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Canadian Journal of Gastroenterology - Volume 12 1998, Issue 5, Pages 327-332

Endoscopy Department of Surgery, St Michael’s Hospital, Wellesley Central Site, University of Toronto, Toronto, Ontario, Canada



Copyright © 1998 Hindawi Publishing Corporation. This open-access article is distributed under the terms of the Creative Commons Attribution Non-Commercial License CC BY-NC http:-creativecommons.org-licenses-by-nc-4.0-, which permits reuse, distribution and reproduction of the article, provided that the original work is properly cited and the reuse is restricted to noncommercial purposes.

Abstract

Most operations in the abdominal cavity and chest can be performed using minimally invasive techniques. As yet it has not been determined which laparoscopic procedures are preferable to the same operations done through conventional laparotomy. However, most surgeons who have completed the learning curves of these procedures believe that most minimally invasive techniques will be scientifically recognized soon. The evolution, validation and justification of advanced laparoscopic surgical methods seem inevitable. Most believe that the trend towards procedures that minimize or eliminate the trauma of surgery while adhering to accepted surgical principles is irreversible. The functional results of laparoscopic antireflux surgery in the seven years since its inception have been virtually identical to the success curves generated with open fundoplication in past years. Furthermore, overall patient outcomes with laparoscopic procedures have been superior to outcomes with the traditional approach. Success is determined by patient selection and operative technique. Patient evaluation should include esophagogastroduodenoscopy, barium swallow, 24 h pH study and esophageal motility study. Gastric emptying also should be evaluated. Patients who have abnormal propulsion in the esophagus should not receive a complete fundoplication Nissen because it adds a factor of obstruction. Dor or Toupet procedures are adequate alternatives. Prokinetic agents, dilation or pyloroplasty are used for pyloric obstruction ranging from little to more severe. Correcting reflux laparoscopically is more difficult in patients with obesity, peptic strictures, paraesophageal hernias, short esophagus, or a history of previous upper abdominal or antireflux surgery.





Autor: Eric C Poulin, Christopher M Schlachta, and Joseph Mamazza

Fuente: https://www.hindawi.com/



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