bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS01.055: LAPAROSCOPIC NISSEN FUNDOPLICATION IN GERD: SINGLE INSTITUTIONAL EXPERIENCE IN KOREA
Authors: Hyun Kim Chang , Kim Jin-Jo 
Published: September 2018

Abstract

Background
The aim of this study is to analyze our experience with laparoscopic Nissen fundoplication.

Methods
We retrospectively collected data from 42 patients who diagnosed with GERD underwent laparoscopic Nissen fundoplication between January 2010 and December 2017

Results
There were 23 male and 19 female with an average age of 41.1 ± 15.9. Typical symptoms were present in 39 (85.7%) and atypical symptoms in 36 (%). Both typical and atypical symptoms were present in 34 of patients (81.0%). Fourteen patients (33.3%) had poor PPI responses. Preoperative studies showed hiatal hernias in 19 patients (45.2%), Barrett's esophagus in 6 (14.2%), and reflux esophagitis in 21 (50.0%). Mean DeMeester score was 9.1 ± 14.2, mean operation time 78.8 ± 28.1 minutes. There was no perioperative complication. However there was only one redo-operation case due to severe tightness of fundal wrap formation. At 3 months after surgery, typical symptoms were completely controlled in 23 patients (59.0%), partially improved in 12 patients (30.8%), and not controlled in 4 patients (10.1%) and atypical symptoms were completely controlled in 22 patients (61.1%), partially improved in 12 patients (33.3%), and not controlled in 2 patients (5.6%)

Conclusion
In our study, complete remission rates of typical and atypical symptoms were 59.0% and 61.1%, respectively after laparoscopic Nissen fundoplication. Laparoscopic Nissen fundoplication is an effective treatment method of controlling the symptoms of GERD.

Disclosure
All authors have declared no conflicts of interest.
PS01.059: REFLUX RELATED SYMPTOMS ARE LESS COMMON IN SOUTH-EAST HUNGARIAN SUBJECTS, THAN EXPECTED ON THE BASIS OF EPIDEMIOLOGIC STUDIES OF THE WESTERN COUNTRIES
Authors: Helle Krisztina , Bálint Lenke , Ollé Georgina , Vadászi Klára , Inczefi Orsolya , Róka Richárd , Szekeres Veronika , Wittmann Tibor , Rosztoczy Andras 
Published: September 2018

Abstract

Background
Most population based epidemiologic studies indicate approximately 20% prevalence of Gastroesophageal Reflux (GER) related typical symptoms appearing at least monthly. Since most of these works were carried out in the western countries, a little is known about Central-Europe, where substantial part of the population still lives outside of the larger cities.
The aim of the study was to obtain population-based data on the prevalence of GER related symptoms in South-East Hungary.

Methods
Two thousand and two consecutive blood donor volunteers (M/F: 1156/846, mean age: 39 (17–66) years) were enrolled. Data collection was carried out by means of a questionnaire. Typical (heartburn, regurgitation) and atypical (esophageal, extraesophageal) symptoms were assessed.

Results
Typical symptoms of GER such as heartburn and acidic regurgitation were reported by 22% (450/2002) and 17% (333/2002) of the studied healthy subjects. The 63% and 51% of them had such symptoms less than once per month. Monthly heartburn episodes were reported by 14, and weekly by 6 percent of the cases, while acidic regurgitation occurred in 8 and 3 percent respectively. Of the atypical (esophageal and extraesophageal) symptoms upper airway symptoms were the most prevalent (19%), although only 13% had such symptom at least monthly. Globus occurred in 6%, while other atypical symptoms were reported by less than 5% of the subjects. Typical GER symptoms occurred more frequently in females, coffee drinkers and subjects with moderate obesity. Current and former smoking and alcohol-use were associated with increased GER symptom prevalence.

Conclusion
In contrast to the studies carried out in the western countries South-East Hungarian subjects seem to have less GER related symptoms.

Disclosure
All authors have declared no conflicts of interest.
PS01.065: MAGNETIC SPHINCTER AUGMENTATION AS AN EFFECTIVE ALTERNATIVE TO ROUX-EN-Y CONVERSION AFTER BILLROTH II GASTRECTOMY
Authors: Lazzari Veronica , Asti Emanuele , Sironi Andrea , Melloni Matteo , Bonavina Luigi 
Published: September 2018

Abstract

Background
Background and hypothesis Conversion into a 60 cm Roux-en-Y jejunal loop is the most common remedial procedure in patients with gastroesophageal reflux after Billroth II gastrectomy. While this allows diversion of bilio-pancreatic secretions, symptomatic acid reflux may persist in the presence of a mechanically incompetent lower esophageal sphincter. We hypothesized that magnetic sphincter augmentation (MSA) may relieve symptoms and control esophagitis by reducing both acid and biliary reflux.

