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Biomedical subjects

Glyn G Jamieson

Publications and source records attributed to Glyn G Jamieson.

At least 19 recordsLinked to original sources
PubMed2006

Analysis of illness behavior in patients after "failed" antireflux surgery.

HYPOTHESIS: Patients complaining of problems after antireflux surgery may have differences in illness behavior that could influence the decision to perform a revision procedure or its outcome. DESIGN: A prospective comparative questionnaire survey of consecutive series of patients. SETTING: University teaching hospital. PATIENTS: Those undergoing esophageal pH and manometric studies from July 1, 2001, through July 1, 2004, for investigation of new or recurrent symptoms after previous antireflux surgery. There were 52 eligible patients, of whom 4 were excluded because of refusal to enter the study (n = 1) or communication difficulties (n = 3). Of the remaining 48 patients, 22 underwent revision surgery and 26 did not. These 2 groups were compared with 167 patients with primary gastroesophageal reflux disease investigated during the same period. INTERVENTION: Self-administered, validated illness behavior questionnaire completed after informed consent was obtained. MAIN OUTCOME MEASURES: Illness behavior categories derived from the questionnaire answers: general hypochondriasis, disease conviction, psychological vs somatic illness perception, affective inhibition, affective disturbance, denial, irritability, Whiteley index of hypochondriasis, affective state, and disease affirmation. RESULTS: There were no significant differences in illness behavior category scores between the 2 groups with postoperative problems and patients with primary gastroesophageal reflux disease. CONCLUSION: Patients with problems after antireflux surgery have an illness behavior profile similar to that in patients with primary gastroesophageal reflux disease irrespective of whether there is objective evidence of recurrent reflux disease.

Adult↗
PubMed2006

Laparoscopic anterior 180 degrees partial fundoplication: five-year results and beyond.

HYPOTHESIS: Laparoscopic anterior 180 degrees partial fundoplication provides good long-term relief for symptoms of gastroesophageal reflux disease and is associated with few adverse effects. DESIGN: Prospectively evaluated case series. SETTING: University teaching hospital. PATIENTS: The late clinical outcome was determined for all patients who had undergone a laparoscopic anterior 180 degrees partial fundoplication by us between August 1, 1993, and November 30, 1999. INTERVENTIONS: Long-term (>/=5 years') follow-up after laparoscopic anterior 180 degrees partial fundoplication was obtained using a structured questionnaire. MAIN OUTCOME MEASURES: Overall satisfaction and the symptoms of heartburn and dysphagia were assessed using analog scales, and the presence or absence of other adverse outcomes was also determined. RESULTS: One hundred seventeen procedures were performed. The outcome at 5 to 11 years' (mean, 6.4 years') follow-up was determined for 113 patients (97%). Twelve patients (11%) died of unrelated causes during follow-up, and 1 patient underwent esophagectomy. Further surgery was undertaken in 12 patients (11%): 8 for recurrent reflux, 3 for a symptomatic hiatal hernia, and 1 for dysphagia. For 100 patients with clinical outcome data at late follow-up, gastroesophageal reflux symptoms were significantly improved following surgery and were well controlled in 80 patients. The incidence and severity of dysphagia were reduced after surgery. Normal belching was preserved in 91 patients, and almost all patients were able to eat normally. The overall outcome of surgery was rated as satisfactory, with 95 patients reporting that they considered their original decision to undergo surgery correct. CONCLUSIONS: Laparoscopic anterior 180 degrees partial fundoplication is an effective procedure for the surgical treatment of gastroesophageal reflux and is associated with a high rate of patient satisfaction at late follow-up. Compared with Nissen fundoplication, however, it is likely to be associated with a higher risk of recurrent reflux, although this is balanced by a lower rate of adverse effects.

Female↗
PubMed2006

Quality of life following laparoscopic anterior 90 degrees versus Nissen fundoplication: results from a multicenter randomized trial.

