13
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Case report of robotic dor fundoplication for scleroderma esophagus with aperistalsis on manometry

      case-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Highlights

          • Scleroderma commonly affects the esophagus.

          • Tailored therapy is crucial for successful management of scleroderma esophagus.

          • Robotic Dor Fundoplication is an effective option for patients with scleroderma esophagus.

          Abstract

          Scleroderma is a systemic disease of collagen deposition resulting in fibrosis of small arteries and arterioles. It commonly affects the skin, lungs, and gastrointestinal tract. The most common site of GI tract involvement is the esophagus. We present the case report of a 44 year old female with scleroderma esophagus and severe reflux which was successfully treated with robotic dor fundoplication. Because of the wide variety of symptoms with which this problem can present, a tailored approach taking into consideration the patient’s symptomatology and findings during diagnostic work-up was implemented with good results. The patient exhibited complete resolution of symptoms at short term follow up. Robotic dor fundoplication is an effective option for patients with scleroderma esophagus and no evidence of hiatal hernia or esophageal shortening.

          Related collections

          Most cited references5

          • Record: found
          • Abstract: found
          • Article: not found

          Comparison of surgical approaches to recalcitrant gastroesophageal reflux disease in the patient with scleroderma.

          Scleroderma is associated with severe esophageal dysmotility and gastroesophageal reflux disease (GERD). Results after antireflux surgery have been suboptimal due to the profound esophageal dysmotility seen in this disease. We hypothesized that laparoscopic Roux-en-Y gastric bypass (RYGBP) would lead to less dysphagia and better control of GERD symptoms. This report summarizes our initial results of RYGBP compared with other surgical approaches.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Antireflux operations in patients with scleroderma.

            Fourteen patients with scleroderma underwent antireflux operations (10 short Nissen, 2 Collis-Nissen, 1 Collis-Belsey, and 1 vagotomy and antrectomy with Roux-en-Y). Esophageal function was assessed preoperatively and postoperatively with a follow-up range of 8 to 181 months (mean, 65 months). Reflux symptoms were relieved in 10 of the 14 patients (p < 0.01), as shown by a decrease in their 24-hour acid exposure of from 15% to 7.5% (p < 0.05). However, the lower esophageal sphincter pressure gradient created by the operations did not increase significantly (3.7 +/- 3.4 mm Hg to 5.5 +/- 3.5 mm Hg). The esophageal acid exposure decreased sufficiently to promote some alleviation of the esophagitis. Radiologic signs of stenosis regressed in 6 of 7 patients. Postoperative endoscopic assessment revealed complete or partial healing of erosions seen preoperatively in 6 of the 7 patients so studied, and healing of all ulcers in 3 patients. Twelve patients continued to have columnar metaplasia. Manometric studies disclosed no significant changes in propulsion and contractility. Distal esophageal resting pressures rose significantly from 6.2 to 9.4 mm Hg (p < 0.05 mm Hg), suggestive of stasis. Radionuclide transit studies, however, showed no significant decrease in the esophageal emptying capacity after operation. It is concluded that conventional antireflux operations in patients with scleroderma can palliate reflux damage without jeopardizing esophageal function.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Combined Collis gastroplasty--fundoplication operations for scleroderma reflux esophagitis.

              Thirty-seven patients with scleroderma and reflux esophagitis, including 16 (43%) with peptic esophageal strictures, have been treated with a combination of the Collis gastroplasty and either a Belsey (240 degree) or Nissen (360 degree) fundoplication. Follow-up data have been obtained through personal interviews, esophageal manometry, and acid reflux testing. There have been no postoperative deaths or wound-healing complications. Five (31%) of the 16 patients with strictures still require intermittent dilatations. In the Collis-Belsey group (17 patients), after an average follow-up of 42 months, reflux symptoms have been eliminated in 11, are mild in three, and moderate or severe in three. Distal esophageal high-pressure zone (HPZ) tone and length have increased from an average of 4.6 mm Hg and 1.6 cm preoperatively to 8.6 mm Hg and 2.3 cm postoperatively. Acid reflux testing with the intraesophageal pH electrode, however, has demonstrated moderate-to-severe reflux in seven patients (41%). In the Collis-Nissen group (20 patients), after an average follow-up of 22 months, reflux symptoms have been eliminated in 17, are mild in two, and severe in one. Average HPZ tone and length have increased from 2.5 mm Hg and 1.2 cm preoperatively to 12 mm Hg and 4.2 cm postoperatively. The acid reflux test has revealed moderate or severe reflux in five patients (25%). Gratifying subjective and objective reflux control can be achieved in scleroderma patients with minimal operative morbidity.
                Bookmark

                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                16 June 2017
                2017
                16 June 2017
                : 37
                : 69-71
                Affiliations
                [0005]Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX, United States
                Author notes
                [* ]Corresponding author. alonso.andrade.f@ 123456gmail.com
                Article
                S2210-2612(17)30273-0
                10.1016/j.ijscr.2017.06.020
                5480277
                28645009
                ca8b8472-10d7-4525-b1d8-915c837bffc2
                © 2017 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 16 February 2017
                : 13 June 2017
                : 13 June 2017
                Categories
                Case Report

                robotic surgery,esophagitis,gastroesophageal reflux,scleroderma,minimally invasive surgery,case report

                Comments

                Comment on this article