Re: Anterior vs posterior partial fundoplication and more.

[Guest guest]

On 11/30/2010 10:06 AM, Donna wrote:

> ... After looking up partial fundoplication I now realize that there is an

anterior and a posterior. ...

Anterior - means in front.

Posterior - means in back.

Partial - means less than 360 degrees, so not all the way around the

esophagus.

The fundoplications we most often discuss (there are others) are:

Dor a 180° anterior partial fundoplication,

Toupet a270° posterior partial fundoplication,

and Nissen a 360° full fundoplication.

The Nissen is generally considered to be too restrictive while

swallowing for patients with achalasia, though there are some surgeons

that believe a full wrap is fine for us. Most of the people in this

support group that think they have a Nissen probably don't. The term

Nissen is often used as a synonym for fundoplication. So, while they

were told they received a Nissen (in other words some kind of

fundoplication) they actually received either a Dor or toupet. If you do

a search for " partial Nissen " it can be very confusing.

The myotomy is done anteriorly and a Dor wrap covers it. Some surgeons

like the Dor because being on the myotomy it " protects the myotomy " and

being only 180° it is less restrictive where as they may believe that

the toupet is too restrictive. Most in our group probably have a Dor.

A toupet wrap starts on one edge of the myotomy and wraps around back

and then connects to the other side of the myotomy which causes the

myotomy to be held open. Some surgeons like the toupet because holding

the myotomy open prevents the myotomy from growing back together, and at

270° it may provide better reflux control than a Dor without being as

restrictive as a Nissen. Some members in this group, including me, have

a toupet.

There are other reasons for and against Dor and toupet, but these are

easy to understand and visualize in terms of anterior and posterior, and

full and partial.

BTW:

> Hyperplastic ...

Hyperplastic means cells are growing faster than normal. Think of it as

an internal growth, like a wart or mole or some kind of blemish. I have

a friend who's wife had esophageal cancer. They had been given a book by

one of those guys that tries to get people paranoid so he can get you to

buy his books to learn the secret he hypes but never seems to make clear

in each book. In the book he claimed, among many things, that proof of

how bad our food and medicines were was all the internal masses modern

medicine was finding. Now if you think about all the growths (masses) we

get on the outside, warts, moles, cysts, lipomas, skin tags and others,

is it any wonder that similar things are found on the inside and that

now that so many people are having CTs, MRIs, and endoscopies, that

doctors are finding more of this stuff on the inside? No big deal,

people always had this stuff and if more people are dying of things like

cancer, most of it is probably because the food and medicine are so good

that people are living long enough to die of old age diseases like some

of the cancers. Unfortunately my friend became angry and lost his faith

in doctors. If you ever have a CT or MRI look at it as big net fishing

for more things to investigate and don't be surprised when something is

found. Most of the time these masses and spots are nothing to worry

about, but because you can't alway tell just what it is, it has to be

watched.

> HLA-DQ Antigens present: DQ2

Of interest in achalasia seems to be HLA-DQ1 but not HLA-DQ2. DQ2 is

associated with enough other problems so people with it probably don't

want achalasia added to the list.

notan