BACKGROUND: The short-term clinical outcomes from a multicenter prospective randomized trial of laparoscopic Nissen versus anterior 90 degrees partial fundoplication have been reported previously. These demonstrated a high level of satisfaction with the overall outcome following anterior 90 degrees fundoplication. However, the results of postoperative objective tests and specific clinical symptoms are not always consistent with an individual patient's functional status and general well being following surgery, and quality of life (QOL) is also an important outcome to consider following surgery for reflux. Hence, QOL information was collected in this trial to investigate the hypothesis: improvements in QOL following laparoscopic antireflux surgery are greater after anterior 90 degrees partial fundoplication than after Nissen fundoplication. METHODS: Patients undergoing a laparoscopic fundoplication for gastro-esophageal reflux at one of nine university teaching hospitals in six major cities in Australia and New Zealand were randomized to undergo either laparoscopic Nissen or anterior 90 degrees partial fundoplication. Quality of life before and after surgery was assessed using validated questionnaires - the Short Form 36 general health questionnaire (SF36) and an Illness Behavior Questionnaire (IBQ). Patients were asked to complete these questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. RESULTS: One hundred and twelve patients were randomized to undergo a Nissen fundoplication (52) or a 90 degrees anterior fundoplication (60). Patients who underwent anterior fundoplication reported significant improvements in eight of the nine SF36 scales compared to four of the nine following a Nissen fundoplication. The majority of these improvements occurred early in the postoperative period. With respect to the illness behavior data, there were no significant differences between the two procedures. Both groups had a significant improvement in disease conviction scores at all time points compared to their preoperative scores. CONCLUSIONS: Patients undergoing laparoscopic anterior 90 degrees partial fundoplication reported more QOL improvements in the early postoperative period than patients undergoing a Nissen fundoplication. However, the QOL outcome for both procedures was similar at later follow-up.

Australia↗
PubMed2006

Postsurgical infections are reduced with specialized nutrition support.

OBJECTIVE: The objective was to examine the relationship between pre-, peri-, and postoperative specialized nutritional support with immune-modulating nutrients and postoperative morbidity in patients undergoing elective surgery. METHODS: Studies were identified by searching MEDLINE, review article bibliographies, and abstracts and proceedings of scientific meetings. All randomized clinical trials in which patients were supplemented by the IMPACT formula before and/or after elective surgery and the clinical outcomes reported were included in the meta-analysis. Seventeen studies (n=2,305), 14 published (n=2,102), and 3 unpublished (n=203), fulfilled the inclusion criteria. Ten studies (n=1,392) examined the efficacy of pre- or perioperative IMPACT supplementation in patients undergoing elective surgery, whereas 7 (n=913) assessed postoperative efficacy. Fourteen of the studies (n=2,083) involved gastrointestinal (GI) surgical patients. Postoperative complications, mortality, and length of stay in hospital (LOS) were major outcomes of interest. RESULTS: IMPACT supplementation, in general, was associated with significant (39%-61%) reductions in postoperative infectious complications and a significant decrease in LOS in hospital by an average of 2 days. The greatest improvement in postoperative outcomes was observed in patients receiving specialized nutrition support as part of their preoperative treatment. In GI surgical patients, anastomotic leaks were 46% less prevalent when IMPACT supplementation was part of the preoperative treatment. CONCLUSION: This study identifies a dosage (0.5-1 l/day) and duration (supplementation for 5-7 days before surgery) of IMPACT that contributes to improved outcomes of morbidity in elective surgery patients, particularly those undergoing GI surgical procedures. The cost effectiveness of such practice is supported by recent health economic analysis. Findings suggest preoperative IMPACT use for the prophylaxis of postoperative complications in elective surgical patients.

Adjuvants, Immunologic↗
PubMed2006

Use of ethylenediaminetetraacetic acid for in vivo stripping of columnar mucosa: pilot study in an experimental model.

