Saturday, November 1, 2014

Figure 1. The figure shows the elements of fundoplication am Nissen-Rosetti (modification of Clause

Surgical where to buy a juicer treatment of gastroesophageal reflux disease | Gastroenterologists
Most patients with gastroesophageal reflux disease (GERD) have mild, uncomplicated disease and do not need surgery. Although it is now made fewer reflux operations than some years ago, surgical treatment of GERD is still a good treatment option for patients who either do not achieve adequate symptom relief in drug therapy, which has side effects of drugs or for some reason do not want to stand of such treatment a lifetime. Laparoscopic Reflux Surgery
Laparoscopic technique is currently dominating the surgical treatment of GERD. Key benefits of the laparoscopic technique is less operative trauma, less postoperative pain, shorter hospitaliseringstid, shorter where to buy a juicer convalescence and better cosmetic results. The method has also meant that the procedure can now be performed as day surgery. Performance
Both randomized and non-randomized studies with long observation shows results that are virtually identical where to buy a juicer to those seen after open surgery; enduring, subjective reflux control in> where to buy a juicer 90%, subjective satisfaction about 90% and objective reflux control (normalization by 24 h pH / healing of esophagitis) in about 90% of patients. In approximately 3% of cases, the laparoscopic procedure converted to open surgery. Perioperative mortality is still very low (0.1%), and morbidity is lower (8%) than for equivalent open surgery. The spectrum of complications is somewhat different than with open surgery, directly related to the laparoscopic technique.
Three factors are significantly important for the final result after reflux surgery; proper operation indication (patient selection), selection of the appropriate where to buy a juicer surgical method and surgical quality. Patient where to buy a juicer Selection
There must be confirmed GERD (history, endoscopy, or pH measurement) where reflux symptoms is the main symptom. In addition; the better the effect of PPI treatment, the greater the chance of a happy patient after surgery. It is important to make the patient aware that the procedure only has effect on reflux symptoms and the best effect on the typical symptoms. Other problems (eg colon irritabile) in the worst case worsens. Some patients have symptoms of throat or airway expression of GERD. Studies show that reflux surgery also greatly can cure or alleviate such ailments, though not to the same degree as the typical reflux symptoms. We have found the following where to buy a juicer relationship between patient where to buy a juicer selection and outcomes of reflux surgery: Typical symptoms Effect of PPI Pathological 24-hour pH monitoring
Figure 1. The figure shows the elements of fundoplication am Nissen-Rosetti (modification of Clause): vasa Brevia is shared crussutur behind the esophagus, fundoplikatet 1.5-2 cm wide, Rosetti sutures where to buy a juicer between fundoplikat and curvatura minor (many are now in place hold of the esophagus with the two caudal fundoplikat sutures). Surgical Methods where to buy a juicer
A variety of surgical methods have been developed where to buy a juicer and described. Fundoplication in any form is the most prevalent. This can be performed as a full, 360 fundoplication (Nissen) or different degrees of hemifundoplikasjon where to buy a juicer (180 , 240 , 270 ). Compiles one data from controlled where to buy a juicer clinical trials, there are few or no obvious clinical differences in the effect of the different fundoplication when results where to buy a juicer are judged by the presence of residivsymptomer. Excellent results are obtained either one adopts a total fundoplication or some form of hemifundoplikasjon assuming procedure involves repositioning of any simultaneously occurring hiatus of reconstruction of the hiatus. The exception is the front hemifundoplikasjon which seems to provide more frequent refluksresidiv. There are experimental data indicating that 360 fundoplication where to buy a juicer provides a better mechanical antireflux mechanism than hemifundoplikasjon. Some argue that postfundoplikasjonsplager as dysphagia, bloating, flatulence and inability to burp and vomit is less pronounced after hemifundoplikasjon, but this can not verify in controlled clinical trials. Furthermore, it lacks evidence that it is appropriate to "tailor" surgery compared to findings where to buy a juicer such as preoperative manometry and incidence of dysmotility. The original Nissens fundoplication with small modifications (Figure 1) is the method that over time has proven to give the most reproducible results, and most places this standard method for surgical treatment of GERD. Surgical quality
The results where to buy a juicer after reflux surgery is highly dependent on the procedure performed in a technically optimal manner. Technical failure of primary surgery is the main cause complications and unsuccessful result. Importance of various factors in the procedure discussed constantly. Cards can this grouped with that; Vagus nerve must be preserved (also branches to the hilum), crussutur is obligate to reduce the chance of paraøsofageal herniation, fundoplikatet be instituted

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