Bernardo Borraez

Gastroesophageal Reflux Disease: Diagnostic Evaluation

The diagnosis of gastroesophageal reflux disease (GERD) is frequently based on symptoms and upper endoscopy only, with a wrong diagnosis of GERD that occurs in up to 30 % of patients. Since a correct diagnosis of GERD is necessary to avoid inappropriate medical therapy and to properly select patients who might benefit from laparoscopic antireflux surgery, the proper evaluation of patients with symptoms suggestive of GERD should always include esophageal manometry and ambulatory 24-h pH monitoring.

Gastroesophageal Reflux Disease: Treatment

A laparoscopic total fundoplication has become the gold standard for the surgical treatment of gastroesophageal reflux disease. Short-term outcomes are excellent, with lower perioperative morbidity and faster recovery than conventional open total fundoplication. Long-term follow-up studies have shown similar symptom control between the two approaches. A laparoscopic partial fundoplication is performed in selected patients to reduce the incidence of postoperative dysphagia and gas-related symptoms. The sphincter augmentation device, a new minimally invasive antireflux procedure, has been recently proposed as an alternative to laparoscopic fundoplication.

Localización atípica del quiste tirogloso

El quiste tirogloso es una malformacion congenita asociada a la falta de involucion del conducto tirogloso, ubicado entre el foramen de la lengua y la glandula tiroides. Su incidencia predomina en la infancia, aunque tambien se puede presentar en la adultez. Es comun que la presencia de infecciones de las vias aereas superiores o el desarrollo de fistulas hagan parte del cuadro clinico del paciente y se evidencie una masa. Se reporta el caso de un paciente de sexo masculino de 39 anos de edad, que curso con una lesion nodular corres- pondiente a un quiste tirogloso con apariencia de tejido tiroideo residual, de localizacion atipica en la linea media suprahiodea, que fue removido quirurgicamente. Dada su ubicacion, se requirio la pertinente planeacion imaginolo- gica y prequirurgica para la valoracion de la glandula tiroides con el fin de resecar toda la lesion, usando la tecnica de Sistrunk con remocion total del hueso hioides para evitar la recurrencia. Se discuten las caracteristicas clinico-patolo- gicas de la enfermedad y se establece la importancia de la ubicacion para la toma adecuada de decisiones clinicas o quirurgicas que permitan brindar un tratamiento con un resultado seguro y eficaz para el paciente. The thyroglossal cyst is a congenital abnormality resulting from a defective closing of the duct located between the foramen of the tongue and the thyroid gland. Its incidence predominates in childhood, although it can also occur in adulthood. It is common that the presences of upper airway infections or fistulas become a part of the patients clinical signs and as the mass becomes apparent. This report corresponds to a case of a 39 year old male patient with a nodular lesion. A thyroglossal cyst with an atypical location in the midline superior part of the hyoid bone was diagnosed, which was surgically removed. Because of its location careful imaging and presurgical planning was required for thyroid gland assessment. The Sistrunk technique was performed removing the hyoid bone completely to prevent recurrence. Clinico-patholo- gical features of the disease are discussed, the importance of the location for surgical considerations to provide the best outcome for the patient. O quisto tireoglosso e uma malformacao congenita asso-ciada a falta de involucao do conduto tireoglosso localizado entre o ovale da lingua e a glândula tiroides. Sua incidencia predomina na infância, embora tambem possa se apre-sentar nos adultos, sendo comum na clinica do paciente a presenca de infecoes aereas superiores ou a frequente presenca de fistulas sendo evidenciada uma massa.No presente artigo se faz o reporte correspondente a um paciente masculino com 39 anos de idade, que apresentou uma lesao nodular convergente a um quisto tireoglosso com aparencia de tecido tiroide residual, de localizacao atipica na linha media supra-hioideus, remo-vido cirurgicamente. Devido a sua locacao foi preciso planejamento imagenologico para valoracao da glândula tiroides, visando ressecar a totalidade da lesao mediante a tecnica de Sistrunk, com remocao total do osso hioideus para evitar recorrencia. O artigo discute as caracteris-ticas clinico patologicas desta doenca e se estabelece que a adequada tomada de decisoes clinicas e cirurgicas depende em grande medida da locacao da lesao.

Operations for Achalasia

This chapter describes the preoperative work-up, operative planning, and the technique of a laparoscopic Heller myotomy and partial fundoplication.

Laparoscopic Operations for Esophageal Leiomyoma

This chapter describes the preoperative work-up, operative planning, and the laparoscopic enucleation of esophageal leiomyoma.

Hybrid Transthoracic Esophagectomy

The patient is a 68-year-old man with a 20-year history of heartburn and regurgitation. He was initially treated empirically with H2 blocking agents and antacids. Ten years after onset, the patient felt that his symptoms were getting worse, so a complete work-up was done, with the following findings:

Operations for Gastroesophageal Reflux Disease

The patient is a 58-year-old man with idiopathic pulmonary fibrosis (IPF). His pulmonary function tests have become progressively worse over the past 2 years. He has had heartburn and regurgitation for many years, and frequently wakes up at night with fluid in his mouth and coughing. His evaluation included these findings:

Esophageal Diseases: Radiologic Images

Esophageal diseases are functional disorders (gastroesophageal reflux disease (GERD), achalasia, esophageal diverticula), congenital abnormalities (esophageal duplication cyst), or tumors (leiomyoma, gastrointestinal stromal tumors (GIST), cancer). In the evaluation of these disorders, no single test provides all the needed information, but the final diagnosis and treatment plan are based on information provided by multiple tests. For instance, in patients with GERD, a barium swallow describes the anatomy of the esophagus and stomach (hiatal hernia, Schatzki’s ring, stricture); an upper endoscopy determines if mucosal injury is present and excludes gastric and duodenal pathology; esophageal manometry defines pressure, length, and position of the lower esophageal sphincter; quality of esophageal peristalsis; and pressure of the upper esophageal sphincter and its coordination with the pharyngeal contraction; ambulatory pH monitoring determines if abnormal gastroesophageal reflux is present, if reflux extends to the proximal esophagus and pharynx, and if there is a temporal correlation between episodes of reflux and symptoms experienced by the patient.