BACKGROUND: Barrett's oesophagus is an important clinical problem that can lead to oesophageal adenocarcinoma. A variety of mucosal ablation strategies are now being applied in an attempt to prevent this, although they all can cause complications. Animal experiments that suggest that ethylenediaminetetraacetic acid (EDTA) could be a novel agent for ablation of Barrett's oesophagus are reported in this article. METHODS: Dark Agouti rats were used in all experiments. To determine the feasibility of using EDTA to strip intestinal type mucosa, segments of the small intestine were exposed in vitro to EDTA at various concentrations with or without agitation. The conditions required for EDTA to strip mucosa from a vascularized loop of small bowel were then optimized in vivo. Cannulated small bowel loops were irrigated with different concentrations of EDTA with or without pulsation of the irrigation solution. The effect of similar treatments on the normal mucosa of the rat oesophagus was then determined. Mucosal healing after EDTA stripping was studied in an isolated small bowel loop survival model. RESULTS: Ethylenediaminetetraacetic acid with agitation or pulsation resulted in stripping of the intestinal columnar mucosa in vitro and in vivo. The extent was influenced by the concentration of EDTA and duration of exposure. Squamous epithelium was relatively resistant to stripping. In the survival model the small bowel mucosa regenerated without stricture formation. CONCLUSION: Small bowel columnar mucosa can be removed by EDTA in vivo without stricture formation. A refinement of this approach could be applicable to the ablation of Barrett's oesophagus.

Animals↗
PubMed2006

Laparoscopic cardiomyotomy for achalasia: long-term outcomes.

BACKGROUND: Although the laparoscopic approach to oesophageal myotomy for achalasia is associated with reduced early postoperative morbidity compared with the open approach, most published reports describe relatively short-term follow up. For this reason, in a prospective cohort study, we determined the longer-term outcome for patients with uncomplicated achalasia who underwent a laparoscopic myotomy. In addition, we sought to identify preoperative factors predicting a good postoperative outcome. METHODS: The outcome for 167 patients who underwent a laparoscopic cardiomyotomy and anterior partial fundoplication at one of two teaching hospitals was determined. All patients underwent preoperative assessment with a contrast swallow radiology, gastroscopy and oesophageal manometry. Patients also underwent objective symptom evaluation before and after surgery using various outcome scales to determine dysphagia, reflux symptoms, side-effects and overall satisfaction with the clinical outcomes. Patients were followed prospectively at yearly time points and data were managed on a computerized database. Postoperative objective investigations were undertaken if clinically indicated. RESULTS: Median operating time was 78 min (range, 30-210 min). Most patients left the hospital within 72 h of surgery. Surgery was associated with a 5% complication rate and a 4% rate of conversion to open surgery. Five per cent of patients required a subsequent intervention during follow up. Over longer-term follow up (5 years or longer), 77% of patients had either no or minimal symptoms. At 1, 3 and 5 years, 96, 93 and 97% of patients indicated that they thought that they had made the correct decision to undergo surgery, although men consistently fared worse on their reported dysphagia outcome across a range of measures. CONCLUSION: Laparoscopic myotomy with anterior partial fundoplication achieves a good outcome for patients undergoing treatment of achalasia. Male patients do not perceive their outcome to be optimal in comparison with females but in the long term, they do not regret proceeding.

Adolescent↗
PubMed2005

Metallothionien 3 expression is frequently down-regulated in oesophageal squamous cell carcinoma by DNA methylation.

BACKGROUND: Metallothionein 3 (MT3) inhibits growth in a variety of cell types. We measured MT3 gene expression by RT-PCR, and DNA methylation in the MT3 promoter by combined bisulphite restriction analysis, in four oesophageal cancer cell lines and the resected oesophagus from 64 patients with oesophageal squamous cell carcinoma (SCC). RESULTS: MT3 expression was not detected in one of the four oesophageal cell lines. The MT3 promoter was methylated in all of the oesophageal cell lines, but the degree of methylation was greater in the non-expressing cell line. After treatment with 5-aza-2'-deoxycytidine there was a reduction in the degree of methylation, and an increase in MT3 expression, in each of the cell lines (p < 0.01). Methylation was detected in 52% (33 of 64) of primary SCC and 3% (2 of 62) of histologically normal resection margins. MT3 expression was measured in 29 tumours, 17 of which had methylation of MT3. The expression of MT3 was significantly less in the methylated tumours compared to either the unmethylated tumours (p = 0.03), or the matched margin (p = 0.0005). There was not a significant difference in MT3 expression between the tumour and the margin from patients with unmethylated tumour. No correlations were observed between methylation of MT3 and survival time, patient age, gender, smoking or drinking history, tumour stage, volume, or lymph node involvement. CONCLUSION: We conclude that MT3 expression is frequently down-regulated in oesophageal SCC, by DNA methylation, but that this is not a prognostic indicator.

