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Minimally Invasive Surgery - Surgery of the esophagus

Benign diseases of the esophagus include severe GERD and achalasia.

GERD (reflux of stomach acid into the esophagus) is often treated with acid blocking medication (common examples include omeprazole, Nexium®, Protonix® and Prevacid®). Despite maximum therapy with these medications, some people still experience severe reflux symptoms. In these cases surgery may be the only option to treat the problem because the sphincter muscle is too weak to prevent acid from leaving the stomach and entering the bottom of the esophagus (show picture). Operations used to treat this involve wrapping part of the stomach around the muscle to reinforce it. These are performed laparoscopically and result in improvement of symptoms in nearly 90% of cases. Typically, patients are able to go home 2 days after the procedure.

The lower esophageal sphincter muscle 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 (show picture). The treatment for this is an operation which splits the muscle to allow passage of food more normally. This is also done laparoscopically and, as a result, most people go home 2 days after the procedure.

Another problem which can result is a paraesophageal or hiatal hernia. The aperture in the diaphragm (breathing muscle) through which the esophagus passes gets larger and part of the stomach, and sometimes other organs, can get pushed up into the chest (see picture). This 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 causing complete blockage. Patients with this problem often have upper abdominal pain and cannot hold down any food or drink. This tends to be more of an emergency. Either way, paraesophageal hernias are repaired laparoscopically. The operation makes use of a few small incisions on the abdomen; the stomach is pulled out of the chest and put back into normal position and the aperture in the diaphragm is closed just enough to allow the esophagus to pass through it. The stomach is wrapped around the junction of the esophagus and the stomach loosely to prevent recurrence. Patients typically go home 2 days after the surgery.

A thorough evaluation is performed by our surgeons who specialize in the treatment of diseases of the esophagus. This will involve a test called manometry, where a special probe is placed in the esophagus to measure the effectiveness of the muscle contractions. Additionally, a similar test which measures the acid content of the stomach and esophagus is performed and is called a 24-hour pH monitoring. These tests are essential to properly diagnose GERD or achalasia and determine which operation is appropriate.

These tests can be performed in our state-of-the-art diagnostic GI laboratory and is the only one on Staten Island. The results are interpreted by the surgeons and used to tailor the surgical approach appropriate for you.

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