Upper Gastrointestinal Procedures
- Laparoscopic fundoplication
- Laparoscopic paraesophageal hernia repair
- Laparoscopic heller myotomy for achalasia
- Laparoscopic gastrectomy
- Laparoscopic transgastric surgery
The goal of this surgery is to relieve heartburn and prevent complications caused by longstanding acid reflux. Normally the valve separating the stomach and the esophagus closes automatically to keep stomach acids down. However, with reflux disease the sphincter muscle controlling this valve weakens, allowing stomach acid to travel up into the esophagus. This condition causes painful heartburn and indigestion.
In a fundoplication procedure, a new valve is constructed by wrapping the upper portion of the stomach around the lower end of the esophagus. The wrap supports the sphincter muscle controlling this valve so that stomach acid is not allowed to push its way up into the esophagus. Using a laparoscope to perform this operation allows the surgeon to make only four or five quarter-inch incisions at various points on the abdomen to provide access for endoscopic instruments. This reduces the hospital stay to only 2-3 days, with a 1-2 week recovery period.
Acid reflux is a backflow of stomach acid into the esophagus. Acid reflux frequently happens when the lower esophageal sphincter releases more often that it should and at inappropriate times. This allows harsh stomach juices to back up into the esophagus.
A hiatal hernia is caused by an opening in the flat muscle, known as the diaphragm, which separates the lungs from the abdomen, allowing the stomach to bulge into the chest cavity. This can cause increased heartburn and difficulty swallowing. The hiatal hernia is believed to be caused by a variety of factors which include obesity, trauma, stress, heavy lifting and in some cases, people are born with a hernia.
Back to top
Laparoscopic paraesophageal hernia repair
A Paraesophageal hernia is a medical condition in which a large portion of the stomach herniates into the thorax or chest cavity. Many people who have a paraesophageal hernia may experience pain after eating, vomiting, constipation, chest fullness, shortness of breath or epigastric pain.
Treating this condition with laparoscopic surgery requires 4 to 6 small incisions for the laparoscope. The hernia sac is usually excised to reduce the risk of recurrence and an antireflux procedure is also usually performed to secure the stomach in its proper location within the abdomen. The average post surgical hospital stay is anywhere from 2-4 days.
Back to top
Laparoscopic heller myotomy for achalasia
A heller myotomy is a surgical procedure to correct a condition called Achalasia. This is a condition characterized by the reduced ability to move food down the esophagus into the stomach. The value between the esophagus and stomach (lower esophageal sphincter) is set at an abnormally high pressure and does not relax to let food through, in addition, the esophageal smooth muscle wall loses its wave-like contraction, which normally forces food down the esophagus into the stomach. Persons who suffer from this condition report gastro-esophageal reflux, regurgitation and dysphagia, a swallowing disorder that can be life threatening. These patients are at increased risk of cancer of the esophagus. If achalasia is left untreated, total removal of the esophagus my be required.
Traditionally, this surgery required a standard left thoracotomy, an opening of the chest cavity. However, treating this condition with the laparoscopic heller myotomy requires 3-5 half-inch incisions in the abdomen. Using the laparoscopic equipment, the surgeon frees the esophageal muscle from the lower end of the esophageal sphincter, thus, allowing the lower esophageal sphincter to relax and empty food into the stomach. This surgical procedure relieves the patient of their symptoms in 85% to 90% of the cases.
Back to top
A gastrectomy involves removing a portion of the stomach usually containing a tumor. This is required for larger tumors that are more likely to be cancerous.
Back to top
Laparoscopic transgastric surgery
Laparoscopic Transgastric surgery involves operating inside the stomach using small incisions in the abdominal wall and stomach wall to remove small polyps and tumors. Stomach polyps are small, usually inflamed, protrusions in the lining of the stomach similar in appearance to polyps in the colon. Up to 25 percent of patients who undergo an upper endoscopy examination are found to have stomach polyps, of which the majority are benign. A opposed to a stomach polyp, a stomach tumor is a non-inflamed abnormal mass of tissue.
Back to top