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N J Demos

Publications and source records attributed to N J Demos.

At least 19 recordsLinked to original sources
PubMed1999

The stapled, uncut gastroplasty for hiatal hernia: 24 years' follow-up.

A simple, tension-free, in situ gastroplasty was devised in the late 1960s and early 1970s to avoid the recurrences and complications of the Collis and Nissen hiatal hernioplasties. Long-term follow-up has now been completed on 153 patients. For this procedure, the anterior gastric wall is stapled, not cut, and the fundoplication is performed on the cardia and the neoesophagus created by the stapling and is sutured under the diaphragm. A total of 161 patients underwent the stapled, uncut gastroplasty and were followed for up to 24 years. Conditions included reflux in 145, organic stricture in 23, giant hiatal hernia in 14 (with or without obstruction) and collagen esophagus in six. Post-operative tests included subjective symptom evaluation by questionnaire, esophageal manometry and 24-h pH monitoring. Of the total 161 patients, 89 were followed up for 2-10 years and 64 for 1-24 years; seven were lost to follow-up and one died soon after the operation. The stapled, uncut gastroplasty and fundoplication produced 95% excellent and good results (Matthews classification grade I and II). After the procedure, the esophagus was significantly lengthened (from 2.55 +/- 0.96 to 3.2 +/- 0.32 cm; p < 0.001) and sphincter pressure was significantly increased (from 6.35 +/- 3.5 to 27.3 +/- 6.82 mmHg; p < 0.0001). No leakage, bleeding, or 'slipped' recurrence was observed. Only one patient experienced dissolution of the wrap and recurrent symptoms. Aspiration, scleroderma, stricture and short esophagi, post-gastrectomy gastric remnants and hiccups were treated with excellent and good long-term results. The stapled, uncut gastroplasty has universal application with excellent results, not only in typical cases of gastroesophageal reflux, but also in complicated situations such as short esophagus, strictures, or dysperistaltic and aperistaltic esophagus.

Follow-Up Studies↗
PubMed1993

Control of postresection gastroesophageal reflux: the intercostal pedicle esophagogastropexy experience of 26 years.

The devastating consequences of reflux subsequent to transthoracic esophagogastrostomy are aspiration, regurgitation, bleeding, recurrent pneumonias, and recurrent strictures in the majority of patients. The misery of eight such patients was personally witnessed. None of them could sleep in their bed at night. Sixty-eight patients were protected from reflux by the intercostal pedicle esophagogastropexy in the last 26 years. They were followed for 1500 months with esophagram, endoscopy, motility, and pH studies. None had disabling reflux or its complications. Eight patients died. Two patients who survived 18 and 10 years have controllable dumping. The histology of the pedicle was preserved without causing any morbidity. A most gratifying group of five patients with benign disease were protected by the pedicle and survived so far from 2 to 23 years. The intercostal pedicle esophagogastropexy is the only antireflux procedure which has consistently prevented reflux through intrathoracic anastomosis over the past 26 years and 1500-month patient follow-up.

Aged↗
PubMed1984

Stapled, uncut gastroplasty for hiatal hernia: 12-year follow-up.

A total of 82 patients with gastroesophageal reflux were consecutively treated with stapled, uncut gastroplasty and complete fundoplication over a 12-year period. The conditions treated included symptomatic reflux; esophageal stricture; massive hernia; collagen esophagus; short esophagus; Barrett's esophagus; recurrent, massive bleeding or anemia; small gastric remnant after gastrectomy; and acute volvulus. The transthoracic approach of stapled, uncut gastroplasty gives superb exposure. Outstanding features of the procedure are the safety and versatility resulting from the small amount of fundus required, no need either to ligate short gastric vessels or to suture the esophagus itself, and preservation of anatomical continuity between the wrapping fundus and the wrapped gastric tubular segment. There have been no deaths and no cases of anatomical or symptomatic recurrence in the series. Complications included some nondebilitating and mainly self-limiting symptoms.

Esophagus↗
PubMed1983

Y-V cardioplasty for recurrent achalasia.

Long-term follow-up of patients with achalasia has revealed recurrences many years following an initially successful cardiomyotomy. In three patients with recurrent achalasia, one previously operated on by us and another twice recurrent, we were confronted with an apparently previously complete myotomy at reoperation. We elected to perform a cardioplasty using the Y-V principle employed previously in duodenal stenosis. We added a Belsey type of partial plication. Five-year follow-up with history, esophagram, esophageal function studies, and endoscopy has revealed no recurrence of dysphagia and no symptoms of reflux or esophagitis.

Cardia↗
PubMed1980

Intercostal pedicle method for control of postresection esophagitis. Thirteen-year clinical study.

In attempting to solve the problem of gastroesophageal reflux esophagitis, we tested an experimental technique in 1967. In the past 13 years we have applied that intercostal pedicle method to prevent reflux in 43 patients. Thirty-four patients had esophagogastrectomy and esophagogastrostomy for cancer. Six additional patients underwent palliative, nonresective esophagogastrostomy. In another two patients the lower esophagus was resected for complete full-wall thickness fibrous stricture. One patient had severely symptomatic reflux. Six patients treated by resection for cancer are long-term survivors. The two patients with benign stricture were followed for 2 years and the last patient with severe reflux symptoms was followed for 13 years. History, esophagography, fluoroscopy, and fiberoptic esophagoscopy were used for follow-up in 40 of 43 patients. Motility and pH studies were used for follow-up in 21 instances. There have been no symptoms of regurgitation and reflux. No stricture has been seen though one patient needed a few dilatations for the first 2 years and none in the last 2 years. The esophagogram shows a typical slinglike appearance. The lower esophageal sphincter-like pressure has been as high as 26 mm Hg in the immediate postoperative period, settling to 12 to 15 mm Hg in the long-term follow-up. The pH is definitely alkaline in the esophagus. Competence has also been observed in the only two patients who had an ephemeral anastomotic leak. We recommend the intercostal pedicle technique in all cases of esophagogastrostomy performed in the chest.

Esophagitis, Peptic↗
PubMed1975

Congenital lung malformations: a unified concept and a case report.

A left upper lobectomy in a 5-month-old infant revealed a specimen whose tissue, both grossly and microscopically, was characteristic of intr- and extrapulmonary swquestration, bronchial atresia, and adenomatoid cystic malformation. This case may be considered the missing link between the various congenital lung malformations, for it illustrates their interrelationship or their common origin. Atresia or malformation of the main bronchus seems to be the defect shared by all these anomalies. A similar bronchial abnormality probably is responsible for congenital lobar emphysema and isolated congenital lung cysts.

Angiocardiography↗