Benign Esophageal Disease. Modern Surgical Approaches and Techniques

Preface
Contents
Contributors
1: Gastroesophageal Reflux Disease: Workup and Evaluation
	General Considerations
	Clinical Findings
		Symptoms
			Clinical Evaluation
		Endoscopy
		Barium Swallow
		Esophageal Manometry
		Ambulatory pH Monitoring
		Gastric Emptying Study
	Differential Diagnosis
	Complications
	References
2: Endoscopic Therapies for GERD
	Introduction
	Transoral Incisionless Fundoplication (TIF)
	Muse
	Stretta
	Novel Procedures
	Conclusion
	References
3: Magnetic Sphincter Augmentation
	Introduction
	Design and Use
	Indications and Contraindications
	Early Research and Development
	Post-Market Experience and Long-Term Follow-Up
	Conclusion
	References
4: Surgical Therapy for GERD
	Introduction
	Symptomatology and Pathophysiology
		Gastroesophageal Junction (GEJ) Incompetence
		Increased Acid Production
		Impaired Esophageal Motility and Acid Clearance
		Obesity
	Sleeve Gastrectomy
	Preoperative Workup
	Surgical Interventions
		Fundoplication
	Esophageal Lengthening Procedures
	Laparoscopic Magnetic Sphincter Augmentation
	Gastric Bypass
	Electrical Lower Sphincter Augmentation (EndoStim)
	Reflux After Sleeve Gastrectomy
	References
5: Recurrence of Symptoms After Surgical Therapies
	References
6: Short Esophagus: Its Relationship with Fundoplication Failure and Postoperative Recurrence of the Hiatal Hernia
	History
	Pathophysiology
	Why Yes, Why No
	Evaluation and Diagnosis
	Anatomy
	Endoscopy
	Manometry
	Radiology
	Intraoperative Measurement
	Reported Incidence
	Post-fundoplication Failure: Technical Failure or Short Esophagus?
	Recurrence of Postoperative Hiatal Hernia: Is the Short Esophagus the Cause? Failure in the Dissection of the Sac and Mobilization of the Esophagus?
	Collis Gastroplasty: When to Indicate?
	References
7: Hiatal Hernia
	Classification
	Symptoms and Complications
		Evaluation
		Endoscopy
		Barium Swallow
		Esophageal Manometry
		pH Monitoring
		Computed Tomography
		Surgical Treatment
	Patient Positioning
	Trocar Placement
	Dissection of the Hernia Sac and Mobilization of the Esophagus
	Closure of the Diaphragmatic Crura
	Fundoplication
	References
8: Redo Antireflux Surgery
	Introduction
	Causes of Fundoplication Failure
	Early Failure
	Late Failure
	Presentation
	Workup
	Surgical Options and Techniques
		Redo-Fundoplication
			Technique
		Hiatal Hernia Repair with Mesh Reinforcement
		Collis Gastroplasty for the Short Esophagus
		Diaphragmatic Relaxing Incision
		Roux-en-Y Gastrojejunostomy
			Technique
		Minimally Invasive Esophagectomy
			Technique
		Reoperative Antireflux Surgery After Prior Transoral Incisionless Fundoplication
		Reoperation After Failed Magnetic Sphincter Augmentation
		Outcomes
	References
9: Motility Disorders: Workup and Evaluation
	Introduction
	Achalasia
		Symptoms
		Diagnosis
	Esophagogastric Junction Outflow Obstruction (EGJO)
		Symptoms
		Diagnosis
	Diffuse Esophageal Spasm (DES)
		Symptoms
		Diagnosis
	Jackhammer Esophagus (JHE)
		Diagnosis
		Symptoms
	Absent Contractility
	Minor Disorders of Peristalsis
		Provocative Tests
		Postsurgical Assessments
	References
10: Motility Disorders: Medical Modalities
	Motility Disorders and High-Resolution Manometry
	Major Disorders of Peristalsis
		Achalasia
		Esophagogastric Junction Outflow Obstruction
		Hypercontractile Esophagus
		Distal Esophageal Spasm
		Absent Contractility
	Minor Disorders of Peristalsis
		Ineffective Esophageal Motility
		Fragmented Peristalsis
	References
11: Esophageal Motility Disorders
	Overview
	History
	Initial Workup and Diagnosis
		History and Physical Exam
	Initial Testing
		Upper GI Fluoroscopy
		EGD
		Manometry
	Differential of Dysmotility Syndromes
		Achalasia
		Chagas Disease
		Systemic Sclerosis (Scleroderma)
		Other Spastic Disorders of the Esophagus
	Pharmacological Treatment
	Endoscopic Treatment for Achalasia
	Surgical Treatment for Achalasia
	Peroral Endoscopic Myotomy
	Recurrent Dysphagia
	Total Esophagectomy
	Conclusion
	References
12: The Endoscopic Treatment of Esophageal Motility Disorders
	Introduction
	Botulinum Toxin (BTx) Injection
	Pneumatic Dilation
	Peroral Endoscopic Myotomy (POEM)
	Treatment Options According to the HRM
	References
13: Redo Interventions in Failed Procedures
	Introduction
	Rates of Motility Treatment Failure
	Symptoms of Motility Treatment Failure
	Reasons for Motility Treatment Failure
		Incorrect Indication for Initial Surgery
		Primary Surgical Failure
		Incomplete Myotomy
		Gastroesophageal Reflux Disease (GERD)
		Failed Fundoplication
		Ineffective Esophageal Motility/Pan-Aperistalsis
		Esophageal Cancer Development
		Other Causes of Treatment Failure
	Patient Workup
