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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The low morbidity and early recovery associated with laparoscopic procedures have heralded a new era for many types of surgery. In addition to the initial promising reports for duodenal ulcer disease and gastroesophageal reflux discussed above, there is a growing body of reports of gastric procedures performed laparoscopically, including omentopexy for perforated duodenal ulcer and laparoscopic repair of full-thickness stomach injury. Laws et al recently described the use of transthoracic vagotomy in recurrent peptic ulcer disease for four patients who had previously undergone a gastric drainage procedure. As with any new procedure, laparoscopic techniques for duodenal ulcer and Nissen fundoplication reviewed in this section need to be evaluated further for long-term effectiveness and comparability to existing therapy. At least one controlled multicenter trial is ongoing to compare the long-term results and cost-effectiveness of laparoscopic surgery for duodenal ulcer with those of standard medical therapy, and as surgeons gain more experience with these laparoscopic procedures, it is likely that other similar trials will be initiated.
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PMID:Laparoscopic repair of duodenal ulcer and gastroesophageal reflux. 138 3

Barrett's esophagus, a premalignant condition associated with chronic gastroesophageal reflux, carries an approximate 40-fold increase in the incidence of adenocarcinoma. Between 1975 and 1994, 113 patients with Barrett's esophagus underwent antireflux procedures at the Mayo Clinic. The antireflux procedure was performed more than 3 months after the diagnosis of Barrett's disease in 39 patients (34.5%) and during the initial preoperative evaluation in 74 (65.5%). Uncut Collis-Nissen fundoplication was performed in 69 patients (61.1%), Nissen fundoplication was performed in 16 (14.2%), cut Collis-Nissen fundoplication was performed in 12 (10.6%), Belsey repair was performed in nine (8.0%), Collis-Belsey repair was performed in six (5.3%), and Nissen fundoplication with an anterior gastropexy was performed in one (0.9%). There was one operative death (0.9% mortality). Morbidity occurred in 41 patients (36.3%), including cardiac arrhythmia in eight (7.0%), pneumonia in six (5.3%), empyema in five (4.4%), hemorrhage in four (3.6%), myocardial infarction in two (1.8%), and wound dehiscence, wound infection, perforated duodenal ulcer, and postoperative leak in one each (0.9%). Median follow-up for the 112 survivors of operation was 6.5 years (range 4 months to 18.2 years). Excellent or good alleviation of symptoms was obtained in 92 patients (82.2%). Ninety-nine patients (88.4%) are currently alive and 13 (11.6%) have died. Three patients (2.7%) subsequently had adenocarcinoma of the esophagus after the antireflux procedure at 13, 25, and 39 months; two of these died of cancer. The incidence of esophageal carcinoma in this select group of patients was one in 273.8 patient-years of follow-up. We conclude that although antireflux procedures in patients with Barrett's esophagus result in long-term control of reflux symptoms, the possibility of esophageal cancer still exists. Endoscopic surveillance should therefore be recommended.
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PMID:Barretts's esophagus: does an antireflux procedure reduce the need for endoscopic surveillance? 864 13