1. Yuen Soon Oesophagogastric Laparoscopic Physiology

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

3. Laparoscopic Single Incision Surgery MATTU  Teaching  Research

6. The

12. Complex Reflux is surgery appropriate?

13. Common Symptoms Heartburn Globus Chest Pains

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

15. Complex Atypical Symptoms Dysphagia Pain

16. Differential Diagnoses Cancer Dysmotility  Oesophageal  gastric

17. Treatment Conservative Medical  PPI  Barrier Surgical

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

19. Indications for Surgery Lifestyle Breakthrough Symptom Control Complex Reflux Control

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

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

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

23. Hypotensive dysmotility – typical of GORD

25. Vigorous Achalasia

28. Structural obstruction at the PIP

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

31. Bravo System

32. Enterra Gastric Pacing

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

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

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

36. Thank You Any questions