Gastroesophageal ebb is a common co...

Gastroesophageal ebb is a common condition; greatest in number people experience heartburn or dysphasia at a time in their lives. For many patients it is a manageable disease. For others, it can progres to morose symptoms, including inflammation and disruption of the mucosal lining.

Gastroesophageal ebb disease (GERD) is a chronic condition that come abouts when the lower esophageal sphincter mechanism relaxes or becomes incompetent. Many GERD cases can be treated with medical therapy alone (eg antacids, rantidine hydrochloride, omeprasole); however, long-term therapy is sometimes required. In GERD therapy, the goals are to decrease gastroesophageal ebb and neutralize it, enhance esophageal clearance, and shelter esophageal mucosa. Long-term therapy, however, may not be appropriate because of the outlay of the medications. Other complications of the disease, as it was as nonhealing ulcerations, recurrent strictures, and Barretts columnar-lined esophagus--which may lead to esophageal carcinoma(1)--may ne to be treated surgically.

SURGICAL INTERVENTION

Surgical intervention for GERD usually is accomplished by means of performing one of three procedures:

* the Nissen, in which the fundus of the stomach is wrapped around the lower 4 cm to 6 cm of the esophagus and sutur in place;

* the Hill, in which the lower part of the stomach and the cardioesophageal junction are sutur to the median arcuate ligament; or

* the Belsey Mark IV, in which the fundus is wrapped 270 stations around the circumference of the esophagus, leaving its posterior wall free

A transabdominal approach (ie, Nissen manner of proceeding Hill procedure) usually is used in surgical intervention. A transthoracic approach is used in the Belsey Mark IV action and on patients who previously have had an left upper quadrant step or who are extremely obese. A vagotomy or pyloroplasty may be performed at the same time as any of these procedures

SILICONE PROSTHESIS

An alternative to traditional surgical repair of the gastroesophageal ebb is a silicone prosthesis (Figure 1) In this deed through an upper abdominal vertical incision, the prosthesis is placed around the esophagus, in a less degree than the diaphragm, and above the stomach. A radiopaque marker onward the device allows X-ray detection after the conduct Proper placement of the prosthesis allows passage of pabulum into the stomach, while preventing the stomach from sliding into the chest cavity.

[Figure 1 ILLUSTRATION OMITTED]

CASE STUDY

M L a 12-year-old female, was diagnosed with GERD Five years earlier, the young patient beared an accidental gunshot wound to her back. She had major injuries that required removal of three-quarters of her stomach. In addition to an extensive practice on her spine, Ms L underwent a splenectomy, left nephrectomy, and a partial distal pancreatectomy. She also had a T-12 L1-2 comminuted fracture of the spine that left her a paraplegic.

M L did not have an adequate amount of stomach left for physicians to perform the typical anti-flux operations Ms L used medication and elevated the head of her bed at night to sway reflux; however, her continual state of ebb resulted in frequent weight los Taking into account her not absent weight of 65 lbs, and a fresh weight loss of 20 lb before the operation her physician considered a silicone prosthesis implantation.

Considering prosthesis. The surgeon adviceed Ms L and her family members in succession how the prosthetic device works and the potential risks and complications, including

* bleeding,

* infection,

* malfunction of the device,

* leakage of the silicone, and

* anesthetic-related complications.

M L's physician decided that the benefits outweighed the risks for this patient, and the patient and her parents approvaled to proceed with the implantation of the silicone prosthesis.

Perioperative considerations. There were a great number of troubles about Ms L because of her past and not away condition. Staff members wanted to alleviate anxiety for the patient and her family members in consequence of education.

A perioperative assessment was scheduled for M L and her family members to ask questions and for nursing staff members to allay M L's fears and anxieties and provide patient education. Team members participating in the assessment included staff members from the OR, the anesthesia department, and the postanesthesia care unit (PACU).

During the assessment, staff members verified M L's medical history, previous surgeries and complications, and allergies. M L and her family members reviewed the information from the prosthesis manufacturer. She also given instructions forward how and when to bathe before the process to decrease the risk of detriment infection. Ms L also was instructed not to eat or drink anything les than 12 hours before the procedure

Staff members explained that an IV would be started for M L in the preoperative area, and a nasogastric (NG) tube and Foley catheter would be inserted in the OR. The design for each procedure was explained.