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J M Horbach

Publications and source records attributed to J M Horbach.

8 recordsLinked to original sources
PubMed1998

Prospective study of the effect of the Belsey Mark-IV fundoplication on reflux mechanisms.

BACKGROUND: Transient lower esophageal sphincter relaxations (TLESRs) are the major mechanism permitting gastroesophageal reflux (GER). Little information is available on how anti-reflux surgery affects reflux mechanisms, especially TLESRs. We evaluated the effects of partial fundoplication (Belsey Mark IV) on reflux mechanisms. METHODS: Sixteen patients were prospectively studied before and after Belsey Mark-IV operation by endoscopy, 24-h esophageal pH-metry, and simultaneous recording of pH and lower esophageal sphincter (LES) characteristics by sleeve manometry. RESULTS: The operation was successful in 14 of 16 patients (87%). Fasting and postprandial reflux decreased significantly (P < 0.01) after the operation. Partial fundoplication significantly (P < 0.05) decreased the number of TLESRs per hour in the fasting and postprandial period from 3.2+/-0.4 and 5.6+/-0.5 to 1.7+/-0.3 and 2.8+/-0.4, respectively. The percentage of TLESRs associated with reflux also decreased significantly (P < 0.05). Basal LES pressure increased from 14.7+/-2.1 mmHg to 17.9+/-2.6 mmHg (not significant). CONCLUSIONS: Partial fundoplication controls GER through a reduction in the number of TLESRs and by decreasing the number of relaxations associated with reflux.

Adult↗
PubMed1995

A prospective study on the effect of the Belsey Mark IV 270-degree fundoplication on lower esophageal sphincter characteristics and esophageal body motility.

The effect of the Belsey Mark IV operation on lower esophageal sphincter characteristics and esophageal body motor function was prospectively studied in 38 patients who underwent successful operation (relief of symptoms, healing of esophagitis; group I) and 8 who had surgical failure (group II). Mean follow-up was 3 years (0.5 to 8 years). Only in group I a rise in basal lower esophageal sphincter pressure (from 8.3 +/- 0.8 mm Hg to 14.5 +/- 0.5 mm Hg, p < 0.001), total sphincter length (from 2.7 +/- 0.1 cm to 3.4 +/- 0.1 cm, p < 0.001), and the intraabdominal sphincter segment (1.3 +/- 0.1 cm to 2.3 +/- 0.1 cm, p < 0.001) with a reduction of the intrathoracic segment (from 1.5 +/- 0.1 cm to 1.1 +/- 0.1 cm, p < 0.05) was recorded. Preoperative and postoperative lower esophageal sphincter pressure and length values showed a large overlap. Antireflux operation had no effect on peristaltic amplitude, velocity, and duration, irrespective of the outcome of operation. One of five patients with incomplete swallow-induced lower esophageal sphincter relaxation had moderate dysphagia. Successful operation by 270-degree fundoplication is accompanied by a significant increase in lower esophageal sphincter pressure and length and does not affect esophageal body motor function.

Adult↗
PubMed1994

A prospective study of effects of Belsey MK IV antireflux surgery on endoscopic esophagitis, lower esophageal sphincter pressure, and 24-hr pH measurements. Relation to symptom improvement.

A prospective study on the effect of the Belsey MK IV operation on esophagitis, lower esophageal sphincter pressure (LESP), and acid reflux as monitored on 24-hr pH recording was conducted to investigate the association between objective changes and the effect of operation on reflux-associated symptoms. Thirty-one patients were included. The effect of surgery on symptoms was recorded in all patients, and 22 patients agreed to undergo endoscopy, manometry, and 24-hr pH recording. Follow-up ranged from three to nine years (mean five years); 87% reported long-lasting improvement (50% free of symptoms, 37% major improvement, no medication needed). The combination of symptomatic improvement and absence of esophagitis was found in 70%. LESP significantly increased [8 +/- 6 mm Hg preoperatively, 14 +/- 5 mm Hg postoperatively (P < 0.001)] to a level above 5 mm Hg in 96% of the patients. No endoscopic esophagitis was found in 17 of 20 patients (85%; P < 0.05) (two patients refused endoscopy). The 24-hr pH monitoring normalized in 11 of the 20 patients (55%) (one registration failed). The operation-induced rise in LESP correlated with improvement on endoscopy (r = 0.51; P < 0.002) and with reduction of reflux parameters (number of episodes with pH < 4: r = 0.64; P < 0.05, percentage of total time pH < 4: r = 0.42; P = 0.07). A rise in LESP must be an important aim of antireflux surgery. The Belsey MK IV does not induce a rise to a level that causes severe dysphagia or bloating, but the trade-off is less control of acid reflux.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Prospective evaluation of 24 hour ambulatory pH metry in Belsey Mark IV antireflux surgery.

