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<TR> <TD><IMG height=1 src="images/blank.gif" width=167><BR> <a href="proceduresHamot.htm" onMouseOver="MM_swapImage('nav_0','','images/menu/procedures_dwn.gif',1)" onMouseOut="MM_swapImgRestore()"><img height=43 width=168 border=0 name=nav_0 src="images/menu/procedures_up.gif"></a><BR> </TD></TR> <tr> <td style="padding-bottom:1px;"><a href="staffResourcesHamot.htm" onMouseOver="MM_swapImage('nav_11','','images/menu/staffResources_dwn.gif',1)" onMouseOut="MM_swapImgRestore()"><IMG src="images/menu/staffResources_up.gif" border=0 name=nav_11></a></td> </tr> </TBODY> </TABLE> <!-- end primary navigation --> </DIV> <IMG title="buffer image" height=24 alt="buffer image" src="images/nav_buffer.gif" width=167 border=0> <table align="center" cellpadding="15"> <tbody> <tr><td><a href="http://www.asbs.org/" target="_blank" ><img src="images/asbs.gif" width="81" height="84" border="0" align="middle"></a></td> </tr> </tbody> </table> <DIV><img title="buffer image" height=24 alt="buffer image" src="images/nav_buffer.gif" width=167 border=0></DIV> <DIV><a href="bmiHamot.htm"><IMG src="images/bmi.gif" width="168" height="60" border=0></a></div> <DIV><img title="buffer image" height=24 alt="buffer image" src="images/nav_buffer.gif" width=167 border=0></DIV> </TD> <TD vAlign=top align=left width=620 background="images/BGvitruvianMan.jpg"> <TABLE cellSpacing=0 cellPadding=0 width="100%" bgColor=#ffffff border=0> <TBODY> <TR> <TD><IMG title="title_guests" height=43 src="images/title_graphic_fundo.jpg" width=368 border=0></TD> <TD><IMG title="Overview" height=43 src="images/right_title_overview249.gif" width=252 border=0></TD> </TR> </TBODY> </TABLE> <TABLE border=0 cellPadding=15 width="100%"> <TBODY> <tr> <td> <p align="center" class="style9"><span class="style5"><br /><br /> <span class="style10">Gastroesophageal Reflux Disease (GERD)</span></span><br /> <span class="style9">(repaired by Laparoscopic Nissen Fundoplication)</span></P> <p align="center" class="style9"><span class="style5"><a href="http://www.gerdsurgery.info/" target="_blank" ><strong>www.gerdsurgery.info</strong></a></span></p><br /> <p align="justify" class="style9"><IMG height=35 alt=I src="images/cap-I.gif" border=0>f you suffer from "heartburn" and medication has failed to control your symptoms, you could benefit from a minimally invasive or Laparoscopic Anti-Reflux Surgery. Heartburn is medically referred to as gastroesophageal reflux disease (GERD). You will find following information about GERD on this page.</p> <ul> <li><FONT size=2>What is gastroesophageal reflux disease (GERD)?</FONT></li> <li><FONT size=2>Medical and surgical treatment options for GERD</FONT></li> <li><FONT size=2>How is this surgery performed?</FONT></li> <li><FONT size=2>Expected outcomes</FONT></li> <li><FONT size=2>What to expect if you choose to have laparoscopic anti-reflux surgery</FONT></li> </ul> <p align="center"><span class="style5"><strong>What Is Gastroesphageal Reflux Disease (GERD)?</strong></span></p> <p align="justify" class="style9"><IMG height=35 alt=A src="images/cap-A.gif" border=0>lthough "heartburn" is often used to describe a variety of digestive problems, in medical terms, it is actually a symptom of gastroesophageal reflux disease. In this condition stomach acids reflux, or accidentally "back up", from the stomach into the esophagus. Heartburn is described as a harsh, burning sensation in the area in between your ribs or just below your neck. The feeling may radiate through the chest and into the throat and neck. Many adults in the United States experience this uncomfortable, burning sensation at least once a month. Other symptoms may also include vomiting, difficulty swallowing and chronic coughing or wheezing</strong></span></p> <p align="center"><span class="style5"><strong>What Causes GERD?