Thal-Ashcraft and Boix-Ochod Surgery

Thal-Ashcraft and Boix-Ochod surgery is used for the treatment of gastroesophageal reflux. At present, it is considered that gastroesophageal reflux disease (GERD) is a primary upper gastrointestinal motility disorder caused by multiple factors. Due to the dysfunction of the lower esophageal sphincter (LES), the contents of the stomach enter the esophagus, causing symptoms and esophageal mucosal lesions. The main performance within 1 year of age is milk or vomiting, generally 9 to 24 months improved. Childhood performance is similar to that of adults. The most common symptoms are acid reflux, hiccups, heartburn, chest pain, cough, asthma, nocturnal apnea and recurrent pneumonia, tracheal spasm, and pharyngitis. For a long time, GERD was not recognized and thus was not treated properly. In severe cases, dysphagia can occur and develop into Barrett's esophagus. Since the 1960s, there has been a new understanding of the etiology, pathology, and physiology of GERD. The pathological and physiological factors that cause GERD are considered to be: decreased esophageal acid clearance, decreased esophageal sphincter tension, and increased gastric acid levels. The esophageal epithelium has colonized Helicobacter pylori (HP). Among the many factors in the pathogenesis of GERD, the most important is the functional status of the lower esophageal sphincter. Studies have shown that the anatomical structure of the gastroesophageal junction is conducive to anti-reflux. The lower esophageal sphincter pressure and contraction of the diaphragmatic foot have antagonistic effects on gastroesophageal reflux. Advances in examination methods in recent years, such as: esophageal manometry, endoscopy, esophageal barium meal examination, gastroesophageal gamma photography and 24-hour continuous esophageal pH measurement, enable early diagnosis and treatment of GERD. The purpose of GERD treatment is to reduce the damage of the reflux to the esophageal tissue and enhance the anti-reflux defense mechanism of the esophagus. At present, GERD is mainly treated by internal medicine, and most of the sick children can be improved after systematic medical treatment. Only a small number of sick children need surgery. The purpose of surgical treatment is to enhance the anti-reflux effect of the lower esophageal sphincter. The principle of Thal-Ashcraft and Boix-Ochod surgery is to restore normal anatomical and physiological functions, so as to prevent gastroesophageal reflux. The basic composition of the procedure includes: 1 restoring the normal length of the esophagus; 2 closing the hiatus between the esophagus and the diaphragm, and fixing the esophagus to the normal anatomical position; 3 establishing a normal His angle. Treatment of diseases: gastroesophageal reflux disease Indication Thal-Ashcraft and Boix-Ochod surgery is available for one of the following conditions: 1. The symptoms disappear quickly after the medical treatment fails or the drug is stopped, which affects the growth and development. 2. Recurrent pneumonia, asphyxia or sudden infant death syndrome. 3. Gastroesophageal reflux with esophageal hiatus. 4. Progressive stenotic esophagitis. Contraindications 1. Those who have not undergone systematic medical treatment. 2. Poor nutritional status, anemia, hypoproteinemia. 3. Great hiatal hernia and paralysis. 4. The esophagus has been severely narrowed and shortened. Preoperative preparation 1. Correct nutritional disorders such as anemia and hypoproteinemia. 2. Treatment and control of respiratory tract inflammation. 3. When the bed is raised, the bed is raised 20cm, and the medical treatment is continued before surgery. 4. Treatment of esophagitis, so that inflammation, bleeding and ulcers are at rest. 5. Place the stomach tube before surgery. Surgical procedure 1. Incision and free abdominal esophagus with Nissen surgery. The distal end of the baby's esophagus can be lowered by 2 cm. 2. Repair the diaphragmatic muscles such as the esophageal hiatus or the esophageal hiatus hernia, the "8" should be interrupted to suture the esophagus and diaphragmatic space, tighten the diaphragmatic foot. 3. The fundus fold starts from the left side of the stomach and the esophagus junction, and the anterior wall of the fundus is folded 180°. The anterior wall of the stomach and the anterior wall of the esophagus are sutured to the right side of the esophagus. And the gastroesophageal connection is small and curved. Reconstruction of the His angle is the most important feature of this procedure. 4. Suspend and suture the fundus and the adjacent diaphragm surface for 3 stitches, so that the fundus opens like an umbrella. complication 1. Flatulence, delayed gastric emptying, resulting in failure of the split suture. 2. The fundus of the folded suture is too loose, causing recurrence of gastroesophageal reflux. 3. Esophageal stenosis aggravated: due to the original esophagitis, on the basis of the operation of the gastric tube and surgical operation to make the lower end of the esophage mucosal edema. Generally, it can be recovered by itself. If it still cannot be eliminated, it needs to be treated with esophageal dilatation.