiology | 437 | ||
| Anatomy | 437 | ||
| Nomenclature | 439 | ||
| Histologic Type | 439 | ||
| Histologic Grade | 440 | ||
| Tumor, Node, Metastasis Classification and Updates in the Seventh Edition | 440 | ||
| Updates in the Seventh Edition | 440 | ||
| Stage Groupings | 441 | ||
| Anatomic Location and Esophagogastric Junction Tumors | 441 | ||
| Diagnostic Tools | 442 | ||
| Tumor Detection | 442 | ||
| Upper Gastrointestinal Contrast Studies | 442 | ||
| Upper Endoscopy and Biopsy | 443 | ||
| FDG-PET/CT Scans | 444 | ||
| CT Scan and Magnetic Resonance Imaging | 445 | ||
| Endoscopic Ultrasound and Endoscopic ULTRASONOGRAPHY/FINE-NEEDLE Aspiration | 446 | ||
| Endoscopic Resection | 446 | ||
| Bronchoscopy and Endobronchial Ultrasound | 447 | ||
| Laparoscopy and Thoracoscopy | 447 | ||
| Therapy Monitoring | 448 | ||
| Surveillance Strategy | 448 | ||
| Acknowledgment | 450 | ||
| References | 450 | ||
| 37 Endoscopic Management of High-Grade Dysplasia and Superficial Esophageal Carcinoma | 452 | ||
| Abstract | 453 | ||
| Keywords | 453 | ||
| Screening and Surveillance | 452 | ||
| Endoscopic Diagnosis and Staging | 454 | ||
| Endoscopic Treatment of High-Grade Dysplasia/Intramucosal Cancer | 455 | ||
| Ablation | 455 | ||
| Radiofrequency Ablation | 455 | ||
| Cryotherapy | 455 | ||
| Endoscopic Resection | 457 | ||
| Endoscopic Resection, Mucosal Ablation, or Both? | 459 | ||
| Conclusion | 460 | ||
| References | 460 | ||
| 38 Multimodality Therapy in the Management of Locally Advanced Esophageal Cancer | 462 | ||
| Abstract | 463 | ||
| Keywords | 463 | ||
| Perioperative Chemotherapy Versus Surgery Alone | 462 | ||
| Does Perioperative Chemotherapy Improve Survival in Patients With Esophageal Cancer and, If So, Does This Depend on Histology? | 462 | ||
| Do Triplet Regimens Confer an Advantage Over Doublets? | 465 | ||
| Is Chemotherapy More Effective When Administered in the Pre- or Postoperative Setting? | 466 | ||
| Neoadjuvant Chemoradiation Versus Surgery Alone | 466 | ||
| Does Neoadjuvant Chemoradiation Improve Local/Regional Control Compared With Surgery Alone in Patients With Esophageal SCC and EAC? Does It Provide Improved Systemic Control Compared With Surgery Alone? | 468 | ||
| Does Neoadjuvant Chemoradiation Provide Improved Systemic Control Compared With Surgery Alone? | 469 | ||
| Can the Benefits of Neoadjuvant Chemoradiation Be Achieved With Acceptable Toxicity? | 469 | ||
| Chemotherapy Versus Chemoradiation Before Surgery | 470 | ||
| The Case for Neoadjuvant Chemoradiation | 470 | ||
| The Case for Neoadjuvant Chemotherapy | 470 | ||
| Definitive Chemoradiation | 472 | ||
| Conclusion | 474 | ||
| References | 475 | ||
| 39A Surgical Approaches to Remove the Esophagus | 477 | ||
| Abstract | 478 | ||
| Keywords | 478 | ||
| Surgical Therapy | 477 | ||
| Patient Assessment | 477 | ||
| Extent of Resection for Locoregional Esophageal Cancer | 477 | ||
| Technique of Open en Bloc Transthoracic Esophagectomy | 479 | ||
| Technique of Transhiatal Esophagectomy | 480 | ||
| Reconstruction | 480 | ||
| Cervical Anastomosis | 481 | ||
| Intrathoracic Anastomosis | 481 | ||
| Colon Interposition | 481 | ||
| Complications | 482 | ||
| Results | 483 | ||
| Role of Neoadjuvant Therapy | 484 | ||
| Salvage Surgery | 485 | ||
| Summary | 485 | ||
| Acknowledgment | 486 | ||
| References | 486 | ||
| 39B Surgical Approaches to Remove the Esophagus | 488 | ||
| Abstract | 489 | ||
| Keywords | 489 | ||
