[The surgical treatment of gastroesophageal reflux (GER)].
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to A Del Genio.
Explore the source record for details and available documents.
The Authors report a case of high risk colonic anastomosis treated by intracolonic by-pass procedure. The technique of Coloshield application is described. Its use prevents fecal contamination of the anastomotic site and, in case of dehiscence, anastomotic fistula formation.
Intra-operative esophageal electromanometry (IEM), a method foretold by the authors since 1972, is indicated in the course interventions for functional esophageal disease. The main application of IEM occurs in the presence of myotomy and in the preparation of anti-reflux plasty. As far as myotomy is concerned, IEM can provide guidance in identifying a site for future intervention and, once accomplished, for documenting the completeness thereof. As far as anti-reflux plasty is concerned, it provides an opportunity to verify the onset of an anti-reflux high-pressure zone (nHPZ) that can be calibrated fittingly until the required values are achieved. IEM appears especially useful in effecting a Nissen fundoplication, the frightful complications of which compel many a surgeon to use other types of plasty, despite the lower rate of effectiveness. The perfect identity between the degree of loop closing and the manometric values obtained, and between the loop width and the length of the nHPZ, obtainable through Nissen's fundoplication only, testifies in favor of the use of IEM in preparation of this type of fundoplication only. The Authors present their case studies from 1985 to date, collected at the Service of Surgical Esophagology of the Faculty of Naples, covering 145 cases of Nissen's fundoplication, 70 of which after extramucosal cardias myotomy according to Heller, 54 cases of GER, including 2 cases of scleroderma, epiphrenic diverticula, DES and repeated surgery.
The Authors examine the reconstructive procedures following total or partial esophagectomy, reporting advantages and disadvantages related to stomach, colon or jejunum transposition. The stomach is certainly the organ most widely employed for its adaptability and excellent vascularization; furthermore, only one anastomosis is needed. After a short note on pathophysiology of the most common complications, the Authors point out the advantages of using stapling devices, with special attention to the low incidence of anastomotic dehiscence.
Since 1985 we have done intraoperative manometry in 54 patients operated for achalasia. Manometry allows the assessment of the completeness of the division of the high pressure zone and ascertain the length of fundoplication (Nissen) as well as its pressure. In 26 patients pH and manometric controls were done postoperatively. Absence of reflux was noted in all and the pressure level after operation was 12.53 +/- 4.94 mmHg. Pressure measurements were not different from those of a group of 15 healthy subjects (15.2 +/- 2.45 mmHg). Dynamic studies of the high pressure zone revealed a post-deglutition relaxation of 72.5 +/- 16.32% over the basal tone. We believe that intraoperative manometry is essential in the surgical treatment of achalasia as it allows a precise control of myotomy as well as the fashioning of a high pressure zone to avoid reflux.
Eight patients with classical Kaposi's sarcoma histologically confirmed underwent lymphoscopic and/or lymphographic exploration of the lower limbs where the lesions were located. In all patients lymphoscopy showed abnormal images ranging from irregular distribution of the colouring agent to "starlike images" and dermal reflux. Lymphography was performed in 3 patients and demonstrated, in 2 of them, "lymphatic pools", obvious hyperplasia of the superficial lymphatic vessels and areas of lymphangectasia. The finding in all 8 patients of dynamic abnormalities of the lymphatic system should encourage further investigations in this field, notably to detect a possible correlation between lymph stasis, disorders in regional immunity and the development of classical Kaposi's sarcoma.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Results of a study carried out on pharyngoesophageal transmucosal potential difference (PD) in normal subjects and in patients with peptic esophagitis are reported. Ten healthy individuals used as control group and 12 patients with peptic esophagitis were examined. In all the cases an electric junctional pharyngoesophageal zone was evidenced, characterized by increased negativity at the level of the upper esophageal sphincter between the pharyngeal and esophageal potential difference. No statistically significant differences were observed between the two groups as for the length of PD and its location, which was always shown to be included in the high pressure zone. In healthy subjects the pharyngoesophageal PD was -16.2 +/- 4.23 mV; in patients with peptic esophagitis PD was -25.4 +/- 8.51 mV. However, in the latter PD was shown to be higher than normal in 66% of cases (p less than 0.01). No correlation was evidenced between PD values and manometric alterations of the upper esophageal sphincter. On this basis, such alterations should not be related to possible mucosal injuries, as suggested by several authors, but most likely to a reflected or primary phenomenon, common to that causing the gastroesophageal reflux.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Manometric studies on the action of domperidone 10 mg and 20 mg i.v. on the lower esophageal sphincter pressure (LESP) have been carried on ten healthy volunteers. Domperidone inhibits dopamine receptors and results in an increase of LESP. A dose of 10 mg produces a significant increase in LESP which is rapid and prolonged for thirty minutes; a dose of 20 mg is less efficient. The stimulatory effect of domperidone on LESP suggests an important role for endogenous dopamine as an inhibitory neuromodulator of LES pressure. The use of domperidone in therapy for reflux esophagitis is suggested.
Explore the source record for details and available documents.
Gastric emptying was studied in 15 patients with hiatal hernia and gastroesophageal reflux by a radionuclide technique with solid meal. Thirteen healthy subjects were used as control group. The obtained results have shown that, even in the time when the radionuclide activity decreases of 50% in the region of gastric activity (T1/2) in the 15 patients was not statistically different with respect to the control group, ten patients showed delayed emptying (116.4 +/- 16.88 min) with a mean delay of 30% in the time of half-emptying with respect to the control group (p less than 0.01). This finding is important for its surgical implications since this delayed emptying should be kept in mind when planning Nissen fundoplication or other antireflux procedures: in such case surgery can be complicated with a "gas bloat syndrome".
Explore the source record for details and available documents.