The Surgical clinics of North America
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Surg. Clin. North Am. · Aug 2015
ReviewConcepts for Developing Expert Surgical Teams Using Simulation.
This article investigates how simulation-based training can enhance the effectiveness of surgical teams. First, a description of team training within surgical settings is provided. Then, empirical work from a variety of fields is introduced to describe common characteristics of expert teams, with a specific focus on training surgical teams in simulated settings. Finally, methods and suggestions for evaluation of simulation-based team training are discussed.
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Surg. Clin. North Am. · Jun 2015
ReviewEndoscopic dilatation, heller myotomy, and peroral endoscopic myotomy: treatment modalities for achalasia.
At present, LHM with partial fundoplication is considered the gold standard for the treatment of patients with esophageal achalasia. Endoscopic procedures such as EBTI and PD should be considered as primary treatment modalities only in frail patients. POEM is a new approach with promising short-term results.
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The diagnosis of esophageal motility disorders has been greatly enhanced with the development of high-resolution esophageal manometry studies and the Chicago Classification. Both hypomotility disorders and hypercontractility disorders of the esophagus have new diagnostic criteria. For the foregut surgeon, new diagnostic criteria for esophageal motility disorders have implications for decision-making during fundoplication and may expand the role of surgical therapy for esophageal achalasia by clarifying diagnostic criteria.
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In the presence of long-standing and severe gastroesophageal reflux disease, patients can develop various complications, including a shortened esophagus. Standard preoperative testing in these patients should include endoscopy, esophagography, and manometry, whereas the objective diagnosis of a short esophagus must be made intraoperatively following adequate mediastinal mobilization. If left untreated, it is a contributing factor to the high recurrence rate following fundoplications or repair of large hiatal hernias. A laparoscopic Collis gastroplasty combined with an antireflux procedure offers safe and effective therapy.