n. a surgical operation for *gastro-oesophageal reflux disease in which the upper part of the stomach is wrapped around the lower oesophagus. Nissen fundoplication (named after Swiss surgeon Rudolf Nissen, 1896–1981) consists of a complete (360-degree) wrap; toupe fundoplication is a partial (270-degree) wrap. Fundoplication is now more often performed laparoscopically than via open surgery.
(peritoneoscopy) n. examination of the abdominal structures (which are contained within the peritoneum) by means of a *laparoscope. This is passed through a small incision in the wall of the abdomen after insufflating carbon dioxide into the abdominal cavity (creating a *pneumoperitoneum). Laparoscopy enables visual assessment of abdominal organs, harvesting of biopsies, and cancer staging. Therapeutic uses include aspiration of cysts, division of adhesions, and surgery that would previously have required *laparotomy. Examples include *hysterectomy, *cholecystectomy, *fundoplication, *prostatectomy, *colectomy, *nephrectomy, *oophorectomy, Fallopian tube ligation, and ova collection for *in vitro fertilization. See also minimally invasive surgery. —laparoscopic adj.... laparoscopy
n. inflammation of the oesophagus (gullet). Frequent regurgitation of acid and peptic juices from the stomach causes reflux oesophagitis, the commonest form, which may be associated with a hiatus *hernia. The main symptoms are heartburn, acid regurgitation, *odynophagia, and sometimes difficulty in swallowing (*dysphagia). Complications include bleeding, *stricture formation, and *Barrett’s oesophagus. It is treated with antacids and by maintaining an upright position, using more pillows at night, eating the evening meal earlier in the day, weight loss, and dietary restraint. In severe cases *fundoplication surgery may be required. Corrosive oesophagitis is caused by the ingestion of caustic acid or alkali. It is often severe and may lead to perforation of the oesophagus and extensive stricture formation. Immediate treatment includes food avoidance and antibiotics; later, stricture dilatation is often needed. Infective oesophagitis is most commonly due to a fungus (Candida) infection in debilitated or immunocompromised patients, especially those being treated with antibiotics, corticosteroids, and immunosuppressant drugs, but is occasionally due to viruses (such as cytomegalovirus or herpesvirus). Eosinophilic oesophagitis is a poorly understood condition characterized by infiltration of the oesophageal lining by excess *eosinophils. Autoimmune disease and food allergy are two commonly proposed causes. Treatment is directed towards exclusion of allergens and oral or inhaled steroids.... oesophagitis
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