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Esophageal Surgery

Minimally invasive fundoplication for GERD: the transoral esophagogastric approach

A cardiothoracic surgeon in New York, Dr. Darren Rohan has started a new minimally invasive program for reflux surgery (called fundoplication.)  With the transoral esophagogastric fundoplication  procedure, he can tighten the sphincter (valve) between the stomach and the esophagus by endoscopy (instead of laparoscopic surgery) to prevent acid from refluxing into the esophagus.  This is an important development in the treatment of gerd (gastroesophageal reflux disease) since the incidence of gerd is on the rise – due to obesity and this has led to an increase in esophageal cancer (as discussed in a previous post).

(Now, Dr. Rohan isn’t the first person to perform this procedure but I thought he’s be a great person to tell us more about it here at Cirugia de Torax, so I’ve written to him to request more information and to invite him to contribute a guest post.)

We also know that in addition to esophageal cancer (and Barrett’s esophagus) that reflux does more than destroy tooth enamel.  Work by researchers at Duke has linked reflux with problems with lung transplant recipients, and then to reactive airway disease itself.  While the degree of this relationship is not fully understood and is still debated – it is clear that there is a correlation to reflux disease and airway disease.  It has also been associated with aspiration pneumonia, particularly in patients on reflux suppressing medications.

I’ll be updating this story soon with more information.

Additional references and resources:

World J Gastrointest Endosc. 2010 Dec 16;2(12):388-96.  Gastroesophageal reflux disease: Important considerations for the older patients.  Chait MM.  (free full text).  This article talks about the range of complications and how elderly patients may present with more severe symptoms.
Saudi J Gastroenterol. 2010 Apr-Jun;16(2):84-9.  Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease.  Maher MM, Darwish AA.  9free full text).  An Egyptian study looking at the relationship between relux and lung disease.
This 2009 review of the literature, by Kumar and Gupta  out of India claims no association between reflux and asthma (but uses the effectiveness of acid suppressing medications in treating asthma as their proof of this theory – which is a faulty premise, in my opinion since these medications often don’t effectively treat reflux.)
More about the transoral esophagogastric fundaplication:
Surg Endosc. 2011 Jun;25(6):1975-84. Epub  2010 Dec 8.  Clinical and pH-metric outcomes of transoral esophagogastric fundoplication for the treatment of gastroesophageal reflux disease.  Bell RC, Freeman KD.  (Bell and Freeman also authored the article cited in the text above.)  Free full-text.
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