</strong></span></p> <p align="justify" class="style9"><IMG height=35 alt=W src="images/cap-W.gif" border=0>hen you eat, food travels from your mouth to your stomach through a tube called the esophagus. At the lower end of the esophagus is a small ring of muscle called the lower esophageal sphincter (LES). The LES acts like a one-way valve, allowing food to pass through to the stomach. Normally, the LES closes immediately after swallowing to prevent back-up of stomach juices which have a high acid content. GERD occurs when the LES does not function properly allowing acid to flow back and burn the lower esophagus. This irritates and inflames the esophagus, causing heartburn and eventually may damage the esophagus.</p> <p align="center"><span class="style5"><strong>What Contributes To GERD?</strong></span></p> <p align="justify"><IMG height=37 alt=A src="images/cap-A.gif" border=0> number of people are born with a naturally weak sphincter (LES). For others, however, fatty and spicy foods, certain types of medication, tight clothing, smoking, drinking alcohol, vigorous exercise or changes in body position (bending over or lying down) may cause the LES to relax, causing reflux, or the accidental back-up of acid. A hiatal hernia (a common term for GERD) may be present in many patients who suffer from GERD, but may not cause symptoms of heartburn</p> <p align="center"><A href="#top"><IMG src="images/topRightLg.gif" border="0"></A></p> <p align="center"><span class="style5"><strong>Treatment Of GERD?</strong></span></p> <p align="justify" class="style9"><IMG height=35 alt=T src="images/cap-T.gif" border=0>reatment of GERD generally follows three progressive steps:.</p> <ul> <li><FONT size=2><strong>Life Style Changes:</strong> In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing smoking and alcohol consumption, and altering eating and sleeping patterns can also help.</FONT></li> <li><FONT size=2><strong>Drug Therapy:</strong> If symptoms persist after these life style changes, drug therapy may be required. Antacids neutralize stomach acids and over-the-counter medications reduce the amount of stomach acid produced. Both may be effective in relieving symptoms. Prescription drugs may be more effective in healing irritation of the esophagus and relieving symptoms.</FONT></li> <li><FONT size=2><strong>Surgery:</strong> In many cases, changing diet and taking over-the-counter antacids can reduce how often and how harsh your symptoms are. Losing weight, reducing smoking and alcohol consumption, and altering eating and sleeping patterns can also help.<br /><br />Patients who do not respond well to lifestyle changes or drug therapy, or who continually require medications to control their symptoms, will have to live with their condition or undergo a surgical procedure. Surgery is very effective in treating GERD. However, in the past, this operation required a large abdominal incision resulting in significant pain after surgery and a recovery period of six weeks or greater.<br /><br /> <span class="style11">Since early 1990s, this technique has been modified using laparoscopic (minimally invasive) techniques that avoid the necessity of a large abdominal incision.</span></FONT></li> </ul> <p align="center"><span class="style5"><strong>How Is Laparoscopic Anti-Reflux Surgery Performed?</strong></span></p> <p align="justify" class="style9"><IMG height=36 alt=L src="images/cap-L.gif" border=0>aparoscopic anti-reflux surgery (commonly referred to as Laparoscopic Nissen Fundoplication) involves reinforcing the "valve" between the esophagus and the stomach 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.</p> <p align="justify" class="style9">In a laparoscopic procedure, surgeons use small incisions (1/4 to 1/2 inch) 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.</p> <p align="justify" class="style9">The entire operation is performed "inside" after the abdomen is expanded by pumping a harmless gas (CO2) into it.</p> <p align="center"><span class="style5"><strong>The Expected Results After Laparoscopic Anti-Reflux Surgery</strong></span></p> <p align="justify" class="style9"><IMG height=37 alt=A src="images/cap-A.gif" border=0>ccording to recent studies the vast majority of patients who undergo the procedure are either symptom-free or have significant improvement in their GERD symptoms.