Length and pressure of the reconstructed lower esophageal sphincter is determined by both crural closure and Nissen fundoplication.

Background: Laparoscopic Nissen fundoplication is comprised of: a wrap thought responsible for the lower esophageal sphincter function and crural closure performed to prevent herniation. We hypothesized gastroesophageal junction competence effected by Nissen fundoplication results from closure of the crural diaphragm and creation of the fundoplication.

Methods: Patients with uncomplicated reflux undergoing Nissen fundoplication were prospectively enrolled.

A randomized multiinstitution comparison of the laparoscopic Nissen and Hill repairs.

Background: Laparoscopic Hill repair (LHR) and laparoscopic Nissen fundoplication (LNF) are established surgical antireflux procedures but have never been compared in a prospective trial. This trial was designed to compare the effectiveness of LHR against the gold-standard LNF.

Methods: Patients with uncomplicated gastroesophageal reflux from two esophageal centers were randomly assigned and blinded from 2003 to 2007.

Safety and utility of mediastinoscopy in non-small cell lung cancer in a complex mediastinum.

Background: Adequate mediastinal staging is crucial in patients with locally advanced non-small cell lung cancer. Mediastinoscopy is often omitted after induction therapy or prior mediastinoscopy because of concerns for potential morbidity, safety and unknown utility. We sought to determine the safety and utility of restaging mediastinoscopy before surgical resection.

Hemoptysis and thoracic fungal infections.

Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized.