GERD and Hiatal Hernia: Could LINX® Reflux Management System Be Right for You?

Acid reflux, heartburn, and indigestion are all common symptoms of gastroesophageal reflux disease or GERD. This common problem afflicts over 20 million people every day here in the United States.

A hiatal hernia is when the stomach slips up into the chest. Hiatal hernias can worsen acid reflux because the typical sphincter mechanism in the lower esophagus is dysfunctional, and there is a mechanical disturbance of the natural flow of solid foods and liquids. Pregnancy, obesity, coughing, or constipation increase intra-abdominal pressure, which can worsen the symptoms of reflux and worsen a hiatal hernia.

Generally, hiatal hernias occur more often for patients who are overweight, women, and over 50 years old. Hiatal hernias can be diagnosed with upper endoscopy (EGD), an esophagram or upper gastrointestinal (UGI) series.

The LINX® Reflux Management System is a small and flexible band of interlined titanium beads with magnetic cores. To select the right size, the esophagus is measured with a specialized tool for all patients undergoing placement of a LINX device. First, a necklace-like tool is placed around the lower esophagus at the level of the lower esophageal sphincter (LES) to get the best fit for the LINX device. The measurement tool is then removed, and the LINX device is implanted, making sure the ends of the band are aligned and securely linked.

Magnetic attraction between the beads helps the lower sphincter resist opening to gastric pressures, preventing reflux of the acidic content in the stomach into the esophagus. The device is designed so that normal swallowing pressures temporarily break the magnetic bond, allowing food and liquid to pass normally into the stomach. Due to the magnetic attraction, the device will assist in closing the lower sphincter immediately after swallowing, augmenting the lower esophageal sphincter and restoring the body’s natural barrier to reflux.

If you suffer from GERD and would like to decrease, or in some cases, completely stop taking medication for this problem, the LINX® Reflux Management System could be the perfect solution for you. Schedule an appointment at VIPSurg to learn more.

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Benefits of Robotic Surgery

Technology is changing the way we do practically everything now, and the medical world isn’t immune. The da Vinci robot is changing the way surgeons are performing operations and is providing benefits to both patients and doctors.

While the surgeon sits at a modified computer console, he/she can control the instruments and camera. Placing their fingers into the master controls, the surgeon operates the arms of the da Vinci robot while simultaneously looking through a stereoscopic high-definition monitor that gives a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. The robot’s “hands” have a high degree of dexterity, allowing surgeons the ability to operate in very tight spaces in the body that would otherwise only be accessible through open (long incision) surgery.

Using the da Vinci robot allows surgeons to perform a growing number of surgical procedures. Since these surgeries can be done through very small incisions, patients experience many benefits compared to open surgery, including:

  • Less trauma on the body
  • Shorter hospitalization
  • Reduced pain and discomfort
  • Faster recovery time and return to normal activities
  • Smaller incisions, resulting in reduced risk of infection
  • Reduced blood loss and transfusions
  • Minimal scarring

The surgical team supervises the robot at the patient’s bedside. Unlike traditional surgery where the surgeon stands over the patient sometimes for hours, a surgeon using the da Vinci system is seated, substantially decreasing surgeon fatigue. Add in the greater visualization abilities, enhanced dexterity, and greater precision and there are major advantages for both patients and surgeons using robotic surgery alike.

Dr. Tsuda and Dr. Ryan at VIPSurg are expert robotic surgeons. Call 702-487-6000 to schedule a consultation.

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5 Common Signs and Symptoms of a Hernia

Hernias are caused when fatty tissue or internal organs squeeze through weak muscle walls and connective tissue. A hernia can occur in any part of the body, but the most common areas are the inner groin (inguinal hernia), outer groin (femoral hernia), near the navel (umbilical hernia), upper abdomen (hiatal hernia), or at the site of a recent surgical scar (incisional hernia) They can be mildly to extremely painful, and they sometimes go away when you press on them or lie down. They are aggravated by coughing or sneezing. If a hernia doesn’t resolve itself, you may require surgery.

