The Role of Surgery in GORD

Report
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Gastro-Oesophageal Reflux Disorder
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Present in around 10% of the population
Symptoms or damage to the mucosal lining of the
distal oesophagus
Caused by the contents of the stomach spending a
period of time in the distal oesophagus
Symptoms are not related to the severity of the
damage
Usually a chronic condition with relapses
Menezes, N (2007), Surgeons Net
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Generally requires long term management
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Symptoms relieved in less than 20% of patients
without medication  80% need it for relief
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Antacids to control episodes of heartburn
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PPI’s such as Omeprazole to control gastric acid
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In severe cases surgery is an option
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Oesophagitis
Barrett's Oesophagus
Menezes, N (2007), Surgeons Net
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Effective treatment of severe cases of GORD
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91% Success rate  needs good selection of patients
Those with a poor response to medical treatment
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Patient choice
Barrett’s Oesophagus
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Persisting Volume reflux
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Regurgitation of gastric contents
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Difficult benign strictures
Menezes, N (2007), Surgeons Net
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Involves surgically improving the viability of
the lower oesophageal sphincter
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Nissen Fundoplication
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Toupet Fundoplication
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http://simple-med.blogspot.co.uk/2011_05_01_archive.html
http://www.youtube.com/watch?feature=play
er_detailpage&v=hRIDVQgv5Ek#
Canon C L et al. Radiographics 2005;25:1485-1499
©2005 by Radiological Society of North America
http://radiographics.rsna.org/content/25/6/1485/F20.ex
pansion.html
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Endoluminal gastroplication
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Uses an endoscope to fold the oesophagus and stitch in
place to reduce diameter
at the gastro-oesophegeal
junction
Endoscopic injection of bulking agents
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Endoscope used to inject a bio-compatible polymer
substance around the gastro-oesophageal junction.
http://guidance.nice.org.uk/IPG404
http://guidance.nice.org.uk/IPG55
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Removes the need for long term medication
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Laparoscopic procedures the norm
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Side effects
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Reduce scars, recovery time etc
Dysphagia, belching, bloating and flatulence
Oesophageal motility disorders have the
possibility to worsen outcomes
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Achalasia
Menezes, N (2007), Surgeons Net
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Both medical and surgical methods
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Both effective – around 90%
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Cost effectiveness
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Equals out after 3 years vs medical treatments
Improvement can be increased though losing
weight, stopping smoking and reducing
alcohol intake
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Web Reference 1: http://www.surgeons.org.uk/generalsurgery-tutorials/gastro-oesophageal-reflux-diseasegord.html
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Menezes, N (2007), Surgeons Net
Also contains list of papers for further reading
Medical versus surgical management for gastro-oesophageal reflux
disease (GORD) in adults (2010:3) Wileman SM, McCann S, Grant AM,
Krukowski ZH, Bruce J, Cochrane Database of Systematic Reviews,
John Wiley & Sons/ The Cochrane Library

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