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Risk factors for chronic venous disease (CVD) have been widely reported in population health management. However, predisposing factors associated with patients treated for advanced stages of CVD have yet to be established. We examined the demographics and risk factors associated with advanced clinical presentation of CVD for patients referred for vein ablation.Retrospective analysis of our institutional Vascular Quality Initiative Varicose Vein Registry included endovenous laser treatment and radiofrequency ablation procedures at our tertiary institution, community hospital, and outpatient vein clinic between January 2015 and December 2016. All incompetent truncal veins were divided into two groups based on the Clinical, Etiology, Anatomy, and Pathophysiology clinical class of CVD: mild-moderate (C1-C3) and severe (C4-C6). The two groups were compared in terms of their demographics and medical comorbidities using univariate and multivariate analysis. Data analysis was conducted on SPSS 22.0 (IBM Corp, Armonk, NY).During the study period, a total of 650 incompetent truncal veins were ablated. The mean age of patients was 58 years, and 73% were female. Severe CVD composed 21% of the cohort. Male sex was a risk for advanced CVD (odds ratio, 2.6; P .001). Older age was also associated with severe CVD; the average age was 63 years for patients with advanced stage CVD vs 56 years for mild to moderate CVD (P .001). Race, diabetes, body mass index, number of pregnancies, congestive heart failure, history of venous thromboembolism, current anticoagulation, and history of smoking or current smoking status did not affect the severity of CVD.Among patients treated with vein ablation for superficial venous insufficiency, older age and male sex were associated with increased severity of advanced CVD. Despite the higher incidence of varicose veins among women, men are more likely to have clinically advanced CVD when they present for truncal vein ablation.

A Heller myotomy is performed when medical management has failed to improve the symptomatology of esophageal achalasia. It involves incising the smooth muscular layer of esophagus, allowing the lower esophageal sphincter to relax. The chapter prescribes a minimally invasive approach.

A laparoscopic Nissen fundoplication is performed in order to surgically correct gastroesophageal reflux disease (GERD). It involves a 360 degrees wrap of the fundus of the stomach around its proximal aspect. The chapter describes a laparoscopic approach, which is most commonly performed.

Esophageal cancer is associated with high mortality due to early spread. When indicated, an esophagectomy can be performed with reconstruction, most commonly using the stomach, with the right gastropepiploic artery serving as the vascular pedicle. While there are many ways to perform the surgery, the combination of laparoscopy and thoracoscopy (Ivor – Lewis) has gained popularity. The present chapter describes that approach.