Anti reflux surgery

Laparoscopic Anti-Reflux Surgery Safe and Effective Treatment for GORD Abeezar I. Sarela MSc MS FRCS (Gen Surg) Consultant in Upper Gastrointestinal & Minimally Invasive Surgery The Leeds Nuffield Hospital The General Infirmary at Leeds Wharfedale General Hospital Hon. Senior Lecturer, University of Leeds School of Medicine Clincal Meeting at Leeds Nuffield Hospital, 17 October, 2005

The Problem of GORD ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object]

GORD Predicts Oesophageal Cancer ,[object Object],Heartburn (>5 years duration) Odds ratios Once-a-week x 8 Nocturnal x 11 >20 yrs, and score >4.5* x 43.5

Poor Quality of Life with GORD ,[object Object],64% 22% 48% 14% 25% 29% % of patients AstraZeneca UK Data on File NEX/084/FEB2003. 0 10 20 30 40 50 60 70 80 Symptoms unbearable Interests Sleep Sex life Sport + exercise Concentrating on job N=230 confirmed GORD patients

Debate ,[object Object],[object Object]

Anti-Reflux Surgery NICE Guidance, 2005 ,[object Object]

Agenda ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

GORD Treatment ,[object Object],[object Object],[object Object],[object Object]

PPI Maintenance Therapy: Limitations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PPI Maintenance Therapy: Limitations ,[object Object],[object Object],[object Object],[object Object]

Indications for Surgery ,[object Object],[object Object]

Indications for Surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pre-operative Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

24-hr Ambulatory Oesophageal pHmetry

[object Object],[object Object],[object Object],[object Object],[object Object],24-hr Ambulatory Oesophageal pHmetry

The Operation ,[object Object],[object Object],[object Object]

Immediate Post-operative Issues ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Outcomes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Side-Effects ,[object Object],[object Object],[object Object],[object Object]

Durability ,[object Object],[object Object],[object Object]

Persistent or Recurrent GORD ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],CHOICE

Summary ,[object Object],[object Object],[object Object],[object Object]

Anti reflux surgery

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Anti reflux surgery