Heartburn? Regurgitation of acid? Pain when swallowing and dysphagia?
Your are not alone. 36-77% of the population have experienced it. 7% have daily, 14-20% have weekly and 15-50% have monthly heartburn symptoms. The Esophagus is the superhighway of the gastrointestinal system through the stomach and to the abdominal organs.
As the esophagus winds down to the stomach, it passes through the muscular and fibrous diaphragm. Sometimes these muscles get too lax (obesity?) and the stomach slips through the diaphragm. If surgery is advised for such a hiatel hernia, a Nissen Fundoplication (complete 360 degree wrap) or a Toupet Fundoplication (incomplete 270 degree wrap) of the stomach around the esophagus is done.
However, the reflux esophagitis can also lead to heart burn; long standing inflammation and scarring can lead to Barrett’s esophagus. The scars can lead to structures and that is when food can become stuck in your throat. Chronic prescription acid-controlling medication therapy is very expensive and the arrival of a one-time, no scar procedure might provide similar symptom relief.
The current minimally invasive treatment is laparoscopic fundoplication and uses a rigid scope on a stick with a camara, a video screen, as well as cannulas and 5, 1/2 inch incisions for the small shaft instruments. Most patients leave the hospital the day after surgery.
Flexible endoscopic suturing with a small, mechanical suture replacement device attached to the scope could tighten the top of the stomach and therefore reduce acid reflux. The Bard Endocinch endoscopic treatment requires two endoscopes and an overtube. One endoscope carries the metal sewing capsule offset and attached to the endoscope tip.
The second endoscope allows “cinching” of the sutures by means of a catheter device which deploys a ceramic plug and ring through which the sutures are threaded. Creating two to three plications” arranged side-by-side (circumferentially) and/or in a row one above the other (longitudinally) accomplishes the task.
These achievements of laparoscopic and endoscopic GERD treatment have been reevaluated and refined with the thought of hybrid laparoscopic endoscopic treatment techniques. New developments or new technical equipment will evolve soon in order to re-address indications in regards to tightening the lax open end of the cardia horseshoe within the lesser curve, creating a barrier (speed bump) within the lesser curve at the level of the cardia, altering the angle of His by accentuating it or altering the angle of His by lengthening it.
Further – the future ain’t what it used be.
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