Stomach and Intestinal Disease

Stomach Disorders

Stomach is a large reservoir of food, that exists in the left upper abdomen. A variety of surgical disorders can affect the stomach. They include benign tumors like lipomas, tumors of specific characteristics such as Gastrointestinal Stromal Tumors (GIST) and carcinoid tumors, and malignant tumors like adenocarcinoma of stomach. They also include non-neoplastic processes such as persistent or complicated peptic ulcers, and gastric outlet obstruction. Finally, a variety of bariatric weight-loss operations like Vertical Sleeve Gastrectomy and Roux-en-Y Gastric Bypass are performed on the stomach, in order to bring about restriction of calories and weight loss.

Procedure on the stomach are commonly performed using a laparoscopic or robotic approach. Most patients can expect to leave the hospital within 1-2 days depending on the type of surgery and return to daily activities within one week.

Achalasia

Achalasia is a condition in which the lower esophageal sphincter fails to relax, resulting in difficulty with swallowing. The exact cause of achalasia is unknown. It is believed that the condition is the result of damage to the nerves that normally help the muscles of the lower esophagus relax. Auto-immune and infectious etiologies have been postulated.

Achalasia is a rare disease occurring in one in 100,000 individuals in the US each year. Patients may present with progressive difficulty in swallowing, vomiting, regurgitation of undigested food, weight loss, and weakness. Some may develop pneumonia as a result of aspiration of regurgitated food. A small percentage of patients may develop cancer of esophagus.

Diagnosis is usually made with an upper endoscopic exam. A barium swallow x-ray will show tapering of the lower esophagus and widening of the mid to upper segments, suggestive of achalasia. The final diagnostic test is called esophageal manometry, in which a probe is placed in the lower esophagus through the nose, and measurements are recorded.

Although several non-surgical treatments have been attempted, the mainstay of treatment remains surgical. Most medications like calcium channel blockers or Nitroglycerin fail to provide long-lasting effect. Similarly, endoscopic treatments including balloon dilatation or Botox injection fail to provide long-lasting effect and carry the risk of esophageal perforation. Per Oral Endoscopic Myotomy remains an investigational procedure.

Surgery for achalasia is called laparoscopic Heller myotomy. Using the minimally invasive approach and multiple small incisions, muscle fibers of the lower esophagus are opened, leaving the inner layer intact. This results in relaxation of the affected part and relief of symptoms. An anti-reflux procedure (Toupet Fundoplication) is also included to prevent future reflux and regurgitation of stomach contents. Although this is a major operation, most patients leave the hospital within 24-36 hours and return to normal activities in less than one week. Over 90 percent of patients are symptom free after surgery.

Dr. Zaré has accumulated a large experience in performing minimally invasive Heller Myotomy and fundoplication since 2002. The procedure is currently offered via a robotic approach with exceptional outcomes. To date, each patient undergoing Heller Myotomy has resumed normal eating and experienced dramatic improvement in quality of life.

Intestinal Disorders

Intestines can be affected by benign tumors such as lipomas, tumors of specific characteristics such as carcinoid disease, malignant tumors, adhesive bands, meckels diverticulum, bleeding arteriovenous malformations, appendicitis, etc. Majority of these conditions can be treated by minimally invasive surgery using laparoscopic or robotic approach. Most patients can expect a 1-2-day hospital stay, and a 1-week recovery.