| Indications and Contraindication for Minimally Invasive Esophagectomy | 488 | ||
| Minimally Invasive Ivor Lewis Esophagectomy | 488 | ||
| Abdominal Phase | 488 | ||
| Thoracic Phase | 490 | ||
| Mckeown Minimally Invasive Esophagectomy | 492 | ||
| Transhiatal Minimally Invasive Esophagectomy | 492 | ||
| Laparoscopic Hand-Assisted Esophagectomy | 492 | ||
| Robotic Esophagectomy | 492 | ||
| Results | 492 | ||
| Surgical Outcomes | 492 | ||
| Oncologic and Survival Outcomes | 493 | ||
| References | 493 | ||
| 39C Surgical Approaches to Remove the Esophagus | 495 | ||
| Abstract | 496 | ||
| Keywords | 496 | ||
| Why a Vagal-Sparing Esophagectomy? | 495 | ||
| Indications for a Vagal-Sparing Esophagectomy | 495 | ||
| Surgical Approach | 495 | ||
| Conclusion and Summary | 498 | ||
| References | 498 | ||
| 39D Surgical Approaches to Remove the Esophagus | 499 | ||
| Abstract | 500 | ||
| Keywords | 500 | ||
| Indications | 499 | ||
| Equipment | 499 | ||
| Preoperative Evaluation | 499 | ||
| Choice of Operation | 501 | ||
| Technical Details | 501 | ||
| Abdominal Phase | 501 | ||
| Thoracic Phase | 503 | ||
| Hand-Sewn Anastomosis | 504 | ||
| Combination Stapled and Hand-Sewn Anastomosis | 504 | ||
| Completely Stapled Anastomosis (Linear Stapler) | 504 | ||
| Completely Stapled Anastomosis (Circular Stapler) | 504 | ||
| Cervical Phase | 504 | ||
| Results | 505 | ||
| Conclusion | 506 | ||
| References | 506 | ||
| 40 Extent of Lymphadenectomy for Esophageal Cancer | 507 | ||
| Abstract | 508 | ||
| Keywords | 508 | ||
| Lymphatic Drainage of the Esophagus and Patterns of Spread | 507 | ||
| Lymph Node Tiers | 507 | ||
| Abdominal Lymph Node Dissection | 507 | ||
| Thoracic Lymph Node Dissection | 509 | ||
| Cervical Node Dissection | 509 | ||
| Squamous Cell Cancers Versus Adenocarcinomas | 509 | ||
| Implications of Lymphadenectomy | 510 | ||
| Three-Field Lymphadenectomy | 512 | ||
| Morbidity of Lymphadenectomy | 513 | ||
| Summary | 513 | ||
| References | 514 | ||
| 41 Options for Esophageal Replacement | 515 | ||
| Abstract | 516 | ||
| Keywords | 516 | ||
| Milestones in Surgery for Esophageal Carcinoma | 515 | ||
| Stomach | 517 | ||
| Technique of Gastroplasty With the Creation of a Gastric Tube | 517 | ||
| Anastomosis | 519 | ||
| Cervical Anastomosis | 519 | ||
| Handsewn Anastomosis | 520 | ||
| Semimechanical Anastomosis | 521 | ||
| Intrathoracic Stapled Anastomosis | 521 | ||
| Reversed Gastric Tube | 523 | ||
| Nonreversed Gastric Tube or Split Stomach | 524 | ||
| Complications | 524 | ||
| Reflux | 524 | ||
| Gastric Emptying–Related Symptoms: Pyloric Drainage, Yes or No? | 525 | ||
| Gastric Emptying–Related Symptoms: Gastric Tube Versus Whole Stomach? | 527 | ||
| Treatment of Delayed Gastric Emptying and/or Gastric Outlet Obstruction | 527 | ||
| Intestinal Metaplasia and Gastric Drainage Procedures | 527 | ||
| Dumping and Diarrhea | 528 | ||
| Quality of Life After Surgery | 528 | ||
| Colon | 529 | ||
| Preoperative Management | 530 | ||
| Technique of Left Colon Interposition | 530 | ||
| Technique of Right Colon Interposition | 533 | ||
| Variations | 533 | ||
| Outcomes | 534 | ||
| Jejunoplasty (Jejunal Interposition) | 536 | ||
| Technique of Roux-en-Y Jejunoplasty | 536 | ||
| Technique of Jejunal Interposition | 537 | ||
| Functional Results | 538 | ||
| Free Vascular Grafts | 538 | ||
| Skin | 539 | ||
| No Replacement | 539 | ||
| Conduit Placement | 540 | ||
| References | 542 | ||