Adult↗
PubMed2005

Outcome of oesophagectomy for adenocarcinoma of the oesophagus and oesophagogastric junction.

BACKGROUND: Oesophageal adenocarcinoma is becoming an increasingly important problem in the Western world. Its incidence is increasing and its prognosis is poor. Because most reports of outcomes following oesophagectomy include patients with squamous cell carcinoma, the outcome following oesophagectomy for adenocarcinoma was evaluated at Flinders Medical Centre, Royal Adelaide Hospital and associated private hospitals. METHODS: The study group consisted of 121 patients with oesophageal adenocarcinoma or adenocarcinoma of the oesophagogastric junction who underwent an attempted oesophagectomy between 1985 and 2003. Thirty-two of these patients underwent surgery before 1999 at the Royal Adelaide Hospital. These patients were reviewed retrospectively. In 1999 the recording of details of all patients undergoing oesophagectomy was commenced on a prospectively maintained database. From 1999 to 2003, 89 patients underwent oesophagectomy at either the Royal Adelaide Hospital, Flinders Medical Centre or associated private hospitals. Overall, there were 101 male and 20 female patients, with a median age at surgery of 63 years (range 36-80). Survival data were available for all patients. The present study analysed factors affecting survival in these patients. RESULTS: Tumours were located entirely within the oesophagus in 83 patients, and involved the gastro-oesophageal junction in 38. Eighty-nine underwent an Ivor Lewis oesophagectomy; 20, a cervico-thoraco-abdominal oesophagectomy; nine, a cervico-abdominal oesophagectomy (with either transhiatal or blunt oesophageal dissection); and four procedures were abandoned. Sixty-four per cent of patients had evidence of Barrett's oesophagus in the resection specimen. The overall resection rate was 97%. Significant postoperative morbidity occurred in 36%, and the in-hospital mortality rate was 5% (30-day mortality 3%). The overall 1-year survival rate was 80%, and the 5-year survival rate (including surgical deaths) was 20%. Poorer survival was associated with advanced T stage, and lymph node metastasis. The outcome following resection of tumours confined to the oesophagus was similar to that for tumours involving the gastro-oesophageal junction. Since 2000, the number of oesophagectomies performed in men for adenocarcinoma has doubled, whereas the number performed in women and for squamous cell carcinoma has remained constant. CONCLUSIONS: Oesophagectomy can be performed for patients with adenocarcinoma with an acceptable perioperative mortality rate. However, the longer term outlook following oesophagectomy for most patients with adenocarcinoma remains poor. Nevertheless, early stage tumours are associated with much better survival. For this reason, efforts to diagnose this disease at an early stage are likely to offer the best chance for improving outcomes.

Adenocarcinoma↗
PubMed2005

Aspirin induces apoptosis in oesophageal cancer cells by inhibiting the pathway of NF-kappaB downstream regulation of cyclooxygenase-2.

