Patient Profiles

 

Tom Rich, GERD patient profile

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 Barrett's esophagus is a condition in which the normal squamous lining of the esophagus has been replaced by an abnormal columnar epithelium, which is known as metaplasia.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.

Bonnie Roseff, gastric bypass patient profile (Breast Center employee)

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).

Managing diverticular disease feature

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.