This study evaluated the effect of the 270 degrees Belsey Mark IV fundoplication on 24 hour ambulatory pH metry variables. Thirty seven patients with confirmed gastro-oesophageal reflux disease who had a Belsey Mark IV antireflux procedure were evaluated preoperatively and three to six months postoperatively including endoscopy, lower oesophageal sphincter manometry, and 24 hour ambulatory pH metry. In 30 of 37 patients the Belsey Mark IV fundoplication was judged successful based on symptom relief and healing of oesophagitis. In these 30 patients percentage reflux for total, upright, and supine time (median and range) decreased significantly (p < 0.001) from 10.0% (2.7-35.3%), 10.8% (3.2-39.9%), and 6.7 (0.0-33.0%) respectively to 0.5% (0.0-7.4%), 0.6% (0.0-13.7%), and 0.1% (0.0-4.9%) after operation. This decrease in reflux time resulted predominantly from a significant (p < 0.001) reduction in the number of reflux episodes from 98 (23-231) to 14 (0-82) postoperatively. Normalisation of total reflux time (upper limit of normal for time with pH below 4:4%) was found in 89% and normalisation of total and upright and supine reflux in 64% of successfully operated patients with confirmed abnormal acid reflux before operation. A successful antireflux procedure was associated with significant (p < 0.001) increases in lower oesophageal sphincter pressure from 7.8 (0.6) mm Hg to 14.5 (0.7) mm Hg mean (SEM). In seven patients with a failed antireflux operation basal lower oesophageal sphincter pressure did not change significant;y (preoperative value 5.7 (1.3) mm Hg; postoperative value 7.8 (0.8) mm Hg). In these patients reflux time did not decrease after the operation and remained in the abnormal range in all patients. It is concluded that a successful, in contrast with a failed, Belsey Mark IV fundoplication is associated with significant decreases in total, upright, and supine reflux time. Normalisation of pH metry variables is not a prerequisite for successful antireflux surgery. A surgery. A successful 270 degree Belsey Mark IV fundoplication was associated with a significant increase in basal lower oesophageal sphincter pressure, in contrast with the failure group. Restoration of a sufficient lower oesophageal sphincter barrier is an important aim in antireflux surgery.

Adult↗
PubMed1993

Initial experience with laparoscopic fundoplication in The Netherlands and comparison with an established technique (Belsey Mark IV).

Since the introduction of laparoscopic cholecystectomy as an alternative for conventional cholecystectomy, the number of cholecystectomies per year is showing an increased tendency, suggesting that indications for surgery have broadened now that the morbidity of the procedure has decreased so much. For gastro-oesophageal reflux disease (GORD) the current number of operations performed per year in The Netherlands is small compared with the calculated prevalence of complicated GORD. If the data on epidemiology of GORD by Richter are extrapolated to the population of The Netherlands, there must be at least 4,500 potential candidates for antireflux surgery currently available and only 250 operations are performed per year. Laparoscopic Nissen fundoplication is practised with acceptable results. If with this new development the same tendency as for laparoscopic cholecystectomy arises, this may mean either that too many patients will undergo antireflux surgery or that the potential candidates will now get their chance to have an effective operation with the prospect of low procedure-related morbidity. In The Netherlands, 62 laparoscopic Nissen fundoplications have been performed. There have been no deaths and in 5 patients the laparoscopic procedure had to be converted into a laparotomy. Forty-two of these 62 patients were treated according to a protocol and were included in the follow-up. At one month, 38 out of 42 patients were available for follow-up. At one month after surgery, 38 patients felt that their reflux symptoms had improved. Surgery-induced symptoms were present in 19 out of 38 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

A forme fruste of von Hippel-Lindau disease: a combination of adrenal pheochromocytoma and ipsilateral renal cell carcinoma--a case report.

A patient with the combination of pheochromocytoma and renal cell carcinoma is reported, matching a forme fruste of von Hippel-Lindau disease. A review of the literature on this combination is given and a possible relation between the overlap syndrome, von Hippel-Lindau disease and the combination pheochromocytoma-renal cell carcinoma, is discussed.

Adrenal Gland Neoplasms↗