BACKGROUND: Aspirin has potential in the prevention or treatment of oesophageal cancer, the seventh most common cancer in the world, but its mechanism of action is still not certain. METHODS: The oesophageal squamous cell carcinoma cell line TE-13 was cultured with aspirin at different concentrations or for different times. Proliferation and apoptosis were measured by MTT reduction and flow cytometry. Expression of COX-2 mRNA was measured by RT-PCR and COX-2 protein levels with Western blot analysis. Nuclear NF-kappaB and cytoplasmic IkappaB protein levels were determined by electrophoretic mobility shift assay and Western blot, respectively. RESULTS: Aspirin significantly inhibited cell proliferation and induced apoptosis at concentrations of 1, 4, 8 mmol/L. Aspirin dose-dependently decreased the levels of COX-2 mRNA, COX-2 protein and nuclear NF-kappaB protein and increased the cytoplasmic IkappaB protein. CONCLUSION: We conclude that aspirin inhibits the proliferation of, and induced apoptosis in, the cultured TE-13 SCC cell line. These changes correlate with a reduction in COX-2 mRNA and protein expression, prostaglandin synthesis, an inhibition of NF-kappaB nuclear translocation, and an increase in cytoplasmic IkappaB. These results support the further investigation of the cyclooxygenase pathway in investigating the potential of aspirin and similar drugs in cancer prevention and therapy.

Apoptosis↗
PubMed2005

[Results of laparoscopic antireflux surgery at five years and beyond].

Laparoscopic antireflux surgery was first introduced in 1991. As with any new technique, there was a learning curve during which surgeons had a unique opportunity to prospectively document the evolution of the technique and its results. We have regularly assessed our results and conducted randomised prospective studies with the aim of obtaining solid long-term outcome data. We now have at least 5 years of follow-up for two groups of patients. Group I consists of the first 178 patients who underwent fundoplicature, i.e. during the learning curve. Group II consists of 107 patients who were enrolled in a randomised trial comparing total fundoplicature with anterior partial fundoplication. The re-operation rate was 15% in Group I and only 6% in Group II. Overall, about 85% of patients were free of reflux symptoms 5-8 years after fundoplication, indicating that laparoscopic surgery provides a durable benefit in the vast majority of patients.

Adult↗
PubMed2004

Multicenter, prospective, double-blind, randomized trial of laparoscopic nissen vs anterior 90 degrees partial fundoplication.

HYPOTHESIS: Laparoscopic anterior 90 degrees partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication. DESIGN: A multicenter, prospective, double-blind, randomized controlled trial. SETTING: Nine university teaching hospitals in 6 major cities in Australia and New Zealand. PARTICIPANTS: One hundred twelve patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication were randomized to undergo either a Nissen (52 patients) or an anterior 90 degrees partial procedure (60 patients). Patients with esophageal motility disorders, patients requiring a concurrent abdominal procedure, and patients who had undergone previous antireflux surgery were excluded from this study. INTERVENTIONS: Laparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90 degrees partial fundoplication. MAIN OUTCOME MEASURES: Independent assessment of dysphagia, heartburn, and overall satisfaction 1, 3, and 6 months after surgery using multiple clinical grading systems. Objective measurement of esophageal manometric parameters, esophageal acid exposure, and endoscopic assessment. RESULTS: Postoperative dysphagia, and wind-related adverse effects were less common after a laparoscopic anterior 90 degrees partial fundoplication. Relief of heartburn was better following laparoscopic Nissen fundoplication. Overall satisfaction was better after anterior 90 degrees partial fundoplication. Lower esophageal sphincter pressure, acid exposure, and endoscopy findings were similar for both procedures. CONCLUSIONS: At the 6-month follow-up, laparoscopic anterior 90 degrees culine partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization, and it achieves a higher rate of satisfaction with the overall outcome. However, this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms.

Adult↗
PubMed2004

Endoscopic stapling for pharyngeal pouch: does it make the cut?

