By George Wu
Few scientific disciplines were reworked so dramatically by means of developments in technology and know-how as gastrointestinal surgical procedure. to start with, glossy 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 variety or one other may have constituted a wide block of the key surgical procedures. the appearance of potent H2-histamine receptor antagonists and, extra + + lately, the H ,K -ATPase (proton pump) inhibitors resulted in a precipitous decline in these tactics such that they're hardly ever played this present day. intriguing new ways to treating inflammatory bowel ailments and their complications—such as fistulas— with anticytokine treatment might at some point have a equally profound impression on surgical procedure for this situation to boot. past pharmaceutics, advances in imaging thoughts have drastically facilitated the id and characterization of pathology within the gastrointestinal tract in a manner that might were unbelievable just a couple of years in the past. simply to visualize the pancreas ultimately was once a horrendous job until eventually belly ultrasound, magnetic resonance imaging, or machine tomography made it easy. the truth that the intestine is a hole organ that may be accessed throughout the mouth, anus, or maybe during the wall of the stomach has been totally exploited with fiberoptic endoscopes that may bend round corners comfortably and allow surgical procedure to be carried out via them.
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Extra info for An Internist's Illustrated Guide to Gastrointestinal Surgery
The anterior vagus nerve is identified and protected. With laparoscopic magnification, the longitudinal and circular muscles are carefully divided, exposing the mucosal layer (Fig. 2). The myotomy is now extended proximally 6 cm from the G–E junction and distally 1 cm onto the proximal stomach. The muscle is Chapter 3 / Esophagectomy for Achalasia 29 Fig. 4. Postoperative barium swallow. dissected from the mucosa allowing the mucosa to protrude. Intraoperative flexible endoscopy is then performed to be certain there is no further distal obstruction.
Should en bloc esophagectomy be the standard of care for esophageal carcinoma? Ann Surg 2002;254:581. 29. Young M, Deschamps C, Trastek V, et al. Esophageal reconstruction for benign disease: Early morbidity, mortality and functional results. Ann Thorac Surg 2000;70:1651. 30. Mansour K, Bryan C, Carlson G. Bowel interposition for esophageal replacement: twenty-five-year experience. Ann Thorac Surg 1997;64:752. 31. McLarty A, Deschamps C, Trastek V, et al. Esophageal Resection for Cancer of the Esophagus: LongTerm Function and Quality of Life.
3. Partial fundoplication after myotomy. disease. The surgery is performed under general anesthesia. Five laparoscopic trocars are placed. The peritoneum overlying the distal esophagus is divided and the anterior esophagus is exposed after inducing pneumoperitoneum. The anterior vagus nerve is identified and protected. With laparoscopic magnification, the longitudinal and circular muscles are carefully divided, exposing the mucosal layer (Fig. 2). The myotomy is now extended proximally 6 cm from the G–E junction and distally 1 cm onto the proximal stomach.
An Internist's Illustrated Guide to Gastrointestinal Surgery by George Wu