Methods
Methods A 70 year-old male patient presented with intractable reflux symptoms and grade B esophagitis 46 years after partial gastrectomy and Billroth II reconstruction for perforated gastric ulcer. The patient underwent extensive diagnostic evaluation. There was a 3 cm hiatus hernia, grade B esophagitis, and hyperemia of the gastrojejunal anastomosis. Biopsies were negative for malignancy and Helicobacter Pylori. pH-impedance testing showed combined acid and non-acid reflux; esophageal peristalsis was normal on high-resolution manometry. After informed consent, the patient preferred the option of laparoscopic MSA versus open laparotomy and Roux-en-Y conversion. Pneumoperitoneum was established with a Hasson trocar. After adhesiolysis, a hiatus hernia with retroesophageal lipoma was identified. The gastroesophageal junction was completely reduced in the abdominal cavity and a posterior crural repair was performed. A tunnel was made between the esophageal wall and the posterior vagus nerve and a no. 16 MSA (Linx®) device was applied.

Results
Results The postoperative course was uneventful and the patient was discharged home on postoperative day one. At 1- and 6-month follow-up visit the patient was off-medication, tolerated a free diet, and did not complain of any reflux symptom. The mean GERD-HRQL score decreased from 26 to 2 compared to baseline. A barium swallow confirmed the complete reduction of the hiatal hernia and the absence of reflux in the Trendelenburg position. Esophagitis was completely healed.

Conclusion
Conclusions To the best of our knowledge, this is the first case of MSA implant for refractory gastroesophageal reflux disease after Billroth II gastrectomy. This simple laparoscopic procedure allowed correction of both acid and biliary reflux.

Disclosure
All authors have declared no conflicts of interest.
PS01.072: IT IS NOT ALWAYS RISKY USING MESH IN THE TREATMENT OF HIATAL HERNIA
Authors: Loviscek Maximiliano , Acosta Mauro , Crespin Oscar , Orbe Guido , Villamil Cesar , Loviscek Luis 
Published: September 2018

Abstract

Background
Many studies have shown that the importance of using mesh for paraesophageal hernia repair (PEHR) is to prevent recurrence. Unfortunately, it is associated with high risk of complications such as esophageal or gastric erosion. The aim of this study is to report the results of 38 patients who underwent laparoscopic PEHR with the use of a BioSynthetic mesh (GoreÒ Bio AÒ tissue Reinforcement.USA).

Methods
Observational, retrospective, single-center cohort study. We analysed retrospectively 38 consecutive patients with diagnosis of symptomatic Hiatal Hernia (HH) treated laparoscopically with an absorbable BioSynthetic mesh, between 2011–2017. The classic radiologic classification was used to classify the HH before surgery. This classification consists in four types/stages (I-IV). I: Sliding HH, II: Paraesophageal HH, III: Mixed form and IV: Intrathoracic stomach—upside-down hernia. All patients with Type III—IV hiatal hernia who underwent laparoscopic PEHR using an absorbable BioSynthetic mesh were included. We evaluated the results after PEHR with a symptoms questionnaire using a score 0–4 (Likert scale) and with an esophagogram and an esophagogastroduodenoscopy (EGD) analyzing the surgical success. Success was considered with symptomatic score improvement and/or absence of any symptomatic HH at the esophagogram and/or EGD.

Results
38 patients: 7 males and 31 women. Median age: 66 (range 40–71). 12/38 (31,6%) patients had a type III HH and 26/38 (68,4%) a type IV. All these patients had been treated with a laparoscopic PEHR, using an absorbable BioSynthetic mesh as a reinforcement of the crura and Nissen fundoplication. The median follow-up was 12 months. 16/38 (42%) had a follow-up > 24 months. Success was evident in 95% of the patients. We observed 2 recurrences, one with a symptomatic type I HH and the other with an early type III HH recurrence.

Conclusion
The use of an absorbable synthetic mesh as a reinforcement of the crura in the treatment of the PEH has encouraging good results in the mild term follow up, with an extremely low incidence of complications.

Disclosure
All authors have declared no conflicts of interest.
PS01.075: EUS-GUIDED TRANS-ESOPHAGEAL DRAINAGE OF A MEDIASTINAL ABSCESS DURING PREOPERATIVE CHEMOTHERAPY FOR THORACIC ESOPHAGEAL CANCER
Authors: Sakon Ryota , Tachimori Yuji 
Published: September 2018

Abstract

Background
A Mediastinal abscess can cause sepsis and make a patient sever condition. Early drainage treatment is required. We report a case which EUS-guided drainage was effective for a mediastinal abscess.

