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Difficult Decisions in Thoracic Surgery - part 7

Gastroplasty kéo dài bao gồm sự hình thành của một ống dạ dày theo chiều dọc đóng ghim dạ dày gần từ góc độ song song của ông cong dạ dày thấp hơn. Thủ tục này được thiết kế để kéo dài ống thực quản như một phần của điều trị phẫu thuật các trường hợp phức tạp của bệnh trào ngược dạ dày thực quản | 38 Lengthening Gastroplasty for Managing Gastroesophageal Reflux Disease and Stricture Sandro Mattioli and Maria Luisa Lugaresi A lengthening gastroplasty consists of the formation of a gastric tube by vertically stapling the proximal stomach from the angle of His parallel to the lesser gastric curvature. This procedure is designed to elongate the esophageal tube as part of surgical treatment of complicated cases of gastroesophageal reflux disease GERD in which the esophagus is irreversibly shortened thus the gastroesophageal GE junction cannot be repositioned into the abdomen without excessive tension. This technique was proposed in 1957 by J.L. Collis for the treatment of complicated cases of GERD as an alternative to esophageal resection.1 2 A few years later Collis after following up the patients operated upon reported 59 with GERD at barium swallow and 50 with specific symptoms.3 In 1971 Pearson Langer and Henderson published the results of a series of 24 patients in whom a Collis gastroplasty had been performed in combination with a modified Belsey anti-reflux procedure.4 The concept of the Pearson operation was to elongate the esophagus in order to perform an effective intra-abdominal anti-reflux fundo-plication avoiding any tension on the sutures placed through the distal esophagus the gastric fundus and the diaphragmatic hiatus. Based on the same concept the combination of a Collis gastroplasty with the Nissen fundusplication was proposed by Orringer and Sloan transthoracic Collis-Nissen .5 Details of the Collis-Nissen operation were successively modified by Demos6 and Cameron7 uncut Collis-Nissen thoracic and abdominal approaches and Steichen8 abdominal Collis-Nissen . Innovative laparoscopic and laparothoracoscopic techniques for lengthening gastroplasty associated with a fundoplication have been designed in order to replace the open procedures.6 9-11 Techniques of laparoscopic tubu-larization of the lesser gastric curvature by a wedge resection of the .