| 42 Palliative Therapy for Esophageal Cancer | 545 | ||
| Abstract | 546 | ||
| Keywords | 546 | ||
| Esophageal Dilation | 545 | ||
| Stents | 545 | ||
| Neodymium:Yttrium-Aluminum-Garnet Laser Treatment | 548 | ||
| Photodynamic Therapy | 549 | ||
| Cryotherapy | 549 | ||
| Brachytherapy and External Beam Radiation Therapy | 550 | ||
| Chemoradiation Therapy | 550 | ||
| Comments | 551 | ||
| References | 551 | ||
| 43 Anastomotic Complications After Esophagectomy: | 552 | ||
| Abstract | 553 | ||
| Keywords | 553 | ||
| Classification and Incidence | 552 | ||
| Risk Factors | 552 | ||
| Prevention of Leak | 555 | ||
| Diagnosis of Leak | 556 | ||
| Management | 556 | ||
| Conduit Necrosis | 556 | ||
| Anastomotic Stricture | 557 | ||
| Conduit Airway Fistula | 557 | ||
| Summary | 558 | ||
| References | 558 | ||
| Eight Miscellaneous Esophageal Conditions | 560 | ||
| 44 Nonreflux Esophagitis | 560 | ||
| Abstract | 561 | ||
| Keywords | 561 | ||
| Diagnosis | 560 | ||
| Management | 560 | ||
| Eosinophilic Esophagitis | 562 | ||
| Clinical Presentation | 562 | ||
| Epidemiology | 562 | ||
| Diagnostic Work-Up | 563 | ||
| Pathophysiology | 564 | ||
| Allergic Triggers | 564 | ||
| Management | 564 | ||
| Dietary Therapy | 565 | ||
| Endoscopic Dilation | 566 | ||
| Infectious Esophagitis | 566 | ||
| Candida Esophagitis | 566 | ||
| Cytomegalovirus Esophagitis | 566 | ||
| Herpes Esophagitis | 567 | ||
| Tuberculous Esophagitis | 567 | ||
| Drug-Induced Esophagitis | 567 | ||
| Radiation Esophagitis | 568 | ||
| Acute Esophageal Necrosis | 568 | ||
| References | 569 | ||
| 45 Esophageal Duplication Cyst | 571 | ||
| Abstract | 572 | ||
| Keywords | 572 | ||
| Pathophysiology | 571 | ||
| Clinical Presentation | 571 | ||
| Investigations | 571 | ||
| Imaging Studies | 571 | ||
| Endoscopy | 573 | ||
| Treatment | 573 | ||
| Endoscopic | 573 | ||
| Operative | 573 | ||
| Summary | 575 | ||
| References | 577 | ||
| 46 Submucosal Tumors of the Esophagus and Gastroesophageal Junction | 578 | ||
| Abstract | 579 | ||
| Keywords | 579 | ||
| Surgery | 578 | ||
| Endoscopic Mucosal Resection | 581 | ||
| Endoscopic Mucosal Resection Technique | 583 | ||
| Endoscopic Submucosal Dissection | 583 | ||
| Endoscopic Submucosal Dissection Technique | 583 | ||
| Tunnel Technique | 583 | ||
| Tumors by Type: Leiomyoma | 585 | ||
| Leiomyosarcoma | 589 | ||
| Gastrointestinal Stromal Tumor | 589 | ||
| Schwannoma | 591 | ||
| Granular Cell Tumor | 591 | ||
| Hemangioma | 592 | ||
| Fibrovascular Polyps | 593 | ||
| Conclusion | 595 | ||
| References | 595 | ||
| 47 Caustic Esophageal Injury | 598 | ||
| Abstract | 599 | ||
| Keywords | 599 | ||
| Epidemiology | 598 | ||
| Pathophysiology | 598 | ||
| Chemical Factors | 598 | ||
| Substances | 598 | ||
| Inflammatory Response | 598 | ||
| Clinical Features | 600 | ||
| Initial Investigations and Management | 601 | ||
| Imaging | 601 | ||
| Endoscopy | 602 | ||
| Treatment in Acute Phase | 604 | ||
| Medical Management | 604 | ||
| Surgical Management | 605 | ||
| Treatment in Intermediate Phase | 605 | ||
| Nutritional Support | 605 | ||
| Stricture Prophylaxis | 605 | ||
| Treatment in Chronic Phase | 606 | ||
| Resection or Bypass of Strictures | 606 | ||
| Reconstruction | 606 | ||
| Long-Term Considerations | 607 | ||
| Summary | 607 | ||
| References | 607 | ||
| 48 Etiology and Management of Esophageal Perforation | 610 | ||
| Abstract | 611 | ||
| Keywords | 611 | ||
| Etiology | 610 | ||
| Presentation | 610 | ||
