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 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.
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the esophagus has been replaced by an abnormal columnar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.
The combination of failure to respond to medications,
presence of a hiatal hernia and Barretts esophagus made
him an ideal candidate.
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.
Mr. Rich achieved excellent results with resolution of
his symptoms. Most patients no longer require any medication
after surgery.
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.
No. This operation can be performed in all age groups
including pediatrics.
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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.
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.
BMI greater than 40, high blood pressure, and failure
to lose weight through diet and exercise.
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).
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.
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).
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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:
-
Lack of exercise
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Ignoring the urge to have a bowel movement
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Stress and anxiety
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A side effect of medication
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Changes in life and routine, such as
pregnancy and travel
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.
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.
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.
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