Methods
A 75-year-old man with T3 upper thoracic esophageal squamous cell carcinoma received preoperative chemotherapy. On day 9 the patient had fever and nuchal swelling. CT scan revealed a mediastinal abscess adjacent to the upper esophagus and the right paratracheal region extending to a retropharyngeal abscess. There was no clinical improvement with antibiotic therapy. On day 12 EUS-guided trans-esophageal drainage for the mediastinal abscess was performed.

Results
The echoendoscope was positioned within the upper esophagus, and the mediastinal collection was well visualized endosonographically. The mediastinal abscess was punctured and a pigtail catheter was placed. The retropharyngeal abscess was drainaged by pharyngeal incision. A repeated CT scan confirmed resolution of the abscess. On day 25 upper endoscopy was performed to remove the pigtail catheter. A small perforated hall was identified in the center of the esophageal tumor decreased after chemotherapy. The patients underwent esophagectomy after recovery.

Conclusion
EUS-guided trans-esophageal drainage was useful for a mediastinal abscess.

Disclosure
All authors have declared no conflicts of interest.
PS01.079: OF BARRIERS AND BALLOONS- SURGICAL MANAGEMENT OF ESOPHAGEAL IATROGENIC INJURIES USING PRIMARY REPAIR WITH A ROTATION DIAPHRAGMATIC FLAP: A SERIES FROM OMAN
Authors: Almehdi Raad , Al Riyami Salim , Rabie Reda 
Published: September 2018

Abstract

Background
Background Iatrogenic injuries of the Esophagus remain a challenging turf to dwell upon. Although the timing of surgical intervention, when indicated, may be controlled and hence is more favourable than other types of uncontrolled traumas, however the patient's pre-morbid state as well as the Esophagus’ presenting condition at the time of injury may confound the desired outcome. The Royal Hospital of Muscat is the biggest tertiary centre in Oman. The Upper GI surgical unit was established in 2010. In this small series, we highlight the valuable role of rotational diaphragmatic flaps in perforations of the lower Esophagus.

Methods
A case series of 4 patients presenting with iatrogenic esophageal injuries, who underwent primary repair with a rotation flap between 2012 and 2016.

Results
All patients had iatrogenic lower esophageal tears. The first was from an over inflated balloon of a calibrating tube, misplaced in the esophagus during a standard Sleeve Gastrectomy for Obesity. The second was an intraoperative perforation during a Thoracic surgical procedure for a duplication cyst. The third was a complication of an endovascular stent for a dissecting thoracic aorta aneurysm. The fourth was due to covered stent placed to seal a small perforation following variceal injection in a patient with Child's B liver cirrhosis. The average tear length was 3cms. All were operated within 48hours, before full sepsis had set in. The extent of contamination was localised and its degree minimal to moderate. All underwent a primary repair with a diaphragmatic rotation flap used as a second cover layer. Postoperative fluoroscopy showed intact surgical repair with good flow of contrast. The first three patients were discharged after an average of 12 days. The fourth succumbed to his liver failure and expired after two months in hospital.

Conclusion
Primary repair of iatrogenic lower esophageal injuries, when done early, could be consolidated with reasonable success using a diaphragmatic rotation flap. The flap's length is fashioned as required on a well vascularised pedicle. In comparison to other supportive techniques this flap is more flexible and its tissue more enduring as a good repair harness.

Disclosure
All authors have declared no conflicts of interest.
PS01.080: A CASE REPORT OF JEJUNAL VARICEAL BLEEDING SUCCESSFULLY TREATED WITH PERCUTANEOUS TRANSHEPATIC OBLITERATION AFTER SURGERY OF ESOPHAGOGASTRIC JUNCTIONAL CARCINOMA
Authors: Kawabata Ryohei , Shinno Naoki , Furukawa Haruna , Goda Seiichi , Noura Shingo , Shimizu Junzo , Hasegawa Junichi 
Published: September 2018

Abstract

Background
Varicose veins in the esophagogastric junction rarely occur after surgery of esophagogastric junctional carcinoma, because the collateral pathway of the left gastric vein and short gastric vein was sacrificed. We presented a case of jejunal variceal bleeding successfully treated with percutaneous transhepatic obliteration after surgery of esophagogastric junctional carcinoma.

Methods
Case report.

