Technical Surgical Failures Presentation Etiology and Evaluation

Carrie A. Sims and David W. Rattner

Approximately 48,000 patients undergo antireflux procedures each year in the United States. Although surgery is the most effective treatment for gastroesophageal reflux disease (GERD),anti-reflux operations have reported failure rates between 3-30%. This wide variability reflects differences in operative technique,differences in the length of reported follow-up, and differences in the definitions used to describe failure. For the purposes of this chapter, failure is defined as the development of recurrent or new symptoms after anti-reflux surgery combined with documented pathologic gastroesophageal reflux or anatomic failure. Failures occurring within the first 3 months of surgery are termed early failures and are generally caused by technical errors. Diaphragmatic stressors such as coughing,straining,vom-iting,retching,and weight lifting increase the risk of recurrence, especially in the early postoperative period. When failures occur after 3 months, they are termed late failures and a combination of factors may be responsible. The size of the original hiatal hernia, increased intraabdominal pressure,the presence of Barrett's esophagus,and the use of steroids predispose to late failures. This chapter will discuss the evaluation and management of failed fundoplications.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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