| Diagnosis | 610 | ||
| Treatment | 613 | ||
| Principles of Initial Management | 613 | ||
| Nonoperative Therapy | 613 | ||
| Endoscopic Management | 614 | ||
| Operative Management | 615 | ||
| Primary Surgical Repair | 615 | ||
| Esophagectomy | 616 | ||
| Esophageal Diversion | 617 | ||
| Additional Considerations | 617 | ||
| Location of the Perforation | 617 | ||
| Preexisting Esophageal Pathology | 618 | ||
| Outcomes | 618 | ||
| Conclusion | 619 | ||
| References | 619 | ||
| 49 Management of Esophageal Perforations and Leaks | 621 | ||
| Abstract | 622 | ||
| Keywords | 622 | ||
| Anatomic Considerations | 621 | ||
| Etiology of Esophageal Perforations and Leaks | 621 | ||
| Patient Presentation | 623 | ||
| Evaluation | 623 | ||
| Management | 625 | ||
| To Repair or Not to Repair | 625 | ||
| Surgical Approach | 627 | ||
| Cervical Perforations. | 627 | ||
| Thoracic Perforations. | 627 | ||
| Abdominal Perforations. | 628 | ||
| Adjunctive Considerations. | 628 | ||
| Endoscopic Management of Esophageal Perforations and Leaks | 629 | ||
| Stent Selection | 629 | ||
| Patient Selection for Endoscopic Management | 630 | ||
| Esophageal Stenting for Perforations and Leaks | 631 | ||
| Poststenting Considerations | 631 | ||
| Complications of Stenting | 632 | ||
| Stent-Guided Regeneration and Reepithelialization | 632 | ||
| Conclusion | 632 | ||
| References | 632 | ||
| Nine Hernia | 634 | ||
| 50 Basic Concepts and Factors Associated With Ventral Hernia Recurrence | 634 | ||
| Abstract | 635 | ||
| Optimizing Known Risk Factors | 636 | ||
| Diabetes Mellitus | 636 | ||
| Smoking and Alcohol Cessation | 637 | ||
| Weight Optimization | 637 | ||
| Prior Wound Infections | 638 | ||
| Preoperative Risk Reduction | 638 | ||
| Immune Modulators and Preoperative Nutrition | 638 | ||
| Methicillin-Resistant Staphylococcus Aureus Prophylaxis | 639 | ||
| Prevention of Intraoperative Hypothermia | 639 | ||
| Emergency Operations | 639 | ||
| Hernia Prevention | 639 | ||
| Suture Selection | 639 | ||
| STITCH Length | 639 | ||
| Mesh Reinforcement as Prevention | 640 | ||
| Management of a Hernia | 640 | ||
| Mesh Versus Primary Suture Closure | 640 | ||
| Principles of Mesh Overlap | 641 | ||
| Mesh Location | 641 | ||
| Bridge Versus Buttress | 641 | ||
| Mesh Material: Synthetic, Biologic, or Bioabsorbable | 642 | ||
| Postoperative Management | 643 | ||
| Diabetes Mellitus Control | 643 | ||
| Antibiotic Chemoprophylaxis | 644 | ||
| Drains | 645 | ||
| Activity Restrictions | 645 | ||
| Abdominal Binder | 645 | ||
| Conclusion | 645 | ||
| References | 645 | ||
| 51 Congenital Diaphragmatic Hernia | 648 | ||
| Keywords | 649 | ||
| Embryology, Anatomy, and Physiology | 648 | ||
| Diaphragm Development | 648 | ||
| Lung Development | 648 | ||
| Midgut Development | 648 | ||
| Fetal Circulation | 648 | ||
| Diaphragmatic Hernia | 650 | ||
| Classification | 650 | ||
| General | 650 | ||
| Bochdalek (Posterolateral) Hernia | 650 | ||
| Morgagni (Anterior) Hernia | 650 | ||
| Associated Anomalies | 650 | ||
| Prenatal Diagnosis and Prognostic Indicators | 651 | ||
| Diagnosis | 651 | ||
| Prenatal Ultrasound | 651 | ||
| Liver Position | 651 | ||
| Fetal Magnetic Resonance Imaging | 651 | ||
| Postnatal Diagnosis | 651 | ||
| Treatment and Outcomes | 652 | ||
| Medical Optimization | 652 | ||
| Ventilatory Adjuncts | 653 | ||
| Extracorporeal Oxygenation | 653 | ||
| Timing of Repair | 653 | ||
| Summary | 653 | ||