BACKGROUND: Endoscopic stapling to treat pharyngeal pouch is a relatively new technique with the potential to reduce the morbidity associated with the open approach for pharyngeal pouch. Despite enthusiasm for the endoscopic approach there have been no series reported in Australia, and descriptions of outcomes and benefits are currently anecdotal. The aim of the present study was to determine the outcome associated with endoscopic stapling of pharyngeal pouch in an Australian setting. METHODS: All patients admitted for endoscopic stapling for a pharyngeal pouch between 1998 and 2002 by surgeons from the Adelaide and Flinders Universities were identified, and their medical records were reviewed for clinical and operative details. All patients were interviewed by telephone using a structured questionnaire to determine symptom resolution and patient satisfaction. The Likert scale was used to assess the impact of preoperative and postoperative symptoms upon quality of life. RESULTS: A total of 31 patients were identified. The mean age of the group was 75 years (range: 35-91 years) and half the patients had an American Society of Anesthesiologists physical status score of 3 or greater. In four patients the procedure was abandoned; (for three because of inability to pass the diverticuloscope and for one because the pouch was too small). Standard open surgery was undertaken in these patients. Of the 27 procedures completed endoscopically, interview follow up was obtained in 23, at a mean follow up of 17 months (range: 2-68 months). Outcome was very good or excellent in 21 (91%), with significant symptom resolution, reduction in Likert scores and high patient satisfaction. Three patients had previously had pouch surgery and endoscopic stapling was straightforward in these patients. Recurrence of a symptomatic pouch occurred in three patients. There was no significant morbidity related to the procedure. CONCLUSIONS: The early experience of endoscopic stapling for pharyngeal pouch in Adelaide is encouraging. The procedure achieves excellent control of symptoms and can be undertaken with minimal morbidity. Recurrence may be a problem, although repeat endoscopic stapling can be undertaken without difficulty.

Adult↗
PubMed2003

Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication.

BACKGROUND: Outcomes after surgery can be determined by face-to-face interview, interviewing patients by telephone, or by mailing out questionnaires. For reasons of convenience, many clinical research studies use mail survey methods. Mail-out responses, however, are rarely complete, and patients returning mail-out questionnaires might be different from patients who do not return questionnaires. METHODS: We identified a group of 75 patients who were all sent a mail-out questionnaire 5 or more years after a laparoscopic fundoplication. Some of these patients returned questionnaires and some did not. All patients were subsequently interviewed by telephone. The responses to the two different data collection methods were compared as well as the interview responses of patients who returned questionnaires with those of patients who did not to determine the influence of follow-up methodology on apparent clinical outcome. RESULTS: Of the 75 patients interviewed, 49 patients (65%) had previously returned a mail-out questionnaire and 26 patients had not. The mean time difference between mail-out response and telephone interview was 1 month. When mail-out responses were compared with interview responses of the patients who had returned questionnaires, equivalent answers were obtained for all symptoms except for dysphagia, for which a higher incidence and greater scores were reported by patients in their mail-out questionnaire responses. When mail-out nonresponders were compared with responders, the nonresponders had a lower level of overall satisfaction with the outcome of surgery, a higher incidence of dysphagia, and greater levels of heartburn. CONCLUSIONS: The measurement of surgical outcomes using a mail-out questionnaire may not be an accurate method of assessing patient symptoms and satisfaction after surgery, particularly if follow-up is incomplete. In this study, patients not responding to mail-out questionnaires were more likely to have adverse symptoms and a lower level of satisfaction than patients returning questionnaires. This dissatisfaction could make patients less likely to return mail-out questionnaires, and for this reason studies with incomplete follow-up that rely on mail-out questionnaire responses may report erroneously higher surgical success rates.

Bias↗
PubMed2003

A search for the pathophysiology of the nonspecific "occupational overuse syndrome" in musicians.

The findings of this investigation have suggested a new theory to help explain the origin of activity-related pain. It proposes an as yet unrecognized physiologic process (the physiologic activity limitation process). When the intensity of an activity is greater than that appropriate for an individual's level of fitness for that activity, this process then generates unpleasant sensations, physiologic activity-related pain, the function of which is to limit that activity. The physiologic pain generated by this process will have pathways in common with pain caused by other protective mechanisms.

Algorithms↗
PubMed2003

Gastroenterologists' views of symptoms following laparoscopic fundoplication: anecdotally based medicine?