Here are 5 common signs and symptoms of a hernia:

  1. Visible Lump – often the first indication of a hernia is a visible lump or bulge which left untreated becomes very painful as more tissue is forced through the opening, widening and splitting the muscle, forming a large sac. Sometimes patients notice the bulge before the pain, but often there’s pain before the lump is noticeable to the naked eye.

**It’s very important that you go to your doctor as soon as you notice a lump anywhere as it may signify another health issue.

  1. Pain — ranging from slightly uncomfortable to severely painful, patients report everything from just seeing the bulge with no pain to excruciating pain that cannot be ignored
  2. A Full Feeling — A heavy, bloated, or uncomfortable feeling in your gut is common to those with umbilical or hiatal hernias. A feeling often described as a dragging sensation in the groin may be an inguinal hernia.
  3. Stomach Upset — including indigestion, nausea, and bowel issues may occur with hernias located in the groin or abdominal areas. If a hernia becomes strangulated (or blood supply is cut off), you will experience nausea and vomiting. A strangulated hernia requires immediate emergency medical attention as it is life-threatening to the patient.
  4. Difficulty with Daily Activities — as hernias grow and pain worsens, the quality of your daily life is affected. When common activities such as work, picking up children, and exercise become difficult and uncomfortable, hernia-repair surgery is often the answer.

At VIPSurg, our surgeons are experts in hernia repair using minimally invasive daVinci robotic surgery. Schedule a consultation to learn more.

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Robotic Surgery Explained

Screen Shot 2017-10-10 at 12.35.38 PMRobotic surgery is a type of minimally invasive surgery. “Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fit through a series of quarter-inch incisions. When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision. The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure.

The surgeon controls these instruments and the camera from a console located in the operating room. Placing his fingers into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. Every movement he makes with the master controls is replicated precisely by the robot. When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale, the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves. And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue.

The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment. Utilizing this advanced technology, surgeons are able to perform a growing number of complex surgical procedures. Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including:

  • Less trauma on the body
  • Minimal scarring
  • Faster recovery times

If you’re facing general or bariatric surgery in the Las Vegas area, contact VIP SURG to learn about how we can help. Drs. Tsuda and Ryan specialize in minimally invasive procedures and are experts in robotic surgery. Call for a consultation at 702-487-6000.

LINX: Treating GERD with Innovation

A hiatal hernia occurs when part of the stomach pushes through the diaphragm. The diaphragm normally has a small opening for the esophagus. This opening can become the place where part of the stomach pushes through. Small hiatal hernias often cause no symptoms, while larger ones can cause pain and heartburn, leading to gastroesophageal reflux disease, or GERD. In 2012, the Food and Drug Administration approved a new treatment device called the LINX Reflux Management System to offer a new approach to treating GERD, a disease that is increasing at a rate of 30 percent every decade.

Think of the stomach as a mixing bowl that allows food and digestive juices to combine to begin the digestive process. The stomach has a protective lining that prevents acid in the digestive juices from eating away at the stomach muscle and causing inflammation. Unfortunately, the esophagus does not have a similar protective lining. Instead it relies on the lower esophageal sphincter (LES) to act as a valve to prevent acid from refluxing from the stomach into the esophagus. In the situation of a hiatal hernia, part of the stomach pushes up through the opening allowing acid to pass into the esophagus causing symptoms may include the following:

  • heartburn
  • nausea, vomiting, or retching (dry heaves)
  • burping
  • water brash, the rapid appearance of a large amount of saliva in the mouth that is stimulated by the refluxing acid

Symptoms usually are worse after meals. These symptoms may be made worse when lying flat and may resolve with sitting up or walking.

