Thirty-one patients about to undergo surgery for gastroesophageal reflux were randomized into either a Nissen fundoplication group (12) or a modified Toupet semifundoplication group (19). All patients were followed on a long-term basis for 5 years with a standard questionnaire, endoscopy, and manometry. Ninety-five percent of the patients in the modified Toupet group had good or excellent results versus 67% for the Nissen group. However both procedures are effective in curtailing esophagitis with an improvement of the endoscopic grading in the Nissen group by 91% and 89% in the group undergoing the modified Toupet procedure. A significant improvement in symptoms (acid regurgitation, heartburn, retrosternal pain) was noted in both groups, except for dysphagia in the Nissen group. Three patients with a Nissen fundoplication had a slipped Nissen requiring reoperation and two had gas-bloat syndrome. These specific complications of the Nissen procedure were not found in the modified Toupet group.
In patients with obstructive jaundice, biliary decompression can be achieved by an endoprosthesis inserted by a percutaneous transhepatic approach. The prosthesis sometimes becomes dislodged and thus additional percutaneous transhepatic procedures may be required. To avoid this problem, a nondislodgeable endoprosthesis has been developed. The prosthesis is constructed with a layer of biocompatible material (hydrogel) on its surface. The hydrogel is located in grooves around the endoprosthesis and has the ability to absorb liquid, which increases its size. By placing the rings of hydrogel on either side of the obstruction, dislodgement of the prosthesis can be prevented. The nondislodgeable endoprosthesis has been inserted into 11 patients with biliary obstructions due to malignant strictures. No dislodgement has occurred and the established internal drainage reduced serum bilirubin levels without any major complications.
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