Results
A 50-year-old man with alcoholic liver cirrhosis (Child-B) was admitted for abdominal pain, three months after proximal gastrectomy for esophagogastric junctional carcinoma. After diagnosed with peritonitis due to jejunal perforation, emergency surgery was performed. The next day after surgery, he had developed a lot of black stool. Gastroduodenoscopy revealed the variceal bleeding at the anal side of the esophagojejunal anastomois. Although endoscopic clipping was performed, intermittent bleeding was observed for several days. Since the contrast-enhanced computed tomography scanning revealed jejunal vein dilation at the anal side of the esophagojejunal anastomois, we planned to perform percutaneous transhepatic obliteration. Percutaneous transhepatic portography revealed jejunal varices and drained to the inferior vena cava, and continuously obliterated by 5% EOI (Ethanolamine oleate iopamidol). He was discharged without re-bleeding on the 14th day after the obliteration.

Conclusion
Percutaneous transhepatic obliteration might be a useful treatment option for jejunal variceal bleeding after surgery of esophagogastric junctional carcinoma.

Disclosure
All authors have declared no conflicts of interest.
PS01.081: ENDOVAC IS A SAFE AND RELIABLE METHOD FOR INTRACTABLE ESOPHAGEAL PERFORATION
Authors: Kim Dohun , Nam Seunghyuk 
Published: September 2018

Abstract

Background
Esophageal rupture or sometimes, leak is a fatal disease. However management of esophageal perforation is not simple and invasive procedures are required especially in the case of delayed diagnosis. EndoVAC (endo-luminal vacuum assisted closure) is known as an effective method for esophageal leak or ruptures but it was not clear enough. We report cases of esophageal perforation which are treated with endoVAC to prove its utility.

Methods
All patients with esophageal perforation whether causes of them are traumatic or iatrogenic were included in the study from 2012 to 2018. EndoVAC was applied in all cases. Electrical medical records were analyzed including surgical information and special procedures for perforation. Primary results were length of stay and duration of endoVAC.

Results
During the study period, 9 patients were managed for esophageal perforation. 3 patients were cured with primary closure and 1 patient with stent alone. At last 5 patients were included in the study. Esophageal ruptures were in 2 patients. Primary closure was applied first, but it ruptured again and endoVAC was applied within 20 days in average. Esophageal leaks were in 3 patients. EndoVAC was applied within 15 days in average, especially endoscopic stent was applied first in one patient, but it changed into endoVAC for aggravation of mediastinitis. Overall mean duration of endoVAC was 20 days with 2.5 times of replacement and length of hospital stay was 33 days. All of them were discharged without problems. Additionally, the size of perforation was large and intractable in 2 patients, but all lesions were healed with endoVAC.

Conclusion
EndoVAC can be an alternative and effective treatment for esophageal rupture. Esophagectomy or esophageal stent can be options for those cases but they are too invasive or ineffective sometimes. However endoVAC is not only safe and reliable but also less invasive and easy to apply.

Disclosure
All authors have declared no conflicts of interest.
PS01.086: TRANSGASTRIC VACUUM DRAINAGE FOR OESOPHAGEAL PERFORATIONS: A SIMPLE TECHNIQUE FOR A COMPLEX PROBLEM
Authors: Ariyarathenam Arun , Sanders Grant , Wheatley Tim , Humphreys Lee , Berrisford Richard 
Published: September 2018

Abstract

Background
We present an updated case series of patients treated with a novel Transgastric (TG) drainage technique, previously published by the senior author in 2008 [Ref], which has now been used in 6 hospitals across United Kingdom and Ireland. The technique establishes vacuum drainage of the lumen of the injured oesophagus whilst maintaining its patency, effectively exteriorizing complex oesophageal perforations to allow healing.

Methods
Patients presenting with Boerhaave or iatrogenic rupture, undergo an initial decontamination of the chest with drainage as required. A 32–36 Fr Chest drain is inserted in a PEG guided technique, where the proximal end of the drain is positioned 5 cm above the perforation site within the oesophagus, whilst the distal end is pulled out through the stomach and abdominal wall. Continuous low-pressure suction at -10 cm water is applied. Patients continue to drink water. Further intervention is not required until the leak has healed and the drain removed.

Results
We have used this technique in 20 patients in our institution (3 iatrogenic perforations, 17 Boerhaave), with a median age of 72 (range; 55–85). Perforation length ranged from 1–15 cms. Three cases were performed after stenting failed to control the leak. Pleural decontamination required thoracotomy (n = 12), VATS (n = 2); in 6 cases, no pleural decontamination was required. There were four in-hospital deaths. Median duration from surgery to removal of TG drain was 31 days (range; 10 - 71). Two patients required post discharge dilatation for stricture and are currently asymptomatic.