| Open Surgical Approach | 653 | ||
| Thoracoscopic Approach | 654 | ||
| Morgagni | 656 | ||
| Future Directions | 656 | ||
| Fetal Therapy | 656 | ||
| References | 657 | ||
| 52 Ventral Hernia and Abdominal Release Procedures | 659 | ||
| Abstract | 660 | ||
| Keywords | 660 | ||
| Definitions | 659 | ||
| Anatomy | 661 | ||
| Etiology and Epidemiology | 662 | ||
| Presentation and Indications for Surgery | 663 | ||
| Patient Evaluation | 664 | ||
| Preparation for Surgery | 664 | ||
| Principles of Ventral Hernia Repair | 664 | ||
| Open Ventral Hernia Repair | 665 | ||
| Minimally Invasive Ventral Hernia Repair | 666 | ||
| Operative Technique—Laparoscopic Ventral Hernia Repair | 667 | ||
| Special Considerations | 668 | ||
| Umbilical Hernias | 668 | ||
| Spigelian Hernias | 668 | ||
| Suprapubic Hernias | 669 | ||
| Abdominal Release Procedures | 669 | ||
| Anterior Component Separation | 669 | ||
| Operative Technique | 670 | ||
| Periumbilical Perforator-Sparing Anterior Component Separation | 671 | ||
| Endoscopic Separation of Components | 672 | ||
| Posterior Component Separation | 672 | ||
| Operative Technique | 672 | ||
| Transversus Abdominis Release | 673 | ||
| Operative Technique | 673 | ||
| Cautionary Note | 674 | ||
| Hernia Repair Algorithm | 674 | ||
| Enhanced Recovery Pathways After Abdominal Wall Reconstruction | 676 | ||
| Conclusion | 676 | ||
| References | 676 | ||
| 53A Inguinal Hernia Repair | 679 | ||
| Abstract | 680 | ||
| Keywords | 680 | ||
| Surgical Anatomy of the Region | 679 | ||
| Laparoscopic Versus Open Repair | 679 | ||
| Operative Technique | 682 | ||
| Transabdominal Preperitoneal Repair | 682 | ||
| Totally Preperitoneal Hernia Repair | 684 | ||
| Transabdominal Preperitoneal Repair Versus Totally Extraperitoneal Repair | 686 | ||
| Complications | 686 | ||
| Vascular Injuries | 686 | ||
| Bowel Injury | 686 | ||
| Bladder Injury | 686 | ||
| Urinary Retention | 686 | ||
| Recurrence | 687 | ||
| Ischemic Orchitis | 687 | ||
| Groin Pain | 687 | ||
| References | 687 | ||
| 53B Inguinal Hernia Repair | 689 | ||
| Abstract | 690 | ||
| Keywords | 690 | ||
| Background | 689 | ||
| Anatomy | 689 | ||
| Surgical Technique | 689 | ||
| Conventional Anterior Open Approach | 689 | ||
| Lichtenstein Repair | 692 | ||
| Plug-and-Patch (Rutkow–Robbins) Repair | 692 | ||
| Preperitoneal Repair | 692 | ||
| Bilayer Mesh Repair | 694 | ||
| Tissue (Nonmesh) Repair | 694 | ||
| Femoral Hernias | 694 | ||
| Complications | 694 | ||
| Surgical Site Infection | 694 | ||
| Recurrence | 695 | ||
| Chronic Pain (Inguinodynia) | 695 | ||
| Cord and Testicular Injuries | 695 | ||
| References | 695 | ||
| 54 Lumbar, Pelvic, and Uncommon Hernias | 697 | ||
| Abstract | 698 | ||
| Keywords | 698 | ||
| Lumbar Hernia | 697 | ||
| Anatomy and Classification | 697 | ||
| Clinical Presentation and Diagnosis | 699 | ||
| Treatment | 701 | ||
| Obturator Hernia | 703 | ||
| Anatomy and Classification | 703 | ||
| Clinical Presentation and Diagnosis | 703 | ||
| Treatment | 705 | ||
| Sciatic Hernia | 705 | ||
| Anatomy and Classification | 705 | ||
| Clinical Presentation and Diagnosis | 706 | ||
| Treatment | 706 | ||
| Perineal Hernias | 707 | ||
| Anatomy and Classification | 707 | ||
| Clinical Presentation and Diagnosis | 708 | ||
| Treatment | 708 | ||
| Summary | 710 | ||
| References | 710 | ||
| 55 Mesh | 713 | ||
| Abstract | 714 | ||
| Keywords | 714 | ||
| History | 713 | ||
| Evidence for Mesh Repair | 715 | ||
