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Focus On Esophagogastric Surgery!

Epublication, Nov 2015;15(11). URL: http://websurg.com/doi/fc01en11
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Расположение: Список Таблица
When and how to manage esophageal diverticula: surgical and endoscopic procedures
Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), mid-esophagus, or distally (epiphrenic). Most patients with diverticula are asymptomatic. Fewer than one-third of the diverticula produce symptoms severe enough to seek medical attention or to warrant surgery.
Surgical treatment has changed significantly with the development of minimally invasive methods which have increasingly replaced open surgery. If certain indications persist for open surgery, Zenker’s diverticulum is mainly treated with transoral endoscopic flexible or rigid techniques. This approach, which consists of a marsupialization of the diverticulum, also treats the concomitant motor disorder. These esophageal motor disorders are also present in the vast majority of patients with mid-esophageal or epiphrenic diverticula. These diseases are also treated mainly using a minimally invasive approach which consists of a diverticulectomy associated with an esophageal myotomy, which is widely recommended.
B Dallemagne
Лекции
3 лет назад
780 просмотров
28 лайков
0 комментариев
24:26
When and how to manage esophageal diverticula: surgical and endoscopic procedures
Esophageal diverticula are rare. They may occur in the pharyngoesophageal area (Zenker's), mid-esophagus, or distally (epiphrenic). Most patients with diverticula are asymptomatic. Fewer than one-third of the diverticula produce symptoms severe enough to seek medical attention or to warrant surgery.
Surgical treatment has changed significantly with the development of minimally invasive methods which have increasingly replaced open surgery. If certain indications persist for open surgery, Zenker’s diverticulum is mainly treated with transoral endoscopic flexible or rigid techniques. This approach, which consists of a marsupialization of the diverticulum, also treats the concomitant motor disorder. These esophageal motor disorders are also present in the vast majority of patients with mid-esophageal or epiphrenic diverticula. These diseases are also treated mainly using a minimally invasive approach which consists of a diverticulectomy associated with an esophageal myotomy, which is widely recommended.
Gastric GIST: minimally invasive surgical modalities
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and the stomach is the most frequent location (50-60%). Gastric GIST presents as a submucosal tumor and is often found incidentally. Submucosal tumors greater than 2cm are indicated for resection. Indication for laparoscopic surgery is not strictly determined by the size, but whether surgery can follow resection principles, 1) R0 resection with histologically negative margins, 2) all efforts are made to prevent tumor rupture. Wedge resection using a linear stapler, also called “exogastric resection” is effective in most cases. However, the operator should pay attention to align the direction of the linear stapler “transversely” to the long axis of the stomach, otherwise it can cause gastric lumen narrowing after resection, especially in case of a relatively large tumor with endophytical growth. Endoscopy is very useful to identify and define tumor resection margins for endophytic tumor, and the “eversion” technique is one option to reduce the amount of normal mucosa resection. GIST cases located at the posterior wall of the upper stomach are technically challenging, and transgastric or intragastric techniques are suggested as good surgical options for such tumors. Laparoscopic or endoscopic “coring out” techniques can be dangerous, because of the high risk of tumor rupture and gastric wall perforation, which can cause peritoneal seeding when both take place simultaneously.
SH Kong
Лекции
3 лет назад
1983 просмотров
116 лайков
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22:10
Gastric GIST: minimally invasive surgical modalities
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and the stomach is the most frequent location (50-60%). Gastric GIST presents as a submucosal tumor and is often found incidentally. Submucosal tumors greater than 2cm are indicated for resection. Indication for laparoscopic surgery is not strictly determined by the size, but whether surgery can follow resection principles, 1) R0 resection with histologically negative margins, 2) all efforts are made to prevent tumor rupture. Wedge resection using a linear stapler, also called “exogastric resection” is effective in most cases. However, the operator should pay attention to align the direction of the linear stapler “transversely” to the long axis of the stomach, otherwise it can cause gastric lumen narrowing after resection, especially in case of a relatively large tumor with endophytical growth. Endoscopy is very useful to identify and define tumor resection margins for endophytic tumor, and the “eversion” technique is one option to reduce the amount of normal mucosa resection. GIST cases located at the posterior wall of the upper stomach are technically challenging, and transgastric or intragastric techniques are suggested as good surgical options for such tumors. Laparoscopic or endoscopic “coring out” techniques can be dangerous, because of the high risk of tumor rupture and gastric wall perforation, which can cause peritoneal seeding when both take place simultaneously.