1.
Describe his condition/diagnosis
Mr. Rich suffered from severe
gastroesophageal reflux (heartburn)
since 1991. His condition
had progressively worsened
over the years to the point
that medications had become
ineffective. He also had a
large hiatal hernia (portion
of the stomach herniated into
the chest) causing him significant
chest pain and difficulty
with certain foods.
2.
Was he diagnosed with Barretts
esophagus? If so, can you
describe the condition?
Yes, Barretts esophagus was
present. Barrett's esophagus
is a condition in which the
normal squamous lining of
the esophagus has been replaced
by an abnormal columnar epithelium,
which is known as metaplasia.
People who have Barrett's
esophagus have a 30 to 40
fold increased risk in developing
esophageal cancer as compared
to the general population.
Still, the overall cancer
risk in patients who have
Barrett's esophagus is low.
3.
What made him a good candidate
for the Nissen Fundoplication
procedure?
The combination of failure
to respond to medications,
presence of a hiatal hernia
and Barretts esophagus made
him an ideal candidate.
4.
What did the surgery involve?
In the laparoscopic approach
small incisions are use to
enter the abdomen through
canulas (narrow tube-like
instruments). The laparoscope,
which is connected to a tiny
video camera, is inserted
through the small incision,
giving the surgeon a magnified
view of the patient's internal
organs on a television screen.
The hiatal hernia is repaired
and the valve between the
esophagus and the stomach
is reinforced by wrapping
the upper portion of the stomach
around the lowest portion
of the esophagus - much the
way a bun fits around a hot
dog. Hospital stay is 24-48
hours with the patient going
home with only band-aids as
dressings.
5.
Outcome?
Mr. Rich achieved excellent
results with resolution of
his symptoms. Most patients
no longer require any medication
after surgery.
6.
What are the benefits of the
laparoscopic versus the conventional
open approach?
The advantage of the laparoscopic
approach is that it usually
provides reduced post-operative
pain, shorter hospital stay,
faster return to work, less
wound complications and improved
cosmetic result.
7.
Are there any age limits to
qualify for the procedure?
No. This operation can be
performed in all age groups
including pediatrics.
1.
Describe her condition / diagnosis
Mrs. Roseff had failed multiple
attempts at diet and exercise
programs with a body mass
index (BMI) equal to 48 kg/m2.
She developed high blood pressure
secondary to the weight requiring
medication.
2.
Can you explain what body
mass index (BMI) is?
BMI represents your weight
in kilograms divided by your
height in meters squared.
Surgical therapy should be
considered for individuals
who have a BMI of greater
than 40 kg/m2 (approximately
100 lbs overweight) or have
a BMI greater than 35 kg/m2
with significant co-morbidities
(i.e. high blood pressure,
diabetes, sleep apnea and
congestive heart failure)
and can show that dietary
attempts at weight control
have been ineffective.
3.
What made her a good candidate
for gastric bypass surgery?
BMI greater than 40, high
blood pressure, and failure
to lose weight through diet
and exercise.
4.
What did the surgery involve?
To perform a laparoscopic
gastric bypass, a laparoscope
(small video camera) is inserted
in the abdomen through a small
incision and provides a magnified
view on a television monitor.
This allows better visualization
of the operative site for
more precise work. A small
stomach (gastric pouch) is
created and a portion of the
small intestine is bypassed.
This causes decreased food
intake (by restriction from
the gastric pouch) and decreased
digestion (malabsorption).
5.
Outcome?
Mrs. Roseff is an excellent
example of how this surgery
changes a person's life. Bonnie
lost approximately 100 lbs
in the first year and no longer
requires her blood pressure
medication. It has given her
a new start in life with the
ability to perform activities
that would not have been possible
in the past. Most patients
lose weight and continue to
do so until 18 to 24 months
after the procedure. Surgery
improves most obesity-related
conditions. For example, diabetes
resolves in over 90 percent
of patients and high blood
pressure in 85 percent.
6.
What are the benefits of the
laparoscopic approach?
By avoiding a large abdominal
incision and bowel manipulation,
the recovery is much faster.
The advantages of the laparoscopic
approach include very small
incisions, reduced postoperative
pain, shorter hospital stay,
less scarring and faster return
to work. A decision is sometimes
made to convert to an open
procedure based on patient
safety (i.e. poor visualization,
uncontrolled bleeding, extensive
scar tissue).
1.
What causes diverticular disease?
Diverticulosis occurs when
small pouches, known as diverticula,
form in the walls of the colon.
It is believed that diverticula
form when pressure inside
the colon builds and makes
the wall bulge in spots where
it's naturally weak. One of
the causes of this pressure
can be related to constipation.
Normally, your colon muscles
move in waves, expanding and
contracting as they move waste
through your system. But when
waste material is hard and
dry, the muscles have to squeeze
harder, with more force.
In addition
to not getting enough fiber
and fluids, other causes of
constipation include:
If you
have diverticulosis, there's
a good chance you don't know
it. Usually, the small pouches
(diverticula) that form in
the wall of the colon do not
cause any problems and can
only be detected by X-ray.
Diverticulitis occurs when
undigested food or waste matter
is trapped inside the diverticula,
causing the pouches to become
inflamed or infected. The
most common symptom of diverticulitis
is abdominal pain or cramping,
which usually occurs on the
left side. Other symptoms
include nausea, vomiting,
fever and constipation.
2.
What is the "seed theory"?
Is there any truth to it?
Until recently, it was suggested
that patients with diverticulosis
avoid foods with small seeds
such as tomatoes or strawberries
because it was believed that
particles could lodge in the
diverticula and cause inflammation.
However, this now a controversial
point and no evidence supports
this recommendation. It is
okay to eat seeds and nuts.
3.
When is surgery necessary?
If attacks are severe or frequent,
surgery may be necessary.
The affected part of the colon
is removed and the remaining
sections of the colon are
rejoined. This type of surgery,
called colon resection, aims
to keep attacks from coming
back and to prevent complications.
Surgery may also be recommend
for complications of a fistula
or intestinal obstruction.
If antibiotics do not correct
the attack, emergency surgery
may be required. Other reasons
for emergency surgery include
a large abscess, perforation,
peritonitis, or continued
bleeding.
In the elective setting, it
is now possible to perform
minimally invasive colon surgery
through a few small incisions
(1/4 inch). This allows a
shorter hospital stay with
a quicker recovery.