In some patients, reflux into the lower esophagus sets off nervous reflexes that can cause a cough or even spasm of the small airways within the lungs (asthma). A few patientsanatomy-archers may reflux acid droplets into the back of their throat. This acid can be inhaled or aspirated into the lung causing coughing spasms, asthma, or repeated infections of the lung including pneumonia and bronchitis. This may occur in individuals of all ages, from infants to the elderly.

Fortunately, the innovative LINX procedure is helping with this significant health problem. This device is a series of magnets in the form of ring that is implanted around the bottom of the esophagus during a short, 40-minute laparoscopic procedure.

The ring of magnets is designed to stay closed and prevent the reflux valve from opening thereby preventing acid from the stomach move up into the esophagus. The magnets will open up the ring when people are eating to let food in much like a person’s native reflux valve.

 

Here are some things you need to know about the LINX procedure.

  • It is focused on the underlying cause of reflux disease not the side effect. Reflux disease is a result of a damaged lower esophageal sphincter (LES).
  • It is safer than the long-term use of proton pump inhibitors (PPIs). Studies have proven that reflux disease can progress even when PPI therapy has effectively eliminated GERD symptoms. LINX is effective at reducing symptoms and improving quality of life.
  • A recent study published in the New England Journal of Medicine tracked 100 patients for three years after their LINX surgery. That study found an overall decrease in stomach contents reaching the esophagus, fewer reflux symptoms, and a substantial reduction in PPI usage.
  • The side effects disappear over time in most cases. Initially, most patients experience some discomfort, but it typically dissipates over several weeks. In addition, the most commonly reported side effect is mild difficulty swallowing, which usually subsides over time.
  • The cost can be much less than a lifetime of PPI use: a 2010 study by Consumer Reports found once-a-day PPI use can range from $2,000 to $4,500 per year for brand name prescription PPIs.
  • This is minimally invasive and is performed as an out-patient procedure.
  • LINX is reversible and can be replaced.
  • Since the LINX band is placed around the LES, the device can be removed or replaced, if necessary.
  • This procedure is recommended for those with continued GERD symptoms under maximum therapy prescribed by a specialist.
  • LINX is not for everyone with advanced GERD. Today LINX is not approved for those with Barrett’s Esophagus or anyone suffering from esophageal cancer. It is important for everyone suffering from advanced stages of reflux disease to explore all available options before their disease progresses to the point where options are limited.

It is important to take your heartburn symptoms seriously because they are signals from your body that something is wrong. Since reflux disease is a progressive chronic condition, treating it early could prevent you from having to consider surgery later on.

As the first LINX trained surgeons in Las Vegas, Dr. Shawn Tsuda and Dr. Heidi Ryan at VIP SURG are ready to help you fight back against gastroesophageal reflux disease. Schedule a consultation to learn more.

 

 

Heartburn or GERD – It makes a Difference

Acid reflux occurs when stomach contents moves backward into the esophagus. It’s also called acid regurgitation or gastroesophageal reflux (GERD). Acid reflux is a common digestive condition. According to the American College of Gastroenterology, more than 60 million Americans experience acid reflux at least once a month. More than 15 million Americans experience it every day.

Acid reflux usually causes a burning sensation in the chest. The sensation radiates up from the stomach to the mid-chest or throat. This is also known as heartburn. When symptoms that seem like heartburn persist, it could be a disease with more serious consequences. Chronic reflux can sometimes lead to difficulty swallowing and in some cases it can even cause breathing problems like asthma.

Acid reflux is caused when the muscle at the end of the esophagus, the lower esophageal sphincter (LES) is faulty or weak. The LES is a one-way valve that normally opens for limited amounts of time when you swallow. Acid reflux occurs when the LES doesn’t close properly or tightly enough. A faulty or weakened LES allows digestive juices and stomach contents to rise back up into the esophagus.

Large meals that cause the stomach to stretch a lot can temporarily loosen the LES. Other factors associated with reflux include:

  • obesity
  • stress
  • hiatal hernia (when part of the stomach pushes up through the diaphragm)
  • consuming particular foods (particularly carbonated beverages, coffee, and chocolate)

Most people experience occasional acid reflux or GERD. However, in some cases the digestive condition is chronic.

Acid reflux can affect infants and children as well as adults. Children under 12 usually don’t experience heartburn. Instead they have alternative symptoms like:

  • trouble swallowing
  • dry cough
  • asthma
  • laryngitis (loss of voice)

These alternative symptoms can also appear in adults.

Gastroesophageal Reflux Disease (GERD) is a chronic digestive disease. It’s the more serious form of GERD and can eventually cause more serious health problems if left untreated. Acid reflux that occurs more than twice a week and causes inflammation of the esophagus is considered to be GERD.

Most people with GERD experience symptoms such as:

  • heartburn
  • regurgitation
  • trouble swallowing
  • a feeling of excessive fullness

Living with acid reflux is inconvenient. Fortunately, symptoms can generally be controlled through:

  • stopping smoking
  • reducing alcohol consumption
  • eating less fat
  • avoiding foods that set off attacks
  • losing weight
  • sleeping in different positions
  • antacids
  • anti-reflux medication
  • surgery

Most people with reflux will not have long-term health problems. However, GERD can increase the risk of Barrett’s esophagus. This is a permanent change in the lining of the esophagus which increases the risk of esophageal cancer.

If you suffer from GERD that isn’t responding to treatment, schedule an appointment with Dr. Shawn Tsuda to learn about LINX http://www.linxforlife.com/. This could be the answer you’ve been searching for.

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Tips for Choosing the Right Surgeon for You

Whether you need a complicated, invasive surgery or a simple out-patient operation, choosing the right surgeon can seem overwhelming. Even what should be relatively straightforward procedures such as gallbladder removal or hernia repair can sometimes result in serious complications, so you always want to be in good surgical hands. Here are some tips on finding the surgeon and hospital that are best for your situation.

Once you have narrowed down your list of potential surgeons, schedule a consultation. If you have a fairly urgent need for surgery, you may have to cross surgeons off of your list purely because of the wait for a visit. Otherwise, plan to meet with at least two surgeons and discuss your potential surgery.

Things to ask:

  • Is surgery necessary? The best way to avoid surgical errors is to avoid surgery entirely, so ask about the effectiveness and safety of alternatives. Compare those with the risks of surgery and the chance that it will help you.
  • Is your board certification up-to-date? Look for a surgeon who has undergone the necessary training, even after being in clinical practice, to maintain board certification in his or her specialty.
  • What’s your experience? Ask how many operations the surgeon has performed in the past year and how that compares with his or her peers.
  • What are your success, failure, and complication rates? Not all will be able or willing to tell you, but the good ones should.
  • What’s the hospital’s infection rate?
  • Does the hospital follow best practices? The federal Centers for Medicare and Medicaid Services tracks how frequently hospitals give antibiotics on schedule, control blood sugar in heart-surgery patients, prepare skin properly before incisions and take other steps proven to help prevent surgical complications.Make the right choice.

You may be expected to schedule a surgery at the end of the consultation. If you are not confident that you have found your ideal surgeon, do not schedule the surgery. Either way, it’s fine to ask for a day to consider everything the doctor has said before making the surgery official.

If the surgeon you consulted with is not your ideal surgeon, schedule a consultation with a different surgeon. Even if you think the first surgeon is your best choice, a second opinion from another surgeon can be valuable. Most types of insurance will allow for two or three consultations. If you believe you have found your ideal surgeon you can schedule your surgery, confident in your decision.

If you’re looking for an experienced general surgeon in the Las Vegas area, Dr. Shawn Tsuda specializes in minimally invasive surgical techniques including the laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, sleeve gastrectomy, foregut surgery, ventral and inguinal hernia repairs, endoscopy, and basic laparoscopy. Schedule a consultation to learn what he can do for you.