BACKGROUND: Currently gastro-oesophageal reflux disease (GORD) can be managed either medically or surgically. The management decision is often based on the referring doctor's perception of the pros and cons of surgical management versus the medical alternative. A large group of gastroenterologists was surveyed to determine their understanding of the common outcomes of surgical management of GORD. METHODS: A 15-question survey was sent to all gastroenterologists in Australia who were members of the Gastroenterology Society of Australia. Questions centred on management decisions and postoperative symptoms in fundoplication patients. The findings were compared to current published outcome data. RESULTS: One hundred and thirty-four gastroenterologists responded anonymously to the survey. More than 75% described fundoplication as a safe and established procedure, and 80% had referred patients who were well controlled on medication for surgical management. The gastroenterologists' perceptions of the problems of postoperative dysphagia and bloating differed from published outcomes. CONCLUSIONS: Gastroenterologists are often the gatekeepers for the management of patients with GORD. The understanding that this group has about surgical outcomes is important so that patients can make well-informed management decisions. The present study found that gastroenterologists are likely to convey to their patients higher degrees of postoperative dysphagia and bloating following fundoplication than is actually reported. This may deter some patients who would benefit from fundoplication from consulting a surgeon.

Adult↗
PubMed2002

Results of laparoscopic antireflux operations in patients who have Barrett's esophagus.

In most patients who have Barrett's esophagus and who are undergoing open or laparoscopic antireflux surgery, there is a significant improvement in symptom control that is equivalent to that in patients who have uncomplicated gastroesophageal reflux disease. The requirement for reoperation in patients with Barrett's esophagus may be slightly higher, although in the two laparoscopic series published to date, the rate is still only approximately 6%. How much this will increase with longer follow-up, time alone will tell, but given the good results in approximately 95% of patients operated to date, the authors do not believe that the diagnosis of Barrett's esophagus should be considered a blanket contraindication for laparoscopic antireflux surgery. Clearly, in most patients with Barrett's esophagus, an antireflux operation will not result in regression of Barrett's mucosa. It is still unclear whether antireflux surgery provides any protection against subsequent development of esophageal adenocarcinoma. What is clear, however, is that after antireflux surgery, patients who have Barrett's esophagus are still at risk for developing adenocarcinoma and should remain in surveillance programs. The authors believe that laparoscopic antireflux surgery is a safe and effective approach for the cure of reflux-related symptoms in patients who have Barrett's esophagus.

Barrett Esophagus↗
PubMed2002

Tumour implantation following laparoscopy using different insufflation gases.

BACKGROUND: Because of the possibility of intraperitoneal seeding and port-site recurrences following laparoscopic surgery, the role of laparoscopy in cancer surgery remains controversial. Previous experimental studies have suggested that chemical, metabolic and immunological changes following carbon dioxide (CO2) insufflation may be responsible for this phenomenon. Earlier experimental studies done by the University of Adelaide Department of Surgery have also shown that helium insufflation is associated with none of the adverse changes brought about by CO2 insufflation. Helium insufflation is also associated with lower rates of intra-abdominal tumour spread. The aim of this study was to determine whether these identified benefits apply to inert gases in general. METHODS: Twenty-four Dark Agouti rats were randomized to undergo laparoscopy with 40 min insufflation using one of the following four gases (six rats in each group); CO2, helium, argon and nitrogen. A tumour cell suspension was injected into the abdominal cavity at the beginning of laparoscopy. The rats were killed 7 days after surgery, and the peritoneal cavity and port sites were examined for the presence of tumour. RESULTS: Rats undergoing helium insufflation, had the least number of port-site recurrences and the least amount of intraperitoneal tumour spread. Argon and nitrogen pneumoperitoneum were associated with a large number of port-site recurrences and widespread tumour seeding. The effect of CO2 insufflation was intermediate. CONCLUSION: The choice of insufflation gas influences the incidence of port-site metastases and the degree of intraperitoneal tumour spread following laparoscopic cancer surgery. The reduced port-site recurrences and intraperitoneal spread that followed helium pneumoperitoneum is likely to be a unique property of this gas rather than a property of inert gases in general.

Adenocarcinoma↗