Yuen Soon Oesophagogastric Laparoscopic Physiology

Oesophagogastric Surgery Cancer Complex Benign  Oesophageal ruptures  Gastric volvulus  Oesophageal dysmotility Reflux disease

Laparoscopic Single Incision Surgery MATTU  Teaching  Research

The

Complex Reflux is surgery appropriate?

Common Symptoms Heartburn Globus Chest Pains

Complex Reflux Symptoms Mass Reflux Cough/Asthma/recurrent Chest Infections Sore Throat

Complex Atypical Symptoms Dysphagia Pain

Differential Diagnoses Cancer Dysmotility  Oesophageal  gastric

Treatment Conservative Medical  PPI  Barrier Surgical

Medical vs Surgical Only three Trials of Lap vs Medicine  Mahon 2005  Anvari 2006  Grant 2008 All Show improve QOL at 1 year

Indications for Surgery Lifestyle Breakthrough Symptom Control Complex Reflux Control

Why pH Manometry Prove reflux  For surgical therapy  For medical escalation Avoid dysmotility  Gastric  Oesophageal Manage expectation

What is New Regional Oesophageal Physiology Unit  High Resolution Manometry  Impedance pH studies  Bravo  Enterra

Patients All three patients described have  Dysphagia  Odynophagia  Reflux

Hypotensive dysmotility – typical of GORD

Vigorous Achalasia

Structural obstruction at the PIP

Impedance pH Detects Non acid reflux Studies symptom correlation  Manages expectation

Bravo System

Enterra Gastric Pacing

Research Interest Single Port Laparoscopy Microdialysis and Perioperative Physiology Molecular Biology  Tumour Bank

Other Interest Patient Support Groups  OPA  Achalasia Support Group Uganda  Link with Mukono Need to Buy a house!!

Other Other Interest Climbing Basketball Dancing Diving House Hunting  Still Need A House

Thank You Any questions