By Theodore N. Pappas, Lewis B. Schwartz, Steve Eubanks (auth.)
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Extra info for Atlas of Laparoscopic Surgery
Close range direct laparoscopic vision IS requlred. Homeostasl$ IS faCllrtated by oversewlng using running suture technique or by application of fibnn glue or other procoagulant matenals. Intragastnc methylene blue dye confirTrIS the absence of perforatJon. FIGURE 3-24. Antenor hlghly selectJve vagotomy may a1tematJvely be perfOrTrIed wrth a stapling deVlce. After insertion of a bougie dilator through the gastroesophageal junction, the endoscopic stapling device is placed across a double full thickness of the anterior gastnc wall.
Three of the 12 patients required conversion to open laparotomy for equipment failure or bleeding encountered during dissection of the short gastric vesse1s. The remaining nine patients reported complete relief of symptoms. Laparoscopic reduction, crural repair, and fundoplication of a large hiatal hernia was performed by Cuschieri and coworkers  in eight patients. Crural repair and fundoplication was done by continuous suture technique. The average operating time was 3 hours. The postoperative complications were cervical emphysema (three patients), left pneumothorax (one patient), and transient dysphagia (one patient).
The normal physiology of gastric acid secretion is illustrated in Figure 3-5. Production of gastrie acid by the parietal cell is affected by acetylcholine, histamine, and gastrin. Increased gastrie acid and pepsin secretion are often present in patients with peptic ulcer disease. The markedly high acid levels are thought to be due to abnormal proliferation of oxyntic glands . It has become evident, however, that impairment of mucosal resistance may be just as important . Na'-K' ATPase Ulcerogenic factors Elevated acid secretion Increased pepsin concentration Helicobaaer pylod infection Trauma Ischemia NSAIDs Protective factors Prostaglandin E, Mucosal blood flow HCO) production Growth factors Mucous secretion Increased cell turnover Emptying 6 Hista mine • • Gastrin Acetylcholine FIGURE3.....