Esophageal anti-reflux surgery

1. Esophageal reflux symptoms are severe, recurrent, and the medical treatment is not effective. 2. Patients with esophageal stenosis, hemorrhage, chronic ulcers and respiratory tract infections. 3. Patients with hiatal hiatus hernia and symptoms of compression and obstruction. Treatment of diseases: gastroesophageal reflux disease, esophageal hiatus hernia Indication 1. Esophageal reflux symptoms are severe, recurrent, and the medical treatment is not effective. 2. Patients with esophageal stenosis, hemorrhage, chronic ulcers and respiratory tract infections. 3. Patients with hiatal hiatus hernia and symptoms of compression and obstruction. Preoperative preparation 1. Control respiratory infections. 2. Correct anemia and hypoproteinemia. Surgical procedure (A) anterior fixation (Allison surgery) 1. Incision: the posterior lateral incision of the left chest or the inferior temporal incision, through the 8th intercostal space into the chest. 2. Free the lower part of the esophagus and pull the belt. 3. Dissect the hernia sac and cut open, fully free the cardia and the fundus. 4. Make a 6-needle sacral suture at the anterior wall of the stomach about 1 cm from the proximal esophagogastric junction, and 5 cm away from the edge of the hiatus. The iliac muscle is pulled from above through the diaphragm and the suture is ligated. The cardia is fixed. Below the diaphragm. (two) posterior stenosis (Hill surgery) 1. Incision: Incision in the upper abdomen. 2. Cut the peritoneal reflex and the esophageal ligament at the L of the esophageal fissure, free the lower end of the esophagus and pull it with gauze. 3. Separate the diaphragmatic holes in the posterior esophagus and suture a few needles to accommodate only the fingertips. The sacral esophageal ligament is displayed in front of and behind the small curved side of the cardia. A needle fixation line a is sutured between the esophageal fascia bundle and the arcuate ligament, and the three needle correction lines b, c, and d are sutured from top to bottom. Suture. 4. The tip of the finger can be seen from the front wall of the stomach. 5. The door is fixed. (3) Belsey 1. Incision: the posterior lateral incision of the left chest or the inferior temporal incision, through the 8th intercostal space into the chest. 2. The anatomical dissection of the esophagus and the cardia is the same as that of the anterior cardia. 3. 3 to 5 needles of the esophageal hiatus were sutured intermittently behind the esophagus, and were not ligated for the time being. 4. The first layer of the sacral line was sutured at the lower end of the stomach and the lower end of the esophagus. After ligation, the fundus is wrapped around 2/3 of the circumference of the esophagus. 5. The second layer of 3-needle sacral suture was sutured at the lower end of the fundus and the lower end of the esophagus, and then the iliac muscle was taken up from the iliac crest 2 to 3 cm below the esophageal hiatus and the suture was ligated. 6. Finally, the suture behind the esophagus is ligated so that the hole can accommodate the fingertip. (four) fundus stenosis 1. Incision: The median incision of the upper abdomen into the ab 2. Cut the peritoneal reflex and esophageal ligament at the esophageal hiatus, free the lower end of the esophagus and draw with a gauze. Free the fundus and ligature and cut the two upper gastric vessels. 3. Use a long forceps to pull the top of the anterior wall of the fundus from the back of the lower esophagus to the right side of the esophagus, and then to the front of the esophagus, so that the fundus is wrapped around the lower end of the esophagus. 4. The gastric fundus wrapped around the esophagus is sewn with a 5-needle intermittent suture, and the tightness is suitable for accommodating one finger. (5) Collis-Belsey combined surgery 1. Incision: the posterior lateral incision of the left chest or the inferior temporal incision, through the eighth intercostal chest. 2. Free the lower part of the esophagus and pull the belt. 3. The fundus is lifted into the chest through the esophageal hiatus, and the stomach is cut 5-6 cm from the esophagus-gastric angle, and the gastric incision is sutured intermittently. The length of the esophagus is extended and a new esophagus-gastric angle is formed. 4. According to the Belsey surgical method, the newly formed lower esophagus and fundus are creased. (6) Esophagectomy and metastasis The lower esophagus of the scar is removed. Free a pedicled colon or jejunum, anastomosed between the esophagus and the stomach, and then anastomosis of the colon-colon or jejunum-jejunum. (7) Subtotal resection of the "Roux-Y" gastrojejunostomy Adapted to patients with reflux esophagitis and gastric ulcer. The jejunum-jejunum anastomosis is at least 30-45 cm from the gastrojejunostomy to prevent biliary esophagitis that may occur after surgery.