| Mesh Categories | 715 | ||
| Synthetic | 715 | ||
| Material | 715 | ||
| Filament, Weave, Knit | 716 | ||
| Mesh Weight and Burst Strength | 716 | ||
| Porosity | 718 | ||
| Shaped Mesh | 718 | ||
| Coated and Composite Versus Uncoated | 719 | ||
| Biologic Mesh | 720 | ||
| Absorbable Synthetic Mesh | 720 | ||
| Mesh Fixation | 721 | ||
| Mesh-Specific Complications | 722 | ||
| Antimicrobial Coatings | 722 | ||
| Summary and Recommendations | 723 | ||
| References | 723 | ||
| II Stomach and Small Intestine | 726 | ||
| 56 Anatomy and Physiology of the Stomach | 727 | ||
| Abstract | 728 | ||
| Keywords | 728 | ||
| Embryologic Development | 727 | ||
| Gross Anatomy and Anatomic Relationships of the Stomach | 727 | ||
| Vascular, Lymphatic, and Neural Supply to the Stomach | 730 | ||
| Microscopic Anatomy and Physiology of the Stomach | 730 | ||
| Gastric Mucosa | 730 | ||
| Gastric Cells and Physiology of Secretory Products | 733 | ||
| Mucous Cells | 733 | ||
| Parietal Cells | 733 | ||
| Chief Cells | 734 | ||
| Enteroendocrine Cells | 735 | ||
| G Cells. | 735 | ||
| ECL Cells. | 736 | ||
| D Cells. | 736 | ||
| Ghrelin Cells. | 736 | ||
| Protective Factors of the Gastric Mucosa | 737 | ||
| Phases of Digestion | 737 | ||
| Neurophysiology of the Stomach | 738 | ||
| Acetylcholine | 738 | ||
| Neuropeptides | 738 | ||
| Gastric Motility | 738 | ||
| Neural Control | 739 | ||
| Motilin | 739 | ||
| Ghrelin | 739 | ||
| Acknowledgments | 739 | ||
| References | 740 | ||
| 57 Diagnostic and Therapeutic Endoscopy of the Stomach and Small Bowel | 741 | ||
| Abstract | 742 | ||
| Keywords | 742 | ||
| Indications and Contraindications | 741 | ||
| Equipment | 741 | ||
| Endoscopy Tower | 741 | ||
| Endoscope | 741 | ||
| Preparation | 741 | ||
| Sedation | 743 | ||
| Technique | 743 | ||
| Gastric Pathology | 744 | ||
| Therapeutic Endoscopy | 747 | ||
| Tissue Sampling and Excision | 747 | ||
| Control of Gastrointestinal Bleeding | 749 | ||
| Dilation and Stenting of Benign and Malignant Strictures | 751 | ||
| Transluminal Therapy | 753 | ||
| Endoscopy of the Small Bowel | 755 | ||
| Conclusion | 756 | ||
| Acknowledgment | 756 | ||
| References | 756 | ||
| 58 Access and Intubation of the Stomach and Small Intestine | 758 | ||
| Abstract | 759 | ||
| Keywords | 759 | ||
| Nasogastric and Nasoenteric Intubation | 758 | ||
| Indications | 761 | ||
| Contraindications | 761 | ||
| Methods of Bedside Intubation | 761 | ||
| Access to the Stomach or Small Intestine | 763 | ||
| Procedures for Intubation of the Stomach and Small Intestine | 763 | ||
| Gastrostomy | 763 | ||
| Open Gastrostomy | 763 | ||
| Percutaneous Endoscopic Gastrostomy | 763 | ||
| Jejunostomy | 765 | ||
| Combination or Multilumen Tubes | 766 | ||
| Other Devices | 766 | ||
| Management and Complications of Intestinal Tubes | 767 | ||
| Summary | 767 | ||
| References | 767 | ||
| 59 Surgery for Peptic Ulcer Disease | 769 | ||
| Abstract | 770 | ||
| Keywords | 770 | ||
| History of Surgical Treatment of Peptic Ulcer Disease | 769 | ||
| Physiologic Discovery | 769 | ||
| Surgical Treatment | 771 | ||
| Pathophysiology of Peptic Ulcer Disease | 772 | ||
| Helicobacter Pylori and Peptic Ulcer Disease | 773 | ||
| Nonsteroidal Antiinflammatory Drugs and Ulcer Disease | 774 | ||
| Low-Dose Aspirin and Ulcer Disease | 774 | ||
| Acid Hypersecretory States and Ulcer Disease | 774 | ||
| Severe Systemic Disease (Stress Ulcer) | 774 | ||
