检索结果-南通市图书馆

Impact of minimally invasive surgery on the treatment of benign esophageal disorders

World Journal of Gastroenterology 2012年第46期18卷 6764-6770页

作者： Brian Bello Fernando A Herbella marco e allaix marco G Patti Department of Surgery University of Chicago Pritzker School of Medicine

Thanks to the development of minimally invasive surgery, the last 20 years have witnessed a change in the treatment algorithm of benign esophageal disorders. Today a laparoscopic operation is the treatment of choice for esophageal achalasia and for most patients with gastroesophageal reflux disease. Because the pathogenesis of achalasia is unknown, treatment is palliative and aims to improve esophageal emptying by decreasing the functional obstruction at the level of the gastro-esophageal junction. The refinement of minimally invasive techniques accompanied by large, multiple randomized control trials with long-term outcome has allowed the laparoscopic Heller myotomy and partial fundoplication to become the treatment of choice for achalasia compared to endoscopic procedures, including endoscopic botulinum toxin injection and pneumatic dilatation. Patients with suspected gastroesophageal reflux need to undergo a thorough preoperative workup. After establishing diagnosis, treatment for gastroesophageal reflux should be individualized to patient characteristics and a decision about an operation made jointly between surgeon and patient. The indications for surgery have changed in the last twenty years. In the past, surgery was often considered for patients who did not respond well to acid reducing medications. Today, the best candidate for surgery is the patient who has excellent control of symptoms with proton pump inhibitors. The minimally invasive approach to antireflux surgery has allowed surgeons to control reflux in a safe manner, with excellent long term outcomes. Like achalasia and gastroesophageal reflux, the treatment of patients with paraesophageal hernias has also seen a major evolution. The laparoscopic approach has been shown to be safe, and durable, with good relief of symptoms over the long-term. The most significant controversy with laparoscopic paraesophageal hernia repair is the optimal crural repair. This manuscript reviews the evolution of these tec

关键词： Gastroesophageal reflux disease esophageal achalasia Hiatal hernia Laparoscopic fundoplication Laparoscopic Heller myotomy

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Multidisciplinary approach for patients with esophageal cancer

引用

World Journal of Gastroenterology 2012年第46期18卷 6737-6746页

作者： Victoria M Villaflor marco e allaix Bruce Minsky Fernando A Herbella marco G Patti Department of Medicine Section Hematology/Oncology University of Chicago Medicine Department of Surgery University of Chicago Medicine Radiation Oncology University of Chicago Medicine

Patients with esophageal cancer have a poor prognosis because they often have no symptoms until their disease is advanced. There are no screening recommendations for patients unless they have Barrett's esophagitis or a significant family history of this disease. Often, esophageal cancer is not diagnosed until patients present with dysphagia, odynophagia, anemia or weight loss. When symptoms occur, the stage is often stage Ⅲ or greater. Treatment of patients with very early stage disease is fairly straight forward using only local treatment with surgical resection or endoscopic mucosal resection. The treatment of patients who have locally advanced esophageal cancer is more complex and controversial. Despite multiple trials, treatment recommendations are still unclear due to conflicting data. Sadly, much of our data is difficult to interpret due to many of the trials done have included very heterogeneous groups of patients both histologically as well as anatomically. Additionally, studies have been underpowered or stopped early due to poor accrual. In the United States, concurrent chemoradiotherapy prior to surgical resection has been accepted by many as standard of care in the locally advanced patient. Patients who have metastatic disease are treated palliatively. The aim of this article is to describe the multidisciplinary approach used by an established team at a single high volume center for esophageal cancer, and to review the literature which guides our treatment recommendations.

关键词： esophageal Cancer Multimodality therapy Multidisciplinary therapy Chemoradiotherapy esophageal resection esophagectomy

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Gastroesophageal reflux disease and morbid obesity: To sleeve or not to sleeve?

引用

World Journal of Gastroenterology 2017年第13期23卷 2269-2275页

作者： Fabrizio Rebecchi marco e allaix marco G Patti Francisco Schlottmann Mario Morino Department of Surgical Sciences University of Torino Center for esophageal Diseases and Swallowing University of North Carolina

