South Nassau Communities Hospital

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South Nassau in the Community

05/11/2010

Surgery without an Incision to Fix Chronic Acid Reflux Disease


Gregory Nishimura, MD FACS, a laparoscopic and bariatric surgeon at South Nassau Communities Hospital, didn’t need to make a single incision to relieve Vernon Barber of chronic acid reflux disease.

That’s because Dr. Nishimura specializes in using a “minutely invasive” surgical device called the EsophyX® to perform a procedure called “transoral incisionless fundoplication” (TIF), which corrects the cause of chronic acid reflux disease (also known as gastroesophegeal reflux disease, or GERD).

“The fire has gone out and what is left is an occasional smoking ember,” said Mr. Barber. “The results of the surgery, I have to say, appear at this point in time to be a resounding success.”

Clinical studies show that 80 percent of patients that had TIF surgery reported a significant reduction or complete elimination of GERD symptoms. Approximately 79 percent of patients reported that two years after surgery they were still off daily medications, such as H2 blockers and proton pump inhibitors, which they had been using to alleviate and control the symptoms of GERD.

“It has been five months since I had the TIF procedure,” said Mr. Barber. “I am now able to eat and drink just about anything without significant ill effects and I am off of all medications that I needed to manage the reflux.”

GERD occurs when stomach acid or, occasionally, bile flows back (refluxes) into the food pipe (esophagus). This is caused by the weakening or loss of tone of the lower esophageal sphincter (LES), which is a complex band of smooth muscle tissue responsible for closing and opening the lower end of the esophagus and is essential for maintaining a pressure barrier against contents in the stomach. The weakening prevents the LES from closing up completely after food empties into the stomach, allowing acid from the stomach to back up into the esophagus.

The constant backwash of acid irritates the lining of the esophagus and causes GERD signs and symptoms including heartburn, chest pain, dry cough and difficulty swallowing (dysphagia); sour taste in the mouth; hoarseness or sore throat; regurgitation of food or sour liquid; and sensation of a lump in the throat.

To perform TIF, Dr. Nishimura enters the EsophyX into the body through the mouth rather than through an abdominal surgical incision. In combination with an endoscope (a medical device consisting of a long, thin, flexible or rigid tube with a light and a video camera to produce video of the inside of the patient's body on a high-definition monitor), the EsophyX is lowered down the esophagus and into the stomach.

The tip of the EsophyX is equipped with small surgical instrumentation to grip and cut tissue that allow Dr. Nishimura to pull together several folds of tissue in the LES, fasten it with “H” shaped sutures to strengthen and tighten the LES and reconstruct the antireflux valve at the gastroesophageal junction. This restores the function of the LES and eliminates the occurrence and continuation of GERD.

The patient benefits of the EsophyX approach as compared to traditional laproscopic or open GERD surgery includes shorter length of stay in the hospital, reduced discomfort after surgery and no scarring. “In fact, most patients are discharged from the hospital the next day and return to work and are able to perform normal daily activities within a week,” said Rajeev Vohra, MD, FACS, chief of minimally-invasive surgery and bariatric surgery at South Nassau.

In addition to EsophyX, South Nassau’s Division of Minimally Invasive Surgery specializes in the array of traditional minimally-invasive surgeries. This includes the single incision laparoscopic technique to perform gallbladder surgery as well as procedures for gastroesophageal reflux disease (GERD), severe heartburn, hernias and diseases of the intestine, spleen, kidneys and adrenals. For more information or to schedule a consultation, call (516) 374-8631 or go to www.southnassaubariatrics.org.



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