PMID- 9058164
OWN - NLM
STAT- MEDLINE
DCOM- 19970520
LR  - 20041117
IS  - 0172-6390 (Print)
IS  - 0172-6390 (Linking)
VI  - 44
IP  - 13
DP  - 1997 Jan-Feb
TI  - The "balanced" operation for life threatening complications of severe "non 
      responding" form of gastroesophageal reflux disease. A case report.
PG  - 302-6
AB  - The fate of patients developing life-threatening complications of the Barret's 
      non-responding ulcer during an acute treatment is lacking in the literature. 
      Medical therapy with proton pump inhibitors (PPI) for severe forms of 
      gastroesophageal reflux disease fails in 15-20%. Emergency operation is indicated 
      in failed cases. We present an operation which restores anatomical and functional 
      deviations causing reflux disease. Two patients required early surgery due to 
      bleeding and penetration of Barret's ulcer during PPI therapy. Both patients had 
      reflux disease, a Savary Miller stage of IV, and/or the M3; U1; S0; E3 and M3; 
      U3; S0; E3 stage of "MUSE" assessment respectively. The modified "balanced 
      operation" was performed consisting of a truncal vagotomy, hiatus hernia 
      reposition, posterior crura repair, fundoplication and extramucosal pyloroplasty. 
      Both patients had excellent outcomes after surgery. Visick I and II, or M3; U0; 
      S0; E1 and M3; U0; S0; E0 respectively and remained well over the year without 
      any medication. The modified "balanced" operation seems to be the method of 
      choice for treatment of severe, "non responding" form of GERD when complications 
      occur. Various pathophysiological factors such as hyperacidity, the cardia valve 
      and gastric emptying are affected simultaneously. The rationale for the 
      performance of all steps of the "balanced" operation is based on the fact that we 
      do not know before the operation, which steps will be necessary to produce a good 
      result.
FAU - Danis, J
AU  - Danis J
AD  - Surgical Department of the General Public Hospital Hainburg an der Donau, 
      Austria.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Greece
TA  - Hepatogastroenterology
JT  - Hepato-gastroenterology
JID - 8007849
SB  - IM
MH  - Endoscopy
MH  - Female
MH  - Fundoplication
MH  - Gastroesophageal Reflux/*complications/physiopathology/*surgery
MH  - Humans
MH  - Middle Aged
MH  - Surgical Procedures, Operative/methods
MH  - Treatment Failure
MH  - Vagotomy
EDAT- 1997/01/01 00:00
MHDA- 1997/01/01 00:01
CRDT- 1997/01/01 00:00
PHST- 1997/01/01 00:00 [pubmed]
PHST- 1997/01/01 00:01 [medline]
PHST- 1997/01/01 00:00 [entrez]
PST - ppublish
SO  - Hepatogastroenterology. 1997 Jan-Feb;44(13):302-6.