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__NOTOC__
__NOTOC__
{{Aspiration pneumonia}}
{{Aspiration pneumonia}}
{{CMG}}; {{AE}}  
{{CMG}}; {{AE}} {{SSH}}


==Overview==
==Overview==
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].
==Indications==
*Surgical intervention is not recommended for the management of [disease name].
OR
*Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
*The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
**[Indication 1]
**[Indication 2]
**[Indication 3]
==Surgery==
==Surgery==
'''Management of gastroesophageal reflux'''
* Patients with swallowing dysfunction, especially those with neurologic impairment, may have increased frequency and volume of [[Gastroesophageal reflux disease|gastroesophageal reflux]].
* Most patients with mild [[Gastroesophageal reflux disease|GER]] can be effectively managed without [[Nissen fundoplication|fundoplication]], using dietary modification and positioning to reduce the frequency of GER, pharmacotherapy for acid suppression, and occasionally prokinetic agents.
* [[Nissen fundoplication|Fundoplication]] is a surgical procedure to reduce the risk of [[Gastroesophageal reflux disease|GER]]. It should be considered only in patients with GER that is strongly suspected to be contributing to pulmonary disease.
* When evaluating the severity of GER, a gastroenterologist classically focuses on the percent of time that gastric contents spend in the esophagus, which correlate with the risk for peptic esophagitis. From a pulmonary point of view, the number and duration of episodes may be less important than whether the reflux occurs during sleep, when the patient is horizontal and less likely to protect the larynx.


=== Complications ===
*The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
* Gas bloat syndrome: patients report being unable to [[Belching|belch]], leading to an accumulation of gas in the [[stomach]] or small intestine. This is said to occur in 2-5% of patients, depending on surgical technique, and is commonly believed to be related to the tightness of the "wrap". Most often, gas bloat syndrome is self-limiting within 2 to 4 weeks, but in some it may persist. The offending gas may come from dietary sources (especially carbonated beverages). Another suspected cause is subconscious swallowing of air ([[aerophagia]]). If gas bloat syndrome occurs post operatively and does not resolve with time, dietary restrictions, or counselling regarding aerophagia, it may be beneficial to consider treating the condition with an endoscopic balloon dilitation.
OR
* [[dysphagia]]
*Surgery is the mainstay of treatment for [disease or malignancy].
* [[dumping syndrome]]
 
* [[achalasia]]
==Contraindications==
* [[Retching]]
* Esophageal obstruction
* Intrathoracic [[herniation]]
* Rrecurrence of [[Gastroesophageal reflux disease|GER]] due to breakdown of the wrap.
* Complications of fundoplication are most common in patients with neurologic impairment. Failure rates of [[Nissen fundoplication|fundoplication]] range from 2 to 50 percent.
'''Jejunal feeds'''
* For patients with GER who are dependent on enteral feeds, an alternate strategy to reduce GER and the associated risks of aspiration is to place the feeding tube in the jejunum rather than in the stomach; this tends to reduce but not eliminate GER. Disadvantages of jejunal feeds include intolerance of rapid feeding infusions (such that continuous rather than bolus feeds must be used), and a tendency for accidental displacement (except with permanent, surgically placed jejunal tubes). A retrospective study in a group of children with neurological impairment found that the rates of aspiration pneumonia and mortality were similar among those treated with jejunal feeding as compared with those treated with fundoplication. [45]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]

Revision as of 23:35, 3 April 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

Surgical intervention is not recommended for the management of [disease name].

OR

Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]

OR

The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].

OR

The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

Surgery is the mainstay of treatment for [disease or malignancy].

Indications

  • Surgical intervention is not recommended for the management of [disease name].

OR

  • Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either:
    • [Indication 1]
    • [Indication 2]
    • [Indication 3]
  • The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either:
    • [Indication 1]
    • [Indication 2]
    • [Indication 3]

Surgery

  • The feasibility of surgery depends on the stage of [malignancy] at diagnosis.

OR

  • Surgery is the mainstay of treatment for [disease or malignancy].

Contraindications

References

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