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Surgical Procedures

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ESOPHYX

The incisionless solution for GERD, TIF (Transoral Incisionless Fundoplication) treats the underlying cause of GERD without incisions. This innovative procedure reconstructs the antireflux valve and restore's the body's natural protection against reflux.

	The Esophyx device and the endoscope are gently inserted through the mouth.
	The device forms and fasten tissue folds to reconstruct the antireflux valve at the junction of the esophagus and the stomach.

BENEFITS OF TIF

• No external skin incisions - no scarring
• No internal cutting or dissecting of the natural anatomy - more rapid recovery
• Fewer adverse events and complications
• Does not limit future treatment options
• Can be revised if required

IS TIF SAFE?

• TIF has been proven safe in thousand of procedures worldwide.
• To date, side effects have been minimal.

WHAT CAN I EXPECT?

• TIF is performed under general anesthesia and will require you not to eat or drink for several hours prior to the procedure. The procedure itself will generally take 90 minutes.
• Most patients can go home the next day and can return to work and most normal activities within a few days.
• Patients should expect to experience some discomfort in their stomach, chest, nose and throat for the first few days to a week after the procedure.
• Patients will be asked to restrict physical activity for the first week and will be given dietary guidelines to help maximize their success while the tissue heals.

To learn more about this exciting new development for the cure of GERD please click on the following link: ESOPHYX

LAPAROSCOPIC FUNDOPLICATION (NISSEN)

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. This is analogous to the way a bun wraps around a hot dog. Our surgeons use small incisions to enter the abdomen. The laparoscope, a thin telescope-like instrument, is connected to a tiny camera and then inserted through the small incision. This enables our surgeons to have a magnified image of the patient's internal organs projected on a television screen. The abdomen is inflated with gas, causing it to expand, and thereby allowing our surgeons to perform the procedure.

BENEFITS OF THE NISSEN FUNDOPLICATION

• Reduced post-operative pain
• Shorter hospital stay
• Faster return to work
• 5 tiny scars instead of one large abdominal scar. Improved cosmetic result

WHAT CAN I EXPECT?

• Light activity is encouraged while recuperating at home
• Most often post operative pain is mild. Some patients may have need for prescription pain medication
• Normal activities should begin in 1-2 days
• There may be temporary difficulty in swallowing, but that will resolve within one to three months after the surgery

LAPAROSCOPIC TOUPET

The floppy portion of the upper stomach is partially wrapped around the esophagus to create a valve. This is the valve that prevents the reflux of stomach acid into the esophagus. The stomach, like a hot dog bun sits under the esophagus (the hot dog). Our surgeons use small incisions to enter the abdomen. The laparoscope, a thin telescope-like instrument, is connected to a tiny camera and then inserted through the small incision. This enables our surgeons to have a magnified image of the patient’s internal organs projected on a television screen. The abdomen is inflated with gas, causing it to expand, and thereby allowing our surgeons to perform the procedure. The floppy portion of the upper stomach is placed behind the esophagus after which the esophagus is sewn to the stomach on either side. It is also attached to the diaphragm muscle that separates the abdominal and chest cavity

BENEFITS OF THE LAPAROSCOPIC TOUPET

• 5 tiny scars instead of one large abdominal scar. Improved cosmetic result
• Reduced post-operative pain
• Shorter hospital stay
• Faster return to work
• Less risk of complications than the Nissen Fundoplication; such as gas bloat and difficulty swallowing

WHAT CAN I EXPECT?

• Patients may expect to stay one day in the hospital
• Light activity is encouraged while recuperating at home
• Most often post operative pain is mild. Some patients may have need for prescription pain medication
• Normal activities should begin in 1-2 days
• There may be temporary difficulty in swallowing, but that will resolve within one to three months after the surgery
• A progressive diet with transition from pureed to soft food over 1–4 weeks

HELLER MYOTOMY

This surgical procedure is used to treat achalasia, a disorder in which the lower esophageal sphincter fails to relax properly and causes food and liquids to have difficulty reaching the stomach. Five or six small incisions are made in the abdominal wall and laparoscopic instruments are inserted. The myotomy is a lengthwise cut along the esophagus, starting above the lower esophageal sphincter or LES and extending down a little way onto the stomach. The myotomy only cuts through the outsider muscle layers of the esophagus which are squeezing it shut. The inner mucosal layer remains intact.

Food can easily pass downward after the myotomy has cut through the lower esophageal sphincter, but stomach acid can easily reflux upward. For that reason this surgery is often combined with partial fundoplication for the purpose of reducing the incidence of postoperative acid reflux.

This surgery usually eliminates most of the achalasia symptoms but not the underlying cause of it. However, it does, greatly improve the ability for the majority of patients to eat and drink. It is a long-term treatment and considered the definitive treatment for achalasia. Most patients will not require any further treatment. However, there are instances when some might require additional treatment somewhere further down the road.

BENEFITS OF THE HELLER MYOTOMY

• Ability to eat and swallow more easily
• 5-6 tiny scars instead of one large abdominal scar. Improved cosmetic result
• Reduced post-operative pain
• Shorter hospital stay
• Return to work in 3 days to a week

WHAT CAN I EXPECT?

• Most patients are able to drink clear liquids late in the same day. A soft diet is started the day after surgery
• Post operative pain is mild. Some patients may have need for prescription pain medication
• Some patients may develop mild reflux

PARAESOPHAGEAL HERNIA REPAIR

A hiatal hernia is a protrusion of the stomach through the diaphragm into the chest. The hernia may range from less than an inch of the stomach to one that includes all of the stomach and sometimes, other organs as well. The opening of the diaphragm may be very small or up to 4-5 inches in diameter. Paraesophageal hernias occur when the stomach moves up along the side of the swallowing tube or esophagus. They are generally larger than sliding hiatal hernias, which are a direct upward protrusion into the chest.

Patients with hiatal hernias will most likely suffer from heartburn, reflux, regurgitation or many of the other symptoms associated with GERD. In the most serious situations the stomach may develop ulcers, bleeding or twisting that could result in decreased blood flow and perforation of the stomach.

A paraesophageal hernia is commonly fixed with the laparoscopic technique involving 5 small incisions. Mesh material may be used if the opening in the diaphragm is wide. The procedure is combined with either a partial Toupet or a complete (NIssen) fundoplication.

BENEFITS OF THE PARAESOPHAGEAL HERNIA REPAIR

• Resolution of life threatening problems such as bleeding, perforation and pneumonia
• Resolution of heartburn and reflux
• Ability to stop antacid medications

WHAT CAN I EXPECT?

• You will be on a pureed diet for one week
• Your diet will be advanced slowly to a regular diet in 2 to 4 weeks.
• You may return to activity in 1 to 2 weeks
• Prevent swallowing excess air by not using straws. Do not chew gum or tobacco. Avoid foods that cause gas