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Biomedical subjects

R D Henderson

Publications and source records attributed to R D Henderson.

At least 19 recordsLinked to original sources
PubMed1990

Surgical management of 100 consecutive esophageal strictures.

We report our experience with 100 consecutive patients with reflux-induced esophageal structure managed surgically. Preoperative dilatation, total fundoplication gastroplasty, and postoperative dilatation were used in 98 patients. Only two required resection of the esophageal structure. We have identified preoperative factors that adversely affect the results. These include scleroderma; previous operation, either esophageal or gastric, and the severity of the esophageal stricture. Results of nonresectional operations are excellent in uncomplicated cases or with the addition of only one complicating factor. The more complicating factors, the worse the results. Those patients with three preoperative complicating factors do poorly and may benefit from esophageal resection. We conclude that results obtained from this conservative nonresectional management program justify continuance of the use of total fundoplication gastroplasty with preoperative and postoperative dilatation in the management of such patients.

Adult↗
PubMed1989

Closure of chronic postpneumonectomy bronchopleural fistula using the transsternal transpericardial approach.

Thirteen patients with postpneumonectomy bronchopleural fistula occurring 4 months to 10 years after the initial operation have been treated with a transsternal transpericardial approach after the associated empyema had been treated by either tube thoracostomy or open-window thoracostomy. In 10 patients, there were contraindications to using an ipsilateral transthoracic approach. In 10 of the 13 patients, the procedure was successful. Three fistulas recurred; two were quite small, one of them closing spontaneously within 6 months. There were no deaths or clinically significant morbidity related to the transsternal approach. We have found this technique to be most applicable in those patients in whom other procedures have failed to resolve the problem. The technique is relatively simple and safe.

Adult↗
PubMed1989

Myotomy for reflux-induced cricopharyngeal dysphagia. Five-year review.

This report describes 25 patients with reflux-induced cricopharyngeal dysphagia ultimately requiring surgical management. Eighteen patients underwent cricopharyngeal myotomy alone and seven patients required cricopharyngeal myotomy after an antireflux operation failed to correct this symptom. Cricopharyngeal incoordination was demonstrated at manometry in over 90% of patients. Treatment included cricopharyngeal myotomy, which was extended proximally to the pharynx and distally to the intrathoracic esophagus. Results were excellent to satisfactory in 24 of 25 patients. Pathologic examination of the cricopharyngeal muscle demonstrated a wide variety of myopathic degenerative changes. We stress that cricopharyngeal myotomy may be performed even in the presence of reflux without fear of subsequent aspiration.

Adult↗
PubMed1989

The total fundoplication gastroplasty: surgical procedure and radiologic appearance.

The total fundoplication gastroplasty (TFG) consists of a combination of an esophagus-lengthening Collis gastroplasty and suturing of the gastric fundus to the esophagus and neo-esophagus to produce a stable intra-abdominal segment together with a complete Nissen fundoplication tailored in length to control reflux and avoid overcompetence. We studied 50 patients at least three months after TFG with an upper gastrointestinal examination and a tube esophagogram. Tube esophagography enhances distension of the esophagus and esophagogastric junction and eliminates the barium pool often seen in the distal esophagus in double-contrast esophagography. With this technique we were better able to understand the radiologic anatomy of the esophagogastric junction following TFG. Tube esophagography provided additional radiologic information in the five patients (10%) with preoperative peptic strictures of the esophagus. We describe the surgical and radiologic anatomy of the TFG, the technique of postoperative radiographic examination, and the postoperative problems we have encountered.

Adolescent↗
PubMed1988

Review of the surgical management of recurrent hiatal hernia: 5-year follow-up.

Symptoms in patients with hiatal hernia often respond to treatment consisting of diet and medication. Operative procedures, designed to control gastroesophageal reflux and avoid surgically induced problems, are reserved for those with intractable symptoms. When these operative procedures fail, reoperation may be necessary. The reoperative procedure is often technically complex because of esophageal and gastric scar fixation. The authors reviewed the surgical management of recurrent hiatal hernia in 168 patients followed up to 5 years or more; 43 of them had undergone gastric surgery previously.Radiologically, 97% patients studied (142 of 146) had no evidence of anatomic recurrence or reflux post operatively. Manometric studies postoperatively in 114 patients showed that the mean tone of the high pressure zone was within the normal range and lower esophageal disordered motor activity was decreased by 34.5% from the preoperative level. Symptoms of recurrent hiatal hernia were abolished by operation in 88% of the patients; only 4.8% had serious or recurrent symptoms.