| Indications for the Surgical Treatment of Peptic Ulcer Disease | 774 | ||
| Elective Operation for Intractable Duodenal Ulcer Disease | 774 | ||
| Vagotomy | 775 | ||
| Truncal Vagotomy | 775 | ||
| Selective Vagotomy | 776 | ||
| Proximal Gastric Vagotomy | 776 | ||
| Supradiaphragmatic Vagotomy | 776 | ||
| Drainage Procedures | 776 | ||
| Pyloroplasty | 777 | ||
| Heineke-Mikulicz Pyloroplasty | 777 | ||
| Finney Pyloroplasty | 777 | ||
| Jaboulay Gastroduodenostomy | 777 | ||
| Gastrojejunostomy | 778 | ||
| Gastric Resection Procedures | 779 | ||
| Partial Gastrectomy With Billroth I Reconstruction | 780 | ||
| Partial Gastrectomy With a Billroth II Reconstruction | 783 | ||
| Partial Gastrectomy With a Roux-en-Y Reconstruction | 784 | ||
| Choice of Operation for Intractable Duodenal Ulcer | 784 | ||
| Giant Duodenal Ulcer | 785 | ||
| Recurrent Peptic Ulcer Disease | 787 | ||
| Laparoscopic Surgery | 787 | ||
| Elective Operation for Intractable Gastric Ulcer Disease | 788 | ||
| Type I Gastric Ulcer | 788 | ||
| Type II Gastric Ulcer | 788 | ||
| Type III Gastric Ulcer | 789 | ||
| Type IV Gastric Ulcer | 789 | ||
| Type V Gastric Ulcer | 789 | ||
| Gastric Outlet Obstruction | 789 | ||
| Emergency Operation for Complicated Peptic Ulcer Disease | 790 | ||
| Bleeding | 790 | ||
| Operation for Bleeding Duodenal Ulcer | 791 | ||
| Bleeding Gastric Ulcer | 792 | ||
| Perforation | 792 | ||
| Perforated Duodenal Ulcer | 792 | ||
| Perforated Gastric Ulcer | 795 | ||
| Acknowledgments | 795 | ||
| References | 796 | ||
| 60 Zollinger-Ellison Syndrome | 799 | ||
| Abstract | 800 | ||
| Keywords | 800 | ||
| Anatomy, Pathophysiology, and Molecular Biology | 799 | ||
| Clinical Presentation: Symptoms and Signs | 801 | ||
| Diagnosis and Medical Therapy | 801 | ||
| Measurement of Other Gastrointestinal Hormones | 802 | ||
| Genetics and Assessment for Multiple Endocrine Neoplasia Syndromes | 803 | ||
| Tumor Localization | 803 | ||
| Intraoperative Imaging | 804 | ||
| Surgical Therapy and Principles of Surgery | 804 | ||
| Management of Metastatic Disease | 806 | ||
| Systemic Treatments | 807 | ||
| Cytotoxic Chemotherapy | 807 | ||
| Targeted Therapy | 807 | ||
| Somatostatin Analogues | 807 | ||
| Surveillance | 807 | ||
| Prognosis | 807 | ||
| References | 807 | ||
| 61 Gastric Adenocarcinoma | 810 | ||
| Abstract | 811 | ||
| Keywords | 811 | ||
| Epidemiology | 810 | ||
| Risk Factors | 810 | ||
| Pathology | 810 | ||
| Diagnosis | 810 | ||
| Staging | 812 | ||
| Tumor Management | 812 | ||
| Multimodality Therapy | 814 | ||
| Neoadjuvant Therapy | 814 | ||
| Surgical Therapy | 814 | ||
| Lymphadenectomy | 814 | ||
| Adjuvant Therapy | 816 | ||
| Management of Advanced Disease | 816 | ||
| Surveillance | 816 | ||
| Prognosis | 816 | ||
| Prophylactic Gastrectomy | 816 | ||
| Summary | 816 | ||
| References | 817 | ||
| 62 Postgastrectomy Syndromes | 818 | ||
| Abstract | 819 | ||
| Keywords | 819 | ||
| Dumping Syndrome | 818 | ||
| Postvagotomy Diarrhea | 823 | ||
| Gastric Stasis | 823 | ||
| Afferent Loop Obstruction | 825 | ||
| Alkaline (Bile) Reflux Gastritis | 827 | ||
| Roux Stasis Syndrome | 829 | ||
| Marginal Ulcers | 830 | ||
| Gallstones | 831 | ||
| Nutritional Abnormalities | 831 | ||
| Weight Loss | 831 | ||
| Anemia | 831 | ||
| Chronic Calcium Deficit and Osteoporosis | 832 | ||
| References | 832 | ||
| 63 Operations for Morbid Obesity | 835 | ||
| Abstract | 836 | ||
| Keywords | 836 | ||
| Laparoscopic Adjustable Gastric Band | 837 | ||