Laparoscopic sleeve gastrectomy(LSG) has reached wide popularity during the last 15 years, due to the limited morbidity and mortality rates, and the very good weight loss results and effects on comorbid conditions. However, there are concerns regarding the effects of LSG on gastroesophageal reflux disease(GeRD). The interpretation of the current evidence is challenged by the fact that the LSG technique is not standardized, and most studies investigate the presence of GeRD by assessing symptoms and the use of acid reducing medications only. A few studies objectively investigated gastroesophageal function and the reflux profile by esophageal manometry and 24-h p H monitoring, reporting postoperative normalization of esophageal acid exposure in up to 85% of patients with preoperative GeRD, and occurrence of de novo GeRD in about 5% of cases. There is increasing evidence showing the key role of the surgical technique on the incidence of postoperative GeRD. Main technical issues are a relative narrowing of the mid portion of the gastric sleeve, a redundant upper part of the sleeve(both depending on the angle under which the sleeve is stapled), and the presence of a hiatal hernia. Concomitant hiatal hernia repair is recommended. To date, either medical therapy with proton pump inhibitors or conversion of LSG to laparoscopic Rouxen-Y gastric bypass are the available options for the management of GeRD after LSG. Recently, new minimally invasive approaches have been proposed in patients with GeRD and hypotensive LeS: the LINX? Reflux Management System procedure and the Stretta? procedure. Large studies are needed to assess the safety and long-term efficacy of these new approaches. In conclusion, the recent publication of p H monitoring data and the new insights in the association between sleeve morphology and GeRD control have led to a wider acceptance of LSG as bariatric procedure also in obese patients with GeRD, as recently stated in the 5^(th) International Consensus Con

关键词： Sleeve gastrectomy Gastroesophageal reflux Morbid obesity Ambulatory p H monitoring esophageal manometry

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Conversion of laparoscopic colorectal resection for cancer: What is the impact on short-term outcomes and survival?

引用

World Journal of Gastroenterology 2016年第37期22卷 8304-8313页

作者： marco e allaix edgar JB Furnée Massimiliano Mistrangelo Alberto Arezzo Mario Morino Department of Surgical Sciences University of Torino

Laparoscopic resection for colon and rectal cancer is associated with quicker return of bowel function, reduced postoperative morbidity rates and shorter length of hospital stay compared to open surgery, with no differences in long-term survival. Conversion to open surgery is reported in up to 30% of patients enrolled in randomized control trials comparing open and laparoscopic colorectal resection for cancer. In this review, reasons for conversion are anatomical-related factors, disease-related-factors and surgeon-related factors. Body mass index, local tumour extension and co-morbidities are independent predictors of conversion. The current evidence has shown that patients with converted resection for colon cancer have similar outcomes compared to patients undergoing a laparoscopic completed or open resection. The few studies that have assessed the outcomes after conversion of laparoscopic rectal resection reported significantly higher rates of complications and longer length of hospital stay in converted patients compared to laparoscopically treated patients. No definitive conclusions can be drawn when converted and open rectal resections are compared. early and pre-emptive conversion appears to have more favourable outcomes than reactive conversion; however, further large studies are needed to better define the optimal timing of conversion. With regard to long-term oncologic outcome, overall and disease-free survival in the case of conversion in laparoscopic colorectal cancer surgery seems to be worse than those achieved in patients in whom resection was successfully completed by laparoscopy. Although a worse long-term oncologic outcome has been suggested, it remains difficult to draw a proper conclusion due to the heterogeneity of the long-term outcomes as well as the inclusion of both colon and rectal cancer patients in most of the studies. Therefore, we discuss the currently available evidence of the impact of conversion in laparoscopic resection for colon an

关键词： Conversion Laparoscopy Open surgery Colon cancer Rectal cancer Morbidity Mortality Predictors Recurrence Survival

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Transanal endoscopic microsurgery:what indications in 2013?

引用

Gastroenterology Report 2013年第2期1卷 75-84页

作者： Mario Morino marco e.allaix Digestive ColorectalOncologic and Minimally Invasive SurgeryDepartment of Surgical SciencesUniversity of TurinItaly

Thanks to major advances in the field of surgical techniques and neoadjuvant chemoradiation therapy,along with more accurate pre-operative staging tools and the widespread introduction of population-based screening programs,treatment of rectal cancer has been evolving over the past few decades,moving towards a more tailored *** has brought a shift in the treatment algorithm of benign rectal lesions and selected early rectal cancers,for which today transanal endoscopic microsurgery(TeM)is accepted as an effective alternative to abdominal *** 2013,topics of controversy are the role of TeM in the treatment of more advanced rectal cancers,in cases of complete pathological response after chemoradiation therapy and the role of TeM as a platform for single-port surgery and *** article reviews the current indications for TeM and the future perspectives of this approach in the treatment of rectal tumors.

关键词： transanal endoscopic microsurgery full-thickness excision rectal adenoma early rectal cancer chemoradiation NOTeS

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：