Adult↗
PubMed1987

Extended esophageal myotomy and short total fundoplication hernia repair in diffuse esophageal spasm: five-year review in 34 patients.

Diffuse esophageal spasm (DES) is a rare disease, and its surgical management is controversial. There are seven major reported series totaling 148 patients and six operative variations depending on the extent of myotomy and whether or not a hernia repair should be added. There are no five-year follow-up reports. In the present study of 34 patients followed for at least five years, all had a myotomy from the apex of the chest through the high-pressure zone and all had a total fundoplication hernia repair, 16 with gastroplasty and 16 with a standard Nissen fundoplication. The length of the completion fundoplication is reduced to less than 0.5 cm to avoid problems of overcompetence. There were no operative deaths. Follow-up is 100% by clinical history, 82.4% by radiology, and 61.8% by manometry. Radiological follow-up showed no recurrence or reflux, although 1 patient had esophageal mucus retention. Thirty patients (88.2%) are eating normally without dysphagia or spontaneous pain. Two patients (5.9%) have mild dysphagia, and 1 of them also has mild spontaneous pain. One patient has major residual dysphagia, which is being treated conservatively, and 1 has required colon interposition. Good-quality results have been achieved in 94% of patients now followed 5 to 10.7 years.

Esophageal Diseases↗
PubMed1987

Esophageal motor disorders.

Primary esophageal motor disorders are rare, but they respond well to surgery if they are accurately diagnosed and if treatment carefully follows the fundamental principles of management. In the lower esophagus the most important primary disorders are achalasia, diffuse esophageal spasm, and scleroderma. Upper esophageal primary disorders are mostly rare; however, problems of age and neurologic diseases are a significant source of debility, making their management important. Details of investigation and management have been outlined in this article.

Age Factors↗
PubMed1987

A comparative assessment of tube esophagography with double-contrast esophagography in the detection of reflux esophagitis.

We undertook a prospective study comparing the sensitivities of double-contrast and tube esophagography in 34 patients with gastroesophageal reflux and compared our findings with those at endoscopy. Neither test detected changes accurately in mild inflammation; however, they both became more sensitive as the severity of esophagitis increased. The sensitivity of both tests increased from 0% in grade 2 to 86% in grade 4 esophagitis. The tube esophagogram demonstrated inflammatory changes better than the double-contrast esophagogram in only 18% of the 34 patients, all with grade 3 or 4 esophagitis, despite the elimination of the barium pool in the distal esophagus and improved distension of the esophagogastric junction. Endoscopy is still the most reliable means of diagnosing and grading esophagitis.

Adolescent↗
PubMed1986

Surgical management of the failed gastroplasty.

Gastroplasty has been used in surgical management of reflux for 25 years. The creation of a gastric tube before fundoplication complicates further corrective procedures should the original operation fail. Experience has been gained with 51 patients, 34 having partial fundoplication gastroplasty and 17 having total fundoplication, who have had major persistent or recurrent symptoms. All were evaluated by history, radiology, endoscopy, manometry with pH, and acid perfusion testing before surgical management. The patients undergoing partial fundoplication gastroplasty had heartburn (85.3%), reflux (70.6%), and dysphagia (94.1%). Radiologic recurrence was present in 26.5%, endoscopic incompetence in 94.1%, and a stricture in 26.5%. The patients who had a total fundoplication gastroplasty had heartburn (52.9%), reflux (29.4%), and dysphagia (82.4%). Radiologic recurrence was present in 29.4%, endoscopic incompetence in 35.3%, and a stricture in 5.9%. On average, these patients had had 2.3 prior operations (range one to five operations). The dominant cause of failure (in the absence of anatomic recurrence) with partial fundoplication gastroplasty was continued or recurrent reflux and with total fundoplication gastroplasty, too tight or too long a fundoplication. All patients had a thoracoabdominal revision total fundoplication gastroplasty and a 1 cm completion fundoplication. Pyloromyotomy was added if not previously performed. There were no deaths or major morbidity. Follow-up in 51 patients averages 4.2 years (range 0.3 to 8.8 years). None has radiologic recurrence, one has minor reflux, one a traumatic diverticulum, and one has moderate esophageal obstruction. Of these patients, 82.4% are asymptomatic, 13.7% have minor symptoms, and 3.9% (two patients) have significant residual symptoms. This conservative surgical approach avoids the higher mortality of resection with interposition and provides satisfactory results.