</p> <P><strong><FONT size=2>The advantage of the laparoscopic approach is that it usually provides:</FONT></strong></P> <UL> <LI><FONT size=2>Reduced postoperative pain</FONT></LI> <LI><FONT size=2>Shorter hospital stay</FONT></LI> <LI><FONT size=2>A faster return to work</FONT></LI> <LI><FONT size=2>Improved cosmetic result</FONT></LI> </UL> <p align="center"><A href="#top"><IMG src="images/topRightLg.gif" border="0"></A></p> <p align="center"><span class="style5"><strong>The Risks Of Laparoscopic Anti-Reflux Surgery?</strong></span> <p align="justify" class="style9"><IMG height=37 alt=A src="images/cap-A.gif" border=0>lthough the operation is considered safe, complications may occur as they may occur with any operation.</p> <P><FONT size=2><strong>Complications during the operation may include:</strong></FONT></P> <UL> <LI><FONT size=2>Adverse reaction to general anesthesia</FONT></LI> <LI><FONT size=2>Bleeding</FONT></LI> <LI><FONT size=2>Injury to the esophagus, spleen or the stomach</FONT></LI> </UL> <P><FONT size=2><strong>Complications after the operation may include:</strong></FONT></P> <UL> <LI><FONT size=2>Infection of the wound, abdomen, or blood</FONT></LI> <LI><FONT size=2>Other less common complications may also occur</FONT></LI> </UL> <P><FONT size=2><strong>Conversion to an open procedure</strong></FONT></P> <p align="justify" class="style9">In a small number of patients the laparoscopic method is not feasible because of the inability to visualize or handle the organs effectively. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication. It is sound surgical judgment. Factors that may increase the possibility of converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. The decision to convert to an open procedure is strictly based on patient safety.</p> <p align="center"><span class="style5"><strong>Side Effects of The Operation</strong></span></p> <p align="justify" class="style9"><IMG height=36 alt=L src="images/cap-L.gif" border=0>ong-term side effects to this procedure are generally uncommon.</p> <p align="justify" class="style9">Some patients develop temporary difficulty swallowing immediately after the operation. This usually resolves within one to three months after surgery. Occasionally, these patients may require a simple procedure to expand the esophagus (endoscopic dilation) or rarely re-operation.</p> <p align="justify" class="style9">The ability to belch and or vomit may be limited following this procedure. Some patients complain of stomach bloating</p> <p align="justify" class="style9">Rarely, some patients report no improvement in their symptoms.</p> <p align="center"><span class="style5"><strong>What To Expect Before Laparoscopic Anti-Reflux Surgery</strong></span></p> <p align="justify" class="style9"><IMG height=37 alt=T src="images/cap-T.gif" border=0>o determine if you are a candidate for laparoscopic anti-reflux surgery a thorough medical evaluation by your personal physician is necessary. Some diagnostic tests may be necessary. Your surgeon will discuss with you whether or not this operation may be a benefit to you.</p> <UL> <LI><FONT size=2>After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery</FONT></LI> <LI><FONT size=2>After midnight the night before the operation no food or liquids should be taken</FONT></LI> <LI><FONT size=2>If you take medication on a daily basis, discuss this with our staff as we may want you to take some of your medications on the morning of surgery with a sip of water. If you take aspirin, blood thinners or arthritis medication you need to discuss with our staff the proper timing of discontinuing these medications before your operation. Please inform our office If you take a herbal supplement or a natural medicine, e.g. St John s Wort, Ginsung, Biloba or Vitamin E. These medications can interfere with anesthesia or cause excessive bleeding and need to be stopped for a week before surgery</FONT></LI> </UL> <p align="center"><A href="#top"><IMG src="images/topRightLg.gif" border="0"></A></p> <p align="center"><span class="style5"><strong>What