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Prof. ALBERTO DEL GENIO Hon. OESO, FACS

Prof. ALBERTO DEL GENIO Hon. OESO, FACS Professore Emerito di Chirurgia Seconda Università degli Studi di Napoli. RECENTI ACQUISIZIONI DI FISIOPATOLOGIA ESOFAGEA. ENDOSCOPIC PRESSURE OF THE WRAP. TOUPET DOR NISSEN. High HPZ. Tight wrap. Floppy wrap. Low HPZ. Total wrap. 360° HPZ.

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Prof. ALBERTO DEL GENIO Hon. OESO, FACS

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  1. Prof. ALBERTO DEL GENIO Hon. OESO, FACS Professore Emerito di Chirurgia Seconda Università degli Studi di Napoli RECENTI ACQUISIZIONI DI FISIOPATOLOGIA ESOFAGEA

  2. ENDOSCOPIC PRESSURE OF THE WRAP TOUPET DOR NISSEN

  3. High HPZ Tight wrap Floppy wrap Low HPZ Total wrap 360° HPZ Partial wrap portion of HPZ Resting pressure range 20-40mmHg Del Genio A

  4. “SINCE 1972 STANDARDIZED TECHNIQUE” WIDE TRANSHIATAL MINIMAL RETROESOPHAGEAL LENGHT OF THE WRAP (2-3 CM) PRESERVATION OF VAGAL BRANCHES AND LESSER OMENTUM PRESERVATION SGV ANTERIOR FUNDUS

  5. 6

  6. HIGH RESOLUTION COMBINED MANOMETRY AND IMPEDANCE (HR-MII) INTRAOPERATIVE CONTROL ESOFAGEAL MOBILIZATION + IATOPLASTY IATOPLASTY + FIRST STICH NISSEN-ROSSETTI IATOPLASTY + SECOND STICH NISSEN-ROSSETTI IATOPLASTY DISTANCE BETWEEN CRURA AND WRAP IATOPLASTY CORRECTELY FASHIONED FUNDOPLICATIO

  7. Personal Experience (Feb 1992 -Nov 2007) Nissen-Rossetti Fundoplication Del Genio, Febbraio 2010

  8. Peri-operative Results • Hospital stay: 2.3 ± 0.9 days • Mortality: 0 • Intraoperative mucosal injuries: 1/524 (0.2%) • Conversions: 1/524 (0.2%) • Early Complications 1 pt (0.2%): esophageal perforation (laparotomy + drainage in II p.o. day) 1 pt (0.2%): splenic injury (splenectomy in I p.o. day) 3 pts (0.4%): hemorrage (reintervention via laparoscopy in 2 pts and via laparotomy in 1 pt) Del Genio, Febbraio 2010

  9. GERD – Long-term results outcomes from recent series DEL GENIO WORLD J SURG 2007

  10. GERD better reflux control after Nissen fundoplication it has been consistently shown that tailoring antireflux surgery according to esophageal motility is not indicated there is significance evidence that anterior fundoplication offers less effective long-term reflux control META-ANALISI di 9 studi randomizzati (4 Nissen vs Toupet e 5 Nissen/Toupet vs Dor)

  11. POSTOPERATIVE MANOMETRY

  12. HIGH RESOLUTION MANOMETRY AND IMPEDANCE (HRiM) POSTOPERATIVE NISSEN-ROSSETTI PROGRESSION OF THE BOLUS AT IMPEDANCE U.E.S. PERISTALSIS LES + CRURA NORMAL WRAP RELAXATION NORMAL WRAP RELAXATION

  13. PRE POST RESULTS: HRiM

  14. HRiM: LIQUID SWALLOW

  15. HRiM: VISCOUS SWALLOW

  16. INFLUENCE OF ESOPHAGEAL MOTILITY ON LARS SURGERY MANOMETRY 6 m FW-UP 330/406 (81%) 12m FW-UP 276/406 (68%) 24m FW-UP 260/406 (65%) 48m FW-UP 206/406 (53%) LES PRESSURE Pizza, Del Genio et al. Dis Esoph 2008

  17. INFLUENCE OF ESOPHAGEAL MOTILITY ON LARS SURGERY MANOMETRY 6 m FW-UP 330/406 (81%) 12m FW-UP 276/406 (68%) 24m FW-UP 260/406 (65%) 48m FW-UP 206/406 (53%) PERISTALSIS Pizza, Del Genio et al. Dis Esoph 2008

  18. IMPEDANCE BOLUS TOTAL TRANSIT TIME (sec.) at HRiM Del Genio et al. J CLIN GASTROENT 2012

  19. p=N.S. PERISTALSI SECONDARIA (CLEARANCE) p=N.S. Del Genio et al. Eur Surg Res 2007 p=N.S.

  20. POSTOPERATIVE PH-MONITORING AND COMBINED PH-IMPEDANCE (MII-PH)

  21. Del Genio G et al, World J Surg 2007 standard Ph-MONITORING

  22. PH-IMPEDANCE MONITORING Del Genio G et al. Surg Endosc 2008 Del Genio G et al. Dis Esophag 2009 Del Genio G. et al. Gastroenterol 2010

  23. PH-IMPEDANCE MONITORING Del Genio G et al. Surg Endosc 2008 Del Genio G et al. Dis Esophag 2009 Del Genio G. et al. Gastroenterol 2010

  24. POSTOPERATIVE OUTCOMES ON PHARYNGEAL REFLUX

  25. PH-IMPEDANCE MONITORING Tolone, Del Genio. U Surg 2012

  26. SELEZIONE

  27. “IMPEDANCE DRIVEN ANTIREFLUX SURGERY” 2010

  28. ? … ALLORA QUANTO CAMBIA L’INDICAZIONE ALLA CHIRURGIA? Alberto del Genio

  29. COMBINED 24 HOUR PH-IMPEDANCE MII-pH allows identification of 40% of pz with GERD with a NEGATIVE standard pH-monitoring Del Genio G et al, J Gastrintest Surg 2008

  30. Ref #164, #170, #235

  31. HELLER NISSEN-ROSSETTI

  32. CONCLUSION LA CHIRURGIA FUNZIONALE NON PUO’ PRESCINDERE DA UNA ATTENTO STUDIO FISIOPATOLOGICO. QUESTO VALE SIA PER LA SELEZIONE DEI PAZIENTI CHE PER IL CONTROLLO DELLA CORRETTA FUNZIONE DELL’INTERVENTO NEL TEMPO. GLI STUDI DI CHIRURGIA FUNZIONALE HANNO A LORO VOLTA COSTITUITO UN VALIDO MODELLO PER UNA AVANZAMENTO DELLA CONOSCENZA DELLA FISOLOGIA E DELLA FISIOPATOLOGIA.

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