		Upper Gastrointestinal Series (UGI) +/− Barium Tablet
		Esophagogastroduodenoscopy (EGD)
		High-Resolution Manometry (HRM)
		pH/Impedance
		Gastric Emptying Study (GES)
	Medical Treatments
	Pneumatic Dilation (PD)
	Revision of the Index Operation
		Redo Heller Myotomy
		Redo POEM
		Redo Fundoplication
	Conversion to Alternate Surgical Procedure
		Conversion from LHM to POEM
		Conversion from POEM to Heller Myotomy
		Creation of a New Fundoplication
		Esophagectomy
	Robotics
	Conclusion
	References
14: Diverticulum: Workup and Evaluation
	Introduction
	Clinical Presentation
		Zenker Diverticulum
		Midthoracic Diverticulum
		Epiphrenic Diverticulum
		Intramural Pseudodiverticulosis
	Evaluation
		Zenker Diverticulum
		Midthoracic Diverticulum
		Epiphrenic Diverticulum
		Intramural Pseudodiverticulosis
	Conclusions
	References
15: Esophageal Diverticula
	Introduction
	Incidence of Esophageal Diverticula
	Pathophysiology of Hypopharyngeal Diverticula
	Symptoms of Hypopharyngeal Diverticula
	Diagnosis of Hypopharyngeal Diverticula
	Treatment of Hypopharyngeal Diverticula and Defining Treatment Success
	Historical Perspectives on Surgical Management of Hypopharyngeal Diverticula
		Open Surgical Approaches for Hypopharyngeal Diverticula
			Open Hypopharyngeal Diverticulectomy
			Open Hypopharyngeal Diverticulopexy
			Open Hypopharyngeal Diverticular Invagination
			Open Cricopharyngeal Myotomy
			Open Combination Procedures: Cricopharyngeal Myotomy with Other Open Techniques
		Transoral Surgical Approaches for Hypopharyngeal Diverticula
			Transoral Hypopharyngeal Diverticulotomy
			Transoral Hypopharyngeal Diverticulotomy with Thermal Devices
			Transoral Stapled Hypopharyngeal Diverticulotomy
			Transoral Flexible Endoscopic Hypopharyngeal Diverticulotomy
			Transoral Flexible Endoscopic Submucosal Approach Hypopharyngeal Diverticula
	Preoperative Assessment
	Postoperative Care
	Contemporary Surgical Techniques to Hypopharyngeal Diverticula: Open Approach to Hypopharyngeal Diverticula
		Rigid Transoral Approach to Hypopharyngeal Diverticula
		Flexible Endoscopic Approach to Hypopharyngeal Diverticula
	Non-Zenker’s Diverticula of the Esophagus
		Mid-Esophageal Diverticula
			Symptoms of Mid-Esophageal Diverticula
			Diagnosis of Mid-Esophageal Diverticula
			Surgical Treatment of Mid-Esophageal Diverticula
		Intramural Pseudodiverticula of the Esophagus
		Epiphrenic Diverticula of the Esophagus
			Symptoms of Epiphrenic Diverticula
			Diagnosis of Epiphrenic Diverticula
			Surgical Treatment of Epiphrenic Diverticula
			Emerging Transoral Endoscopic Treatment of Epiphrenic Diverticula
	Conclusions
	References
16: Surgical Techniques for Lower Esophageal Diverticula
	Introduction
	Surgical Treatment
		Laparoscopic Approach
		Thoracoscopic Approach
		Robotic Approach
	Postoperative Care
	Conclusion
	References
17: Medical Evaluation of Barrett’s Esophagus
	Introduction
	Definition
	Risk Factors
	Medical Treatment and Surveillance
	Conclusion
	References
18: Ablative Therapies in Barrett’s Esophagus
	Introduction
	Epidemiology of Barrett’s Esophagus
	Risk Factors
		Gastroesophageal Reflux Disease
	Management
	Endoscopic Ablative Therapies
		Radiofrequency Ablation
		Cryotherapy
		Argon Plasma Coagulation (APC)
	Conclusion
	References
19: Endoscopic Mucosal Resection
	Background
	Indications
	Pre-procedural Preparation
	Techniques
	Ligation-Assisted EMR
	Injection-Assisted EMR
	Advantages of EMR
	Limitations of EMR
	Post-procedural Considerations
	Complications
	Oncologic Efficacy
	Conclusion
	References
20: Surgical Management of Esophageal Strictures After Caustic Ingestion
	Introduction
	Clinical Presentation
	Diagnosis
	Initial Management of Corrosive Ingestion
		Neutralizing Agents
		Nasogastric Tube and Gastric Acid Suppression
		Antibiotics
		Triamcinolone and Mitomycin-C
		Systemic Steroids
		Endoscopy
	Surgical Management of Esophageal Stricture
	Ivor Lewis Esophagectomy
	Procedure Steps: Minimally Invasive
		Abdominal Portion
		Thoracic Portion
	McKeown Esophagectomy
	Procedure Steps
	Transhiatal Esophagectomy
	Procedure Steps
	Conclusion
	References
21: Endoscopic Management of Esophageal Perforations
	Introduction
	Etiology
	Location
	Signs and Symptoms
	Diagnosis
	Treatment and Outcomes
	Endoscopy Versus Surgery
	Endoscopic Techniques
	Clips
	Stents
	Endoluminal Vacuum Therapy
	References
22: Surgical Treatment of Esophageal Perforation
	Introduction
	Etiology
	Diagnosis
	Principles of Surgical Management
		Perforations of the Cervical Esophagus
		Perforations of the Thoracic Esophagus
		Perforations of the Abdominal Esophagus
		Postoperative Care
		Alternatives to Surgical Repair
	Summary
	References
Index