Management of XXXX with a selective approach to antireflux surgery.

@entity1 @entity1605 @entity304 @entity2910 @entity11034 @entity357 @entity196 @entity354
BACKGROUND: The role of an antireflux procedure in the management of @entity357 is controversial. To address this issue, we reviewed our experience with selective use of antireflux procedures in @entity1 with pure @entity357 ( @entity1605 ; n = 26) and those with a partial sliding component (type III; n = 11). @entity1 AND METHODS: Surgical repair was performed on diagnosis in all 37 @entity1 . Competency of the lower esophageal sphincter was evaluated on the basis of reflux symptoms, and objectively, with endoscopy in 21 @entity1 and 24-hour esophageal pH studies in 17 @entity1 . Repair included an antireflux procedure in 11 @entity1 , as indicated by @entity354 . RESULTS: Preoperatively, 80% of both @entity196 @entity1 reported obstructive symptoms. @entity304 were present in 27% of @entity1 --19% of @entity1605 and 45% of type III @entity1 . Endoscopy revealed @entity2910 in 5 cases, and 24-hour pH studies indicated significant reflux in 3 of 17 @entity1 . There were no operative deaths and 1 recurrence. Symptoms improved in 92% of @entity1 after surgery. Medically manageable reflux was identified in 2 @entity1 . CONCLUSIONS: Frequent obstructive symptoms and the potential for @entity11034 indicate elective repair of @entity357 on diagnosis. Significant @entity354 is less common, especially in @entity1605 @entity1 , and excellent symptomatic results are obtained with selective application of an antireflux procedure.