Conclusion
TG drainage in effect exteriorizes the oesophageal lumen at the site of oesophageal perforation, encouraging the perforated edges to appose and allow healing by secondary intention. Mediastinal sepsis drains through the transgastric drain (on suction) and intercostal drains placed at decontamination (off suction). Patients tolerate it well, drinking while their perforation heals, avoiding nasogastric intubation. [Ref] Berrisford RG, Krishnadas R, Froeschle P, Wajed S. European Journal of Cardiothoracic Surgery 33(2008):742–744.

Disclosure
All authors have declared no conflicts of interest.
PS01.099: RETROSPECTIVE ANALYSIS OF CLINICAL FEATURES OF 202 CASES WITH ESOPHAGEAL FOREIGN BODIES
Authors: Feng Jinteng , Fan Kun , Gao Rui , Fu Junke , Zhang Guangjian 
Published: September 2018

Abstract

Background
Esophageal foreign bodies refer to objects that are accidentally or intentionally swallowed, or that are naturally swallowed during medication or eating, temporarily staying in or resting in the esophagus. Esophageal foreign body is one of the common emergency of esophageal surgery, more common in the elderly and children. This paper study clinical features of esophageal foreign body in northwestern China in order to improve the abilities of diagnosis and treatment for the disease.

Methods
Clinical data of 202 patients admitted in for esophageal foreign body was analyzed retrospectively. The general information of the patients were collected, and the types of foreign bodies, the location, diagnostic methods, methods of taking out and related complications, hospitalization days, et al were analyzed statistically.

Results
The types of esophageal foreign body included jujube pit (61.8%), animal bones (12.9%) and non-food foreign bodies (24.3%). It mainly occurred in the upper orifice of the esophagus (65.8%). Diagnostic methods were mainly consisted of esophageal angiography (57.9%), chest X-ray (19.8%) and endoscopy (16.4%). Most of the patients (189, 93.6%) were treated with esophagoscopy. Altogether 26 cases presented with complications, and 18 of them were admitted in for jujube pit.

Conclusion
The main cause of esophageal foreign body is jujube pit. Early diagnose and timely management is essential for the disease. How to guide the population as far as possible to avoid ingesting jujube pit wrongly and reduce the incidence of esophageal foreign body is of practical significance.

Disclosure
All authors have declared no conflicts of interest.
PS01.100: THORACOSCOPIC MANAGEMENT OF ESOPHAGEAL LEIOMYOMA: 11 CASE REPORTS
Authors: Aydin Yener , Eroglu Atila , Ulas Ali , Kuran Emre , Ozmen Sevilay 
Published: September 2018

Abstract

Background
The vast majority of esophageal tumors are cancer. Benign esophageal tumors constitute less than 1% of all esophageal tumors. Approximately 80% of benign esophagus tumors are leiomyomas. This study aims to evaluate outcomes of thoracoscopic management of esophageal leiomyomas.

Methods
Between January 2010 and December 2017, eleven cases (5 females, 6 males; mean age 45 years; range 30 to 59 years) who were operated with thoracoscopic resection due to esophageal leiomyoma were retrospectively analyzed. Age and sex of the patients, symptoms, localization of lesions, diagnosis, surgical modality, length of hospital stay and morbidity and mortality rates were reviewed. All cases were preoperatively examined using direct chest radiography, computed tomography (CT), and esophagoscopies, with endoscopic ultrasonography (EUS) also being employed in seven cases.

Results
Five patients had dysphagia and four patients were asymptomatic. Leiomyoma was located in 1/3 of the middle esophagus in all cases. All patients underwent right thoracoscopic enucleation (Single port incision in three cases). Leiomyoma was a solitary lesion in all cases. After the enucleation, 0.9% NaCl was inserted into the posterior mediastinal region. Nasogastric tube was inflated to check for leakage. Except for two cases, in all cases, the esophageal muscle layer was closed as an absorbable suture. The mean diameter of leiomyoma was 5.1 cm (range, 2 to 9 cm). Postoperative mortality was not observed in any of the cases. Postoperative pseudodiverticulum occurred in one of the cases. The mean length of hospital stay was 5.8 days (range, 4 to 11 days).

Conclusion
In esophageal leiomyomas, surgery provides both definitive diagnosis and treatment. Thoracoscopic enucleation in esophageal leiomyomas is an effective and safe treatment method.

Disclosure
All authors have declared no conflicts of interest.