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An Internist's Illustrated Guide to Gastrointestinal Surgery by George Wu

By George Wu

Few scientific disciplines were reworked so dramatically through developments in technological know-how and expertise as gastrointestinal surgical procedure. first of all, smooth ph- macology has nearly eradicated a few varieties of surgical procedure altogether. If one have been to take a peek at a standard working room time table in a hectic medical institution of the Sixties, gastrectomies of 1 sort or one other may have constituted a wide block of the key surgical procedures. the appearance of powerful H2-histamine receptor antagonists and, extra + + lately, the H ,K -ATPase (proton pump) inhibitors ended in a precipitous decline in these tactics such that they're not often played this day. intriguing new techniques to treating inflammatory bowel illnesses and their complications—such as fistulas— with anticytokine treatment might sooner or later have a equally profound impression on surgical procedure for this in addition. past pharmaceutics, advances in imaging options have tremendously facilitated the id and characterization of pathology within the gastrointestinal tract in a manner that may were unbelievable just a couple of years in the past. simply to visualize the pancreas ultimately used to be a horrendous job until eventually stomach ultrasound, magnetic resonance imaging, or machine tomography made it uncomplicated. the truth that the intestine is a hole organ that may be accessed during the mouth, anus, or maybe throughout the wall of the stomach has been totally exploited with fiberoptic endoscopes which may bend round corners conveniently and allow surgical procedure to be carried out via them.

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Brams, MD CONTENTS INTRODUCTION EPIDEMIOLOGY PATHOPHYSIOLOGY ETIOLOGY CLINICAL FEATURES PATIENT EVALUATION TREATMENT OPTIONS SURGICAL MANAGEMENT INDICATIONS CONTRAINDICATIONS SURGICAL TECHNIQUE COMPLICATIONS COST OF PROCEDURE RESULTS OF HELLER MYOTOMY SUMMARY REFERENCES INTRODUCTION At length the Disease having overcome all remedies, he was brought into that condition, that growing hungry he would eat until Oesophagus was filled up to the Throat, in the mean time nothing sliding down into the Ventricle, he cast up raw (or crude) whatsoever he had taken in: when that no Medicines could help and he languished away for hunger, and every Day was in Danger of Death.

360° (Nissen) fundoplication. In the presence of altered esophageal motility, where the propulsive force of the esophagus is not sufficient to overcome the outflow obstruction of a complete fundoplication, a partial 270° Toupet fundoplication can be performed. This procedure is identical to the Chapter 4 / Surgery for GERD 41 Fig. 8. Incision locations for Belsey IV and open fundoplications, trocar positions for laparoscopic fundoplication. Nissen fingoplication except that the stomach is sutured to the esophagus and crura, leaving the anterior esophagus uncovered and able to fully distend (4).

Type II hernia occur more commonly in an older population than do sliding hiatal hernia. The esophagogastric junction remains fixed below the diaphragm, and the gastric fundus herniates through the defect into the mediastinum. Type III is a combination of both types I and II hernia (Fig. 3). Components of both sliding and paraesophageal hernia are present. It is seen in more than 5% of patients. Finally, Type IV is comprised of anatomically complex hiatal hernias. In addition to sliding and paraesophageal components, Type IV hernia contain other viscera such as the colon, omentum, small intestine, pancreas or spleen (Figs.

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