Minimally invasive surgery

When stomach acid, and occasionally stomach content, flows up the esophagus frequently, it can cause irritation to the esophagus lining. This condition, called GERD or reflux, is often treated with acid blocking medications like omeprazole, Nexium, Protonix, and Prevacid. However, there are times when medication is not enough, and surgery is needed to strengthen the muscle that prevents acid from leaving the stomach.

The sphincter muscle at the bottom of the esophagus normally relaxes to allow food to pass into the stomach. In achalasia, the muscle does not relax properly. This causes food to sit in the bottom of the esophagus for a long time causing bad breath, choking, vomiting and eventual enlargement of the esophagus. The treatment for this is an operation that splits the muscle to allow passage of food more normally.

The opening in the diaphragm (breathing muscle) through which the esophagus passes can sometimes get larger, allowing part of the stomach, and sometimes other organs, to get pushed up into the chest. This hiatal hernia can cause shortness of breath, severe acid reflux that does not respond to acid blocking medications and a sensation of food sticking after swallowing. In rare cases, this can cause a twisting of the stomach which leads to complete blockage. Sometimes surgery is necessary to relieve this condition.

In diagnosing GERD and achalasia, we use essential testing like manometry (a special probe that measures the effectiveness of the muscle contractions) and 24-hour pH monitoring, which measures the acid content of the stomach and esophagus. Our surgeons, who specialize in the treatment of diseases of the esophagus, will use this information and more to determine your best course of treatment.

If surgery is involved in your plan of care, we use the latest minimally invasive techniques to reduce risk of infection and minimize your recovery time. Most people go home just two days after surgery.

A hernia occurs when an organ or section of fat protrudes through an opening in the wall that normally holds it back. Some hernias go back in by themselves and others can be pushed back into place. These are called reducible hernias. Though others cannot be repaired in this way and are called irreducible. These are much less common, but can be life-threatening without proper treatment. All hernias can cause discomfort and prevent normal activities.

Inguinal (groin) hernia
The most common type of hernia is the inguinal hernia, which appears in the groin. An example is when the intestine pushes through a weak spot in the abdominal muscle. Primary causes include obesity, pregnancy, heavy lifting and straining to pass stool.

Umbilical (belly button) hernia
We are all born with a tiny hole in the belly button, through which we were fed when we were growing in the womb. Umbilical hernia occurs when part of the intestine pushes through that opening. While this most often occurs in infants, it can also affect adults. 

Incisional hernia
Incisional hernias happen most often after large conventional operations. If after healing, the area around the closed incision is not as strong as it once was, a hernia may develop.

Not all hernias require surgical repair, but when they do, we use minimally invasive surgical techniques whenever possible. Frequently, laparoscopic surgery is performed. This results in less pain after surgery, quicker recovery time, less chance for infection and less scarring.

In most cases, the surgeon will make several small incisions through which a scope and instruments are inserted and the wall is repaired. Sometimes, a piece of plastic mesh is placed to reinforce the area to prevent recurrence. Patients who have this surgery usually go home the same day and are instructed to avoid heavy lifting for one month until the body has healed.

Patients sometimes require the placement of a feeding tube in the beginning part of the small intestine to receive nutrition. Examples might be if the stomach cannot be used or if there is a high risk of choking when the stomach has been used in the past.

Blockages in the small intestine must be treated, as they can cause the blocked part of the intestine to die. They can be caused by:

• Adhesions – fibrous scar tissue that builds up after conventional abdominal surgery, causing intermittent blockage of the intestines as they kink (much like a garden hose), resulting in nausea, vomiting, severe bloating and inability to eat or drink
• Crohn’s disease 
• Diverticulitis
• Hernias
• Benign or cancerous tumors

Minimally invasive surgery to clear intestinal blockage involves less pain after surgery and decreases the amount of time it takes for the intestines to work again, compared to conventional surgery. Typically you can expect to go home in just two to three days.

Patients may require the placement of a feeding tube because of illness and an inability to swallow safely. Typically, these tubes are placed via endoscopy by a gastroenterologist. However, sometimes endoscopy is not possible and the tube must be placed surgically. Feedings tubes may be temporary or permanent depending on the specific situation.

The tube is placed using a laparoscopic approach with only four small incisions, one of which is used for the tube itself. The tube is secured to the stomach using stitches, then that part of the stomach is secured to the abdominal wall.

There are tumors of the stomach—both cancerous and noncancerous—which, depending on the size and type, can be removed using a minimally invasive approach. Once a thorough evaluation is performed to determine the size and extent of the tumor, it can safely be removed laparoscopically. Depending on the location of the tumor, this surgery may entail removal of a small part of the stomach. In some instances, a somewhat larger operation may be needed to reconnect the stomach to the small intestine. It is still possible to perform this laparoscopically with a few small incisions.

Excess weight can cause serious health problems like diabetes, high blood pressure and sleep apnea. For some, bariatric surgery is an effective way to achieve weight loss. It works by limiting the stomach’s capacity. Different types of weight loss procedures accomplish this in different ways. One way is by restricting the amount of food the stomach can hold. Another is by reducing the absorption of food into the body. Some bariatric surgeries use both methods.

At our world-class Center for the Surgical Treatment of Obesity, we regularly perform the following minimally invasive procedures:

• Gastric bypass
• Sleeve gastrectomy
• Lap-band