Background: Surgery is considered the treatment of choice for esophageal achalasia, since it provides symptomatic relief that is stronger and longer lasting. Laparoscopic Heller cardiomyotomy is the preferred treatment for an anti reflux surgery with found oplication. Preoperative HRM is essential to the detection of sufficient fundoplication. Aim of the work: To assess the role of preoperative manometry in selection the type of antireflux surgery with Heller cardiomyotomy (Dor or Nissen fundoplication). Patients and methods: This prospective cohort study was conducted on twenty (20) patients presented to Ain-Shams University hospitals outpatient clinics suffering from chronic dysphagia from January 2018 through January 2020 to assess the role of preoperative manometry in selection of operative type and decision making in treatment of achalasia. Results: Using HRM ,14 patients (70%) with type 1 achalasia underwent Dor fundoplication and in these Dysphagia and regurgitation improved substantially in patients (p value = 0.001 and 0.001 respectively), also there were 4 patients (28.5%) with post-operative reflux. 6 Patients (30%) with type 2 achalasia underwent Nissen fundoplication and in these patients there was a significant improvement in dysphagia and regurgitation (p value = 0.034 and 0.023 respectively), 3 patients (50%) developed post-operative dysphagia, two of them improved on follow up. There was a significant reduction in LES pressure in both Dor and Nissen operation (p value = 0.001 and 0.026 respectively). Conclusion: Preoperative HRM is crucial in choosing type of fundoplication in achalasia as symptomatic responses vary depending on achalasia subtype.
Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.
Background Barrett’s esophagus is a condition which predisposes towards development of dysplasia and finally towards esophageal adenocarcinoma, a highly lethal tumour which has been increasing in incidence over the past three decades. Although BE is the single best identified risk factor for the development of esophageal adenocarcinoma, yet the overwhelming majority of Barrett’s patients will never develop this cancer. Objective To evaluate the incidence of dysplasia in patients with BE regarding risk factors such as gender, smoking, obesity, patient’s age, duration of reflux, treatment received, associated disease as DM and esophageal histopathology. Patients and Methods The study was conducted on 30 patients previously diagnosed with BE. The patients were selected according to some inclusion criteria such as being diagnosed by upper GI endoscopy and a biopsy was taken. Patients with history of previous anti-reflux surgery were excluded. Results A strong correlation was found between the incidence of dysplasia and male gender, mean age 58.17 years, smoking, DM, hiatus hernia and esophagitis. Conclusion As the incidence of dysplasia and esophageal adenocarcinoma continues to rise at an alarming rate, widespread endoscopic surveillance of Barrett’s esophagus patients is performed in order to detect any abnormality at an earlier and potentially curable stage. In addition to highlighting the risk factors that aggravates this pre-malignant condition.
Background: Esophagectomy is a major operation indicated for many reasons mainly in esophageal cancer and loss of esophageal function, this operation due to many considerations we can say it is a true challenge to the upper GI surgeon.
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