Post-fundoplication symptoms and complications: Diagnostic approach and treatment. / Síntomas y complicaciones posfunduplicatura: abordaje diagnóstico y tratamiento.

Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.

[Parenteral nutrition. Experience of 2 years]. / Nutricón parenteral. Experiencia de dos años.

Total parenteral nutrition is a new method, in our media, that permits the direct administration to the blood stream of all the necesary elements for cellular synthesis. Total parenteral nutrition finds in the field of gastroenterology a wide range of indications to correct and prevent malnutrition in a patient who can not eat. Treatment, by the Department of Hyperalimentation, at the Hospital General del Centro Médico Nacional, during a two years period, of 150 patients, has permitted us to evaluate the results and complications of the method and to insist on the importance of a good nutrition in the overall treatment of a patient with a gastro-intestinal disease.