Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: The Esophagogastric Junction
Chapter: Surgical treatments

What are the indications for surgical treatment of GER in children?
S.G. Jolley (Las Vegas) 

In terms of pH normalization, is there any difference between total and partial fundoplication?
L. Lundell (Gothenburg) 

In the Toupet procedure, what are the indications for narrowing the cardia by use of a peritoneal flap?
P. Boutelier (Paris) 

Is Collis gastroplasty likely to prevent failure of partial fundoplications?
L.S. Leonardi, N.A. Andreollo, L.R. Lopes, N.A.Brandalise (Sao Paulo) 

Of what value is peroperative manometry to prevent dysphagia?
F. Veiga Fernandes, A.B. Branco (Lisbon) 

By which mechanism is the gastric emptying rate accelerated after fundoplication?
C. Scarpignato (Parma, Nantes), I. Pelosini (Parma), J.P. Galmiche (Nantes) 

Is there a relationship between gastric emptying parameters and the final outcome of fundoplication? Does it allow for tailoring the operation?
L. Lundell (Gothenburg) 

Is there a role for selective vagotomy in addition to antireflux surgery?
R.L. Brown, J. Sarosiek, R.W. McCallum (Kansas City) 

The post-surgical gastroesophageal junction

What are the consequences of the structural changes of the anatomic cardia in controlling reflux after fundoplication?
J. Bancewicz (Salford) 

How can the pressure profile along the wrap be determined? Is there a correlation with dysphagia? Does it correlate with the opening diameter of the LES?
G.G. Jamieson, S. Tew, R.H. Holloway (Adelaide) 

What are the possibilities of misdiagnosis of achalasia before AR surgery?
C.G. Bremner (Los Angeles) 

What are the consequences of herniation of the repair into the chest? Why are they different from the primary intra-thoracic Nissen?
J.M. Collard, L. Verstraete, R. Romagnoli (Brussels) 

Are there manometric changes likely to predict post-operative symptoms in patients with GER?
M. Ruth, L. Lundell (Gothenburg) 

What are the most frequent causes of failure of AR operations? What is the average time for their occurrence?
G.G. Jamieson (Adelaide) 

      What are the causes of dysphagia following open AR surgery?
           T.H. Gouge (New York) 

How should a risk profile for post-fundoplication "drawbacks" be defined?
L. Lundell (Gothenburg) 

What should be the criteria of cure after AR procedures?
P. Misiuna, W. Polkowski (Lublin) 

What is the optimal surgical procedure for long-term control of GERD with regard the AR barrier and postoperative complaints?
L. Olbe (Gothenburg) 

What attitude should be adopted in failed AR procedures?
J.R. Siewert, H.J. Stein (Munich) 

The irreducible intra-thoracic cardia

Intra-thoracic fundoplication

Are there specific complications related to intrathoracic Nissen fundoplication? What is the role of vagal injury, devascularization of the fundus, and constriction of blood flow in acute complications following intrathoracic Nissen fundoplication?
J.M. Collard, R. Romagnoli, J.B. Otte (Brussels) 

What are the other procedures to be chosen for irreducible hiatal hernias? Collis-Belsey? Collis-Nissen?
P.E. Donahue (Chicago) 

Total duodenal diversion

What are the main drawbacks of diversion of duodenal contents via Roux-en-Y gastrojejunostomy?
J.H. Peters (Los Angeles) 

Is vagotomy likely to efficiently prevent the development of jejunal ulcers?
R. Menguy (Rochester, NY) 

Duodenal switch

For bile diversion, what are the obvious advantages of the duodenal switch procedure on the volume of the gastric reservoir, release of GI hormones induced by stimulation of the duodenal mucosa by chyme, and on duodenal inhibition of acid secretion?
R.A Hinder (Jacksonville), G. Perdikis (Omaha) 

What is the status of gastric emptying after a duodenal switch? Is the Roux-en-Y syndrome of delayed gastric emptying undoubtedly avoided?
R.J. Mason, C.G. Bremner (Los Angeles) 

Are the results of redo surgery different from those of correct primary surgery? What is the rate of postoperative death?
G.G. Jamieson (Adelaide) 

What are the preoperative criteria likely to provide valuable information on a possibly acquired short esophagus, thus avoiding any indication for laparoscopic AR surgery?
S. Mattioli, F. D'Ovidio, M.P. Di Simone, F. Bassi, S. Brusori, L. Ferruzzi (Bologna) 

Laparoscopic AR surgery

Is laparoscopic Nissen fundoplication a logical alternative to long-term therapy for GERD?
M. Anvari (Hamilton) 

What are the formal contraindications to the laparoscopic approach?
G. Champault (Paris) 

Should laparoscopic AR surgery be performed selectively?
A. Watson (London) 

Does laparoscopic approach to the hiatus increase or lower technical demands?
G. Champault (Paris) 

The construction of the valve by automatic stapling
J. Cady (Paris) 

The screw-shaped wraps related to a too low-performed gastric suture
P. Verhaeghe, Y. Delval, R. Stoppa (Amiens) 

Should crural repair be systematically performed?
A. Watson (London) 

What benefit can be expected from the Watson AR procedure?
A. Watson (London) 

Are there specific drawbacks of laparoscopic Nissen fundoplication in terms of GER? Of persistent dysphagia?
A.L. DePaula (Goiania) 

What are the indications for a simplified thoracoscopic hiatal hernioplasty with uncut gastroplasty in high risk patients?
N. Demos, I. Ahmad, J. Scalia, J. Woo, S. Zaklama, C. Patel, M. Lewis, R. Deguzman, D. Shih, A. Lin, S. Shih, W. Siegal (Jersey City) 

How should intraoperative manometry be interpreted during laparoscopic AR surgery?
A. Peracchia, L. Bonavina, R. Incarbone (Milan) 

Can objective arguments on the advantages of laparoscopic AR surgery over conventional approach be specified?
J.M. Collard, C. De Gheldere, M. De Kock, R. Romagnoli (Brussels) 

Open or laparoscopic antireflux surgery: are they competing options?
J.H. Peters (Los Angeles) 

What are the causes of re-operations for failed laparoscopic AR repair?
J. Boulez (Lyons) 

What are the compared long-term results of mano-pHmetry following open versus laparoscopic surgery?
G. Champault (Paris) 

What are the effects of laparoscopic Nissen fundoplication on pulmonary function?
M. Anvari, C. Allen (Hamilton) 

Is it wise to claim of any good results of AR surgery before a minimum period of five years?
B. Salky (New York) 

Gastroplasty by flexible endoscopy: what is the future of the latest minimally invasive operation for GER, without laparotomy, without laparoscopy, with immediate ambulation of the patient?
C.P. Swain, S.S. Kadirkamanathan, D.F. Evans (London) 

Surgery for peptic stenoses

What criteria predict the reversibility of stenoses?
H.W. Boyce (Tampa) 

By what means can the benign nature of a peptic stenosis be established?
R. Lambert (Lyons) 

What are the indications for conservative surgical treatment?
T.H. Gouge, M.I. Rose (New York) 

When should a Collis gastroplasty be performed?
A. Watson (London) 

What is the risk of recurrence of stenosis after AR surgery?
A. Watson (London) 

What are the indications for the resection of a peptic stricture?
J. Baulieux (Lyons) 

Publication date: May 1998 OESO©2015