Postoperative complications were found to occur in approximately 8% of patients, with the rate of conversion to an open procedure of about 4%. The most common perioperative complication was early wrap herniation (1.3%), defined as occurring within 48 hours of surgery. This is one complication that may be more common with the laparoscopic than open approach. The explanation for this is unclear but may be related to the opening of tissue planes by the pneumoperitoneum and the reduced tendency for adhesion formation after laparoscopic compared to open surgery. In an attempt to eliminate this complication, most surgeons routinely perform a crural repair.
Both pneumothorax and pneumomediastinum have been reported. The occurrence of pneumothorax is related to breach of either pleural membrane, usually the left, during the hiatal dissection. Chest drain insertion is usually not required because accumulated carbon dioxide rapidly dissipates following release of pneumoperitoneum by a combination of positive pressure ventilation and absorption.
As with any laparoscopic procedure, instrumental perforation of the hollow viscera may occur. Early esophageal perforation may arise during passage of the bougie, during the retroesophageal dissection, or during suture pull-through. Late esophageal perforation is related to diathermy injury at the time of mobilization. Gastric perforations usually resulted from excessive traction on the fundus for retraction purposes. Recognition of the problem at the time of surgery requires repair, which may be performed either laparoscopically or by an open technique.
Hemorrhage during the course of laparoscopic fundoplication usually arises from the short gastric vessels or spleen. Rarer causes include retractor trauma to the liver, injury to the left inferior phrenic vein, an aberrant left hepatic vein, or the inferior vena cava. Cardiac tamponade as a result of right ventricular trauma has also been reported. Major vascular injury mandates immediate conversion to an open procedure to achieve hemostasis.
What is acid reflux relief?
In medically oriented terms, antonyms of the word relief include pain, distress or damage. That links its meaning to both subjective and objective aspects. Subjective, denoting sensations experienced by the sufferer such as pain and objective, meaning physical findings detected by specialists which are either functional distress or organic damage. Actually relief is related to control measures and it quantitatively signifies removal of an unpleasant existence or reduction of its magnitude. The definition of relief, therefore encompasses alleviation of pain, relaxation of distress and healing of damage. Acid reflux on the other hand has two sides; the subjective side (symptoms) which reflects the symptom of heartburn and the objective side (signs) that reflects the functional and/or organic signs of esophageal changes. Acid reflux relief is therefore a broad term that covers all the measures used to control symptoms and signs of acid reflux disease. Normally, the lower esophageal sphincter remains closed except during swallowing. This prevents the passage of food and acid from the stomach into the esophagus. If the lower esophageal sphincter becomes weakened or relaxed, stomach acid may back up into the esophagus. Frequent acid reflux can irritate and inflame the lining of the esophagus, causing symptoms and signs of acid reflux. A better understanding of relief would thus entail knowledge of some aspects of normal structure and function, so that changes in the disease and its control could be easily considered. Actually acid reflux relief involves both preventive and curative measures, and in addition to treatment; orientation with the causes, symptoms and complications of acid reflux are essential for proper management. Acid reflux relief includes: dietary changes,lifestyle modifications, specific medications and surgical operations.Basic knowledge of the underlying causes and progression of acid reflux and answering frequently asked questions about its relief; add to the depth of understanding.
Tuesday, May 13, 2008
Anti reflux Surgery Complications
Posted by SSS at 11:46 AM