Adolescent↗
PubMed1985

Total fundoplication gastroplasty (Nissen gastroplasty): five-year review.

Gastroplasty was introduced by Collis in 1961 and has undergone several modifications. The combination of total fundoplication with gastroplasty was reported in 1977 and referred to as total fundoplication gastroplasty; however, the term Nissen gastroplasty also is commonly used. This article is an extension of the original 1977 report and, to our knowledge, represents the first 5-year review of total fundoplication gastroplasty. Three hundred fifty-one consecutive patients with intractable reflux were preoperatively evaluated by history, radiographic studies, manometric studies with determination of pH, and esophagogastroduodenoscopy prior to surgical management by total fundoplication gastroplasty. There were no operative deaths. Follow-up averaged 6.5 years with an effective clinical review available for 95.4% of the patients, radiographic studies for 92.3%, and manometric studies with pH evaluation for 70.7%. Among the 335 patients with 5 or more years of follow-up, 93.1% had excellent results with normal eating and no investigative evidence of recurrence of reflux, 4.0% had mild residual symptoms, and 2.9% had persistent or recurrent symptoms. With this technique, the problems of overcompetence and dysphagia are substantially reduced because the completion fundoplication is tailored to a length of 1 cm while anatomical stability is maintained with a long intraabdominal segment.

Adolescent↗
PubMed1985

Transabdominal total fundoplication gastroplasty to control reflux: a preliminary report.

Transthoracic total fundoplication gastroplasty has been reported as having a low mortality and a 1.1% recurrence rate and to produce excellent results in 93.1% of patients, moderate results in 3.7% and poor results in only 2.8% of patients. In approximately 7.0% intercostal neuritis is a serious residual problem. The transabdominal total fundoplication gastroplasty uses the identical repair technique but avoids the chest-wall pain. Previous esophageal or gastric surgery and major esophageal shortening are contraindications to an abdominal approach. The authors report their results with 50 patients who underwent transabdominal total fundoplication gastroplasty and were followed up for 6 to 20 months. There was no mortality or major morbidity. Clinical follow-up was complete, 94% of patients were assessed by roentgenography and 72% by manometry. None had anatomic recurrence, 46 (92%) were asymptomatic and 4 (8%) had minor residual gastric symptoms of fullness or occasional epigastric pain. All were much improved and none had wound pain. Long-term follow-up of transabdominal total fundoplication gastroplasty is necessary; however, since the technique of repair is identical to the thoracic approach, the results should be similar.

Adolescent↗
PubMed1984

Reflux control following gastric surgery.

Reflux is a common complication in patients who have undergone gastric surgery. These patients have bile reflux, often associated with gastric disease, and are resistant to conservative management. In this study the authors have reviewed 124 patients who were treated surgically for reflux that occurred after gastric operations. They were assessed preoperatively by history, radiologic investigation, manometry with pH and endoscopy. Seventeen patients were treated by Belsey hernia repair, 42 by partial fundoplication gastroplasty and 65 by total fundoplication gastroplasty. Thirty-seven patients required additional gastric surgery. Continued reflux was the commonest problem postoperatively; it was effectively corrected by total fundoplication gastroplasty. Of eight patients who had persistent bile gastritis, four had had bile drainage as part of their operation for reflux. From this study the authors conclude that total fundoplication gastroplasty is the most effective procedure to control reflux, but it must be carefully tailored to avoid overcompetence and dysphagia. Associated gastric problems should be treated simultaneously.

Adult↗
PubMed1984

Dysphagia complicating hiatal hernia repair.

