Kulmeet Sandhu

Gastric cancer in the young: An advanced disease with poor prognostic features

Gastric cancer in young patients is rare. We analyzed the clinicopathological features and prognosis of early‐onset gastric carcinoma.

Inguinal Hernia Repair: Laparoscopic

Abstract Symptomatic inguinal hernias are a commonly encountered surgical problem. Repair can be performed with an open or minimally invasive approach. Laparoscopic inguinal hernia repair is now widely performed, especially in the setting of bilateral or recurrent inguinal hernias. This chapter reviews the anatomy, benefits, and possible complications of laparoscopic inguinal hernia repair. Laparoscopic inguinal hernia repair is also compared with the traditional anterior approach, and the operative techniques of both the transabdominal preperitoneal repair and the totally extraperitoneal repair are reviewed. The outcomes of these two procedures are also examined.

Options to Address Delayed Gastric Emptying in Gastroesophageal Reflux Disease

Abstract Gastroparesis is delayed gastric emptying (DGE) without evidence of mechanical outlet obstruction. Symptoms may include chronic nausea, emesis, abdominal pain, early satiety, and bloating. Causes are varied and symptoms can range from mild to debilitating. The latter may be refractory to conservative management with antiemetic and prokinetic medications. Gastroesophageal reflux disease is a failure of the antireflux barrier and is due to a defective lower esophageal sphincter (LES) with reduced pressure, transient LES relaxations, and impaired esophageal peristalsis. It is possible that DGE affects the occurrence of gastroesophageal reflux. This chapter reviews the relationship between the rate of gastric emptying and gastroesophageal reflux and possible surgical interventions for this complex combination.

Routine esophageal manometry is not useful in patients with normal videoesophagram

BackgroundVideoesophagram (VEG) and esophageal manometry (EM) are components of the preoperative evaluation for foregut surgery. EM is able to identify motility disorders and diminished contractility that may alter surgical planning. However, there are no clearly defined criteria to guide this. Reliable manometry is not always easily obtained, and therefore its necessity in routine preoperative evaluation is unclear. We hypothesized that if a patient has normal videoesophagram, manometry does not reveal clinically significant esophageal dysfunction.MethodsWe reviewed patients who underwent protocolized videoesophagram and manometry at our institution. Measures of esophageal motility including the mean distal contractile integral (DCI), mean wave amplitude (MWA), and percent of peristaltic swallows (PPS) were analyzed. The Chicago Classification was used for diagnostic criteria of motility disorders. Normal VEG was defined as stasis of liquid barium on less than three of five swallows.ResultsThere were 418 patients included. 231 patients (55%) had a normal VEG, and 187 patients (45%) had an abnormal VEG. In the normal VEG group, only 2/231 (0.9%) patients had both abnormal DCI and PPS, 1/231 (0.4%) patients had both abnormal DCI and MWA and no patients had both abnormal MWA and PPS. There were no patients with achalasia or absent contractility and 1 patient with ineffective esophageal motility (IEM) in the normal VEG group. This was significantly different from the abnormal VEG group which included 4 patients with achalasia, 1 with absent contractility and 22 with IEM (p < 0.0001). The negative predictive value of VEG was 99.6% and the sensitivity was 96.4%.ConclusionsA normal videoesophagram reliably excluded the presence of clinically significant esophageal dysmotility that would alter surgical planning. Routine manometry is not warranted in patients with normal videoesophagram, and should be reserved for patients with abnormal VEG.

Mo1107 Differences of LES Impedance Planimetry in Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Conversion From Gastric Banding to Sleeve Gastrectomy

Background:Among the extra-esophagealmanifestations of GERD, dental erosion is currently considered one of the most frequent. These dental erosions have a characteristic localization and may sometimes be the first symptom of the GERD. Wireless nasopharyngeal pH metry (ResTech pH probe) is a minimally invasive device for detection of oropharyngeal acid reflux.Aim: To ascertain whether adult patients with dental erosions (DE) have a higher incidence of reflux into the nasopharynx compared with controls using the ResTech phH probe.Materials and methods: A cross-sectional study was conducted among patients whom attend to the dental service at the Health Services Research Center in our institution. Dental erosion was classified by means of severity and anatomic location, according to the Eccles and Jenkins dental (0=no erosion present [control group];grade 1=loss of surface detail, with change confined to the enamel; grade 2=exposure of dentin affecting less than one third of the crown; and 3=exposure of dentin affecting one third or more of the crown). In all subjects eating habits and dental medical history (CPO index) was obtained and GERD symptoms were assessed using the GERD-Q questionnaire and the ISR index. In all subjects a Restech Dx-pH was performed and separate pH thresholds of 0.05). DE subjects had a higher prevalence of positive GERD-Q questionnaires (92% vs 42%, p=0.002) and also higher scores (45 vs 6, p=0.01). DE subjects had more number of reflux episodes at pH 5.0 and 4.5 compared to HC (p<0.05, Figure) . A positive correlation was found between the # of reflux episodes (pH 5.0 and 4.5) with the GERD-Q score (p=0.50 and 0.57). Conclusion: A relationship between DE and GERD was established by precise and accurate measurement of pH changes in the oral cavity using ResTech pH metry. This method could be an ideal tool for evaluation of GRED as cause of DE.