tailieunhanh - EAES Guidelines for Endoscopic Surgery - part 4

Một số các triệu chứng ª postfundoplication º Đã có mặt Trước khi hoạt động và là do các triệu chứng khó tiêu liên quan đến GERD. Bệnh nhân thất bại nên được làm việc với các xét nghiệm chẩn đoán có sẵn để phát hiện nguyên nhân gây ra Bên dưới của thất bại. Nếu có tái phát là trào ngược nhẹ | 106 E. Eypasch et al. Some of the postfundoplication symptoms are present already before the operation and are due to the dyspeptic symptomatology associated with GERD. Patients with failures should be worked up with the available diagnostic tests to detect the underlying cause of the failure. If there is mild recurrent reflux it usually can be treated by medication as long as the patient is satisfied with this solution and his her quality of life is good. In the case of severe symptomatic recurrent reflux or other complications and if endoscopy shows visible esophagitis the indication for refundoplication after a thorough diagnostic workup must be established. Surgeons very experienced in pathophysiology diagnosis and the surgical technique of the disease should perform these redo operations. Expert management of patients undergoing redo surgery for a benign condition is of extreme importance. 9. What Are the Issues in an Economic Evaluation With respect to a complete economic evaluation the panelists refer to the available literature 14 a 76 a Cost cost minimization and cost-effectiveness analyses of gastroesophageal reflux disease must take into account the following issues list incomplete 1. Costs of medications 2. Costs of office visits 3. Costs of routine endoscopies 4. Frequency of sick leaves at work 5. Frequency of restricted family or hobby activity at home 6. Assessment of job performance and restrictions due to the disease 7. Costs of diagnostic workup including functional studies and specialized investigations 8. Costs of surgical intervention 9. Costs for treatment of surgical complications 10. Costs of treatment of complications of maintenance medical therapy such as emergency hospital admissions . swallowing discomfort bolus entrapment in peptic stenoses 11. Perspective of the analysis patient hospital society 12. Health care system socialized private . A special issue is the so-called break-even point between medical and surgical treatment .