Dysphagia may be a continuing or added problem after operations for the control of reflux. In a series of 208 patients treated surgically for recurrent hiatal hernia, 34 (16.3%) presented with dominant dysphagia either caused by or aggravated by the operation. They were evaluated by history, radiology, manometry, and endoscopy. The causes of dysphagia were diagnosed in all patients: reflux stricture in nine patients, tight or long Nissen wrap in 15, muscle injury in three, inappropriate myotomy with reflux in three, myotomy with overcompetent repair in two, and early Nissen intussusception in two patients. Surgical correction was by total fundoplication gastroplasty in 32 patients, Nissen repair in one, and colon interposition in one. In four patients the myotomy was closed. Complete follow-up averages 5.4 years. There has been one anatomic recurrence, 28 patients are asymptomatic, and five are much improved but have minor persistent dysphagia. Only by complete investigation can the cause of dysphagia be recognized and treated.

Adolescent↗
PubMed1983

Management of the patient with benign esophageal stricture.

Benign esophageal strictures are a diagnostic and therapeutic challenge. If the investigation is carefully performed, the etiologic factors can almost always be clearly established. At all times, the possibility of malignant disease must be considered. With an appropriate combination of medical management, bougienage, or surgery, almost all patients can be effectively treated.

Colon↗
PubMed1983

Ultrastructure of the esophageal muscle in achalasia and diffuse esophageal spasm.

The pathogenesis of dysphagia in achalasia and diffuse esophageal spasm (DES) is not understood completely, and the primary site of damage in these two entities is not known. This project was undertaken to study the ultrastructural changes present in the muscular wall of the esophagus in eight patients with achalasia and nine patients with DES, compared with seven controls. The ultrastructural alterations in the smooth muscle of all patients were neither pronounced nor consistent. However, nonspecific changes, including filament disarray, mottling of the fiber density in myocytes, thick and long cytoplasmic dense bodies, long dense plaques, and few nexus junctions were seen in both achalasia and DES. In addition, the smooth muscle cells in achalasia exhibited nuclear and cytoplasmic inclusions. Statistical analysis of the number of muscle cells per unit area suggested that the gross thickening of the muscular wall of the esophagus in cases of DES is because of hyperplasia and not hypertrophy of muscle cells. A striking change seen in achalasia esophagi and a few cases of DES, as compared to the controls, was the marked loss of small nerve fibers and the paucity of granules in the remaining fibers. This study points to a neurogenic pathogenesis for dysphagia in achalasia with secondary nonspecific changes in the smooth muscle in these two diseases. No nerve abnormalities were noticed in DES.

Adult↗
PubMed1983

Total fundoplication gastroplasty. Long-term follow-up in 500 patients.

Total fundoplication gastroplasty was designed to combine the low anatomic recurrence rate of gastroplasty with the effectiveness of reflux control obtained by total wrap. The problems requiring evaluation are anatomic recurrence, continued reflux, dysphagia, inability to belch or vomit, and gas bloat, all of which have been described in procedures employing a total wrap. Five hundred consecutive patients were analyzed 6 to 60 months following operation. There were no deaths and a 3.6% incidence of short-term operative morbidity. Follow-up was available clinically in 98.4% (495 patients), radiologically in 89.6% (448), and manometrically in 69.5% (347). Two patients have anatomic recurrence (0.4%) and none has reflux. Excellent results occurred in 93.4% (467), improvement in 5% (25), and poor results in 1.6% (eight). Repeat operation was necessary in 0.4% (two) for recurrence and in 0.8% (four) for severe dysphagia. The other problems were minor dysphagia in 2.2% (11), gastritis in 1.2% (six), late cholelithiasis in 0.4% (two), and continued pain with poor results in 0.4% (two). The length of the gastroplasty tube and the subdiaphragmatic position of the high-pressure zone (HPZ) did not affect the result of the operation. A long tube and unwrapped supradiaphragmatic HPZ was present in 18.8% (94); none had reflux or major dysphagia. Total length of the gastroplasty wrap was 3 to 4 cm in the first 200 and the incidence of major dysphagia was 5% (10). Reducing the length of fundoplication to 1.5 to 2 cm reduced the incidence of dysphagia to 1.7% (five). Other problems of gastritis and difficulty with belching and vomiting occurred in a random fashion. This procedure is effective in reflux control, prevents anatomic recurrence and, if the completed fundoplication is maintained at 1.5 to 2 cm, yields a low incidence of significant dysphagia.

Aphasia↗