| Operative Steps | 838 | ||
| Band Adjustments | 839 | ||
| Outcomes | 839 | ||
| Complications | 839 | ||
| Laparoscopic Roux-en-Y Gastric Bypass | 840 | ||
| Operative Steps | 840 | ||
| Outcomes | 842 | ||
| Complications | 843 | ||
| Early | 843 | ||
| Late | 843 | ||
| Sleeve Gastrectomy | 843 | ||
| Operative Steps | 843 | ||
| Outcomes | 845 | ||
| Complications | 845 | ||
| Duodenal Switch | 845 | ||
| Operative Steps | 846 | ||
| Outcomes | 847 | ||
| Complications | 847 | ||
| Not Yet Standardized Procedures | 847 | ||
| Single Anastomosis Gastric Bypass | 847 | ||
| Operative Steps | 847 | ||
| Outcomes | 848 | ||
| Single Anastomosis Duodenal Switch | 848 | ||
| Endoscopic Procedures | 848 | ||
| Intragastric Balloons | 848 | ||
| Other Endoscopic Suturing Procedures | 848 | ||
| Conclusion | 848 | ||
| References | 849 | ||
| 64 Foreign Bodies and Bezoars of the Stomach and Small Intestine | 851 | ||
| Abstract | 852 | ||
| Keywords | 852 | ||
| Foreign Body Ingestion | 851 | ||
| Foreign Body Ingestion in Children | 851 | ||
| Exploratory Ingestion | 851 | ||
| Magnets | 851 | ||
| Laundry Pods | 851 | ||
| Batteries | 851 | ||
| Adolescents | 853 | ||
| Adults | 853 | ||
| Intentional Ingestion | 853 | ||
| Illicit Drugs: Drug Packers | 853 | ||
| Unintentional Ingestion | 853 | ||
| Toothpicks. | 853 | ||
| Dentures. | 854 | ||
| Noningested Foreign Bodies. | 854 | ||
| Gastric Bezoars | 854 | ||
| Diagnosis | 854 | ||
| Management | 855 | ||
| References | 855 | ||
| 65 Motility Disorders of the Stomach and Small Intestine | 857 | ||
| Abstract | 858 | ||
| Keywords | 858 | ||
| Gastric Motility | 857 | ||
| Anatomy and Physiology | 857 | ||
| Gastroparesis | 857 | ||
| Mechanisms | 857 | ||
| Epidemiology and Etiology | 857 | ||
| Clinical Presentation | 859 | ||
| Diagnosis | 859 | ||
| Pharmacologic Treatment | 860 | ||
| Intrapyloric Botulinum Injections | 861 | ||
| Gastric Electrical Stimulation | 861 | ||
| Other Surgical Interventions | 862 | ||
| Intestinal Motility | 862 | ||
| Diagnosis of Intestinal Dysmotility | 863 | ||
| Postoperative Ileus | 863 | ||
| Pharmacologic Treatment | 864 | ||
| Surgical Treatment | 864 | ||
| Transplantation | 864 | ||
| Summary | 864 | ||
| Acknowledgments | 864 | ||
| References | 865 | ||
| 66 Miscellaneous Benign Lesions and Conditions of the Stomach, Duodenum, and Small Intestine | 867 | ||
| Abstract | 868 | ||
| Keywords | 868 | ||
| Benign Lesions of the Stomach, Duodenum, and Small Intestine | 867 | ||
| Benign Lesions of the Stomach | 867 | ||
| Benign Lesions of the Duodenum | 867 | ||
| Benign Lesions of the Small Intestine | 869 | ||
| Diagnosis and Treatment of Submucosal Tumors of the Stomach, Duodenum, and Small Intestine | 869 | ||
| Benign Conditions of the Stomach, Duodenum, and Small Intestine | 870 | ||
| Intussusception of the Stomach, Duodenum, and Small Intestine | 870 | ||
| Stenosis and Webs of the Duodenum | 870 | ||
| Duplication Cysts of the Stomach, Duodenum, and Small Intestine | 871 | ||
| Pneumatosis of the Stomach and Small Intestine | 871 | ||
| Conclusions | 872 | ||
| References | 873 | ||
| 67 Surgical Disease of the Stomach and Duodenum in Infants and Children | 874 | ||
| Abstract | 875 | ||
| Keywords | 875 | ||
| Embryology | 874 | ||
| Prenatal Diagnosis | 874 | ||
| Congenital Lesions | 874 | ||
| Stomach and Duodenum | 874 | ||
| Enteric Duplication | 874 | ||
| Incidence and Etiology. | 874 | ||
| Presentation and Diagnosis. | 876 |