1. State of Israel ministry of health Netanya geriatric center (Netanya, Israel)

Keywords:gastroesophageal reflux disease,lower esophageal sphincter,operation,plication,cardia,scheme

Abstract:Surgical treatment of gastroesophageal reflux disease (GERD) is performed in cases where severe symptoms cannot be controlled by conservative methods. Laparoscopic Nissen Fundoplication (LNF) has become the gold standard surgical procedure for management of GERD, which causes a narrowing of the gastroesophageal junction. Several modifications have been proposed to original technique since the results of LNF are not always as good as expected. Often it is not a complicated operation transformed into the kit of manipulations. The relapses ranging from 0.98 % to 42 %. The aims article to substantiate the new tactics of treatment of the GERD. Theoretical foundations: 1) manometric and radiological studies have shown that the failure of the lower esophageal sphincter (LES) is attributable of the weakness of its intra-abdominal portion (2.1 cm from 3.5 cm); 2in the previous study we have shown that in the patients with GERD the LES is not displaced; 3) it was found that the surgical plication of the external anal sphincter and puborectalis muscle increases its sarcomere length and increases anal canal pressure that can be true also for the LES. Conclusion. The scheme of the surgical plication of the intraabdominal part of the LES is offered. This procedure leads to a mechanical narrowing of the cardia, to the narrowing of the LES ring, as well as increases its wall thickness, which implies the ability to restore of its antireflux function.

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Full text is published :
Levin M.D. THE THEORETICAL JUSTIFICATION OF A NEW SURGICAL TECHNIQUE IN GASTROESOPHAGEAL REFLUX DISEASE. RESTORATION FUNCTION OF THE LOWER ESOPHAGEAL SPHINCTER (CARDIOPLICATION). Experimental and Clinical Gastroenterology Journal. 2017;141(05):65-69
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