To Expect The Day Of Surgery</strong></span></p> <UL> <LI><FONT size=2>You usually arrive at the hospital the morning of the operation</FONT></LI> <LI><FONT size=2>A qualified medical staff member will place a small needle/catheter in your vein to dispense medication during surgery</FONT></LI> <LI><FONT size=2>Often pre-operative medications are necessary</FONT></LI> <LI><FONT size=2>You will be under general anesthesia - asleep - during the operation which may last several hours</FONT></LI> <LI><FONT size=2>Following the operation you will be sent to the recovery room until you are fully awake</FONT></LI> <LI><FONT size=2>Most patients stay in the hospital the night of surgery and may require additional days in the hospital</FONT></LI> </UL> <p align="center"><span class="style5"><strong>What To Expect After Surgery</strong></span></p> <UL> <LI><FONT size=2>Patients are encouraged to engage in light activity while at home after surgery</FONT></LI> <LI><FONT size=2>Post operative pain is generally mild although some patients may require pain medication</FONT></LI> <LI><FONT size=2>Usually, anti-reflux medication is not required after surgery</FONT></LI> <LI><FONT size=2>You will need to make the following changes in your diet for the first weeks:</FONT></LI> <UL> <LI><FONT size=2>You will stay on full liquid diet for two to three weeks followed by gradual advance to solid foods</FONT></LI> <LI><FONT size=2>When you get to solid food, you will need to chew your food well and eat very slowly</FONT></LI> <LI><FONT size=2>Avoid watching TV and talking during your meals</FONT></LI> <LI><FONT size=2>Put your knife and fork back on the table after every bite and concentrate on chewing</FONT></LI> <LI><FONT size=2>Take 20 to 25 minutes to eat your meal</FONT></LI> </UL> <LI><FONT size=2>You will probably be able to get back to your normal activities within a short amount of time. These activities include showering, driving, walking up stairs, lifting, work and sexual intercourse</FONT></LI> <LI><FONT size=2>If you have prolonged soreness and are getting no relief from the prescribed pain medication, you should notify our office. You should call and schedule a follow-up appointment within 2 weeks after your operation</FONT></LI> </UL> <p align="center"><span class="style5"><strong>When To Call Our Office?</strong></span></p> <p align="justify"><IMG height=37 alt=I src="images/cap-I.gif" border=0><span class="style9">f you develop any of the following, be sure to call our office at (814) 877-6997 during business hours (9am-5pm Monday-Friday)</span></p> <UL> <LI><FONT size=2>Persistent fever (over 100°F)</FONT></LI> <LI><FONT size=2>Bleeding</FONT></LI> <LI><FONT size=2>Increased abdominal swelling or pain</FONT></LI> <LI><FONT size=2>Persistent nausea or vomiting</FONT></LI> <LI><FONT size=2>Chills</FONT></LI> <LI><FONT size=2>Persistent cough or shortness of breath</FONT></LI> <LI><FONT size=2>Difficulty swallowing that doesn't go away within a few weeks</FONT></LI> <LI><FONT size=2>Drainage from any incision</FONT></LI> </UL> <table align="center" bordercolor="#FF0000" border="3" cellpadding="20" width="90%"><tr><td><p align="center" class="style9"><strong>At night and on weekends, please call the hospital operator at<br />(814) 877-6000<br /> and request to page Dr. Ali or Dr. Arreola</strong></p></td> </tr></table> <p align="center"></p> <p align="center"><A href="#top"><IMG src="images/topRightLg.gif" border="0"></A></p> </TD> </TR> </TBODY> </TABLE> </TD> </TR> <TR> <TD colSpan=2> <TABLE cellSpacing=0 cellPadding=0 align=center border=0 bgcolor="f3efe6"> <TBODY> <TR> <TD colspan="3" align="center"><IMG title="footer" height=42 src="images/footer_graphicHamot.gif" width=790 border=0> </TD> </TR> <TR> <TD align=left width="203"></TD> <TD align=middle width=390> <p align="center"> <a href="disclaimerHamot.htm">Disclaimer</a>&nbsp; | &nbsp; <a href="mailto:amjad.ali@hamot.org">Webmaster</a><br /> ©2008 mylapsurgeon.com</p><br /> </TD> <TD align=left width="203"></TD> </TR> </TBODY> </TABLE> </TD> </TR> </TBODY> </TABLE> </BODY> </HTML>