J.Jpn. Surg. Soc.. 104(9): 582-586, 2003

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Feature topic

SURGICAL TREATMENT FOR REFLUX ESOPHAGITIS

Recently, proton pump inhibitors and the laparoscopic Nissen operation were introduced clinically for the treatment of reflux esophagitis. Although the laparoscopic Nissen operation is becoming increasingly common world wide, medical therapy is still considered the treatment of choice for reflux esophagitis.
The indications for surgical treatment of reflux esophagitis are: 1) patients resistant to medical therapy, especially younger patients; 2) free reflux patients; 3) patients with shortened esophagus or stenosis; and 4) patients with respiratory complications.
The selection of surgical method is as follows: 1) the fundamentally laparoscopic Nissen procedure should be selected for relatively younger patients with good peristalsis in the esophageal body; 2) the laparoscopic Toupet method or the Dor method should be selected for patients with poor esophageal peristalsis; 3) the Tokai University method is suitable for patients with any condition: 4) the Collis-Nissen method, modified Deitel method, or Deitel-Nissen method is suitable for patients with acquired short esophagus; 5) resection and jejunal interposition or double tract reconstruction should be performed in patients with severe stenosis.
Numerous problems remain in the surgical treatment of reflux esophagitis.

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