'Thoracic Surgery' posts
The Stretta procedure is another option to treat GERD.
Per oral endoscopic myotomy could help a range of esophageal, stomach disorders
SEATTLE — September 05, 2014— Swedish surgeons became the first in Washington State to perform a Per Oral Endoscopic Myotomy (POEM) procedure when they successfully treated a 36-year-old patient diagnosed with a rare esophageal disorder known as achalasia.
POEM involves inserting an endoscope in the patient’s esophagus through the mouth. Once in place, surgeons use several instruments placed though a channel in the endoscope to treat the affected area. In the case of Washington’s first patient to undergo the procedure, a team of Swedish surgeons led by Ralph Aye, M.D., and Brian Louie, M.D., cut though the inner wall of the esophagus to place the endoscope between the inner esophageal layer and the outer muscular wall. By cutting the inner most muscle layer, pressure created by the valve between the esophagus and the stomach was relieved and the patient’s case was treated successfully.
Previously, patients with achalasia were treated using five minimally invasive incisions through the abdominal wall. But because POEM does not require any external incisions, patients can recover quicker with similarly successful outcomes.
Over the past year we have offered some of our patients deemed appropriate for surgery a more streamlined approach to their overall care. Previously we have tried to offer chemotherapy, surgery, and radiation to all patients who were healthy and strong enough to undergo the three treatments, as mesothelioma is an aggressive cancer requiring aggressive treatment to optimize survival. This new approach still offers both surgery and radiation, but chemotherapy is given only to those found to have cancer in lymph nodes in the center of chest during surgery.
The advantages of this new treatment paradigm are ...
The Swedish Thoracic Surgery team recently had results from a study published in Annals of Thoracic Surgery, "Short-Term Outcomes Using Magnetic Sphincter Augmentation Versus Nissen Fundoplication for Medically Resistant Gastroesophageal Reflux Disease", in which a retrospective case-control study was performed of consecutive patients undergoing either procedure who had chronic gastrointestinal esophageal disease (GERD) and a hiatal hernia of less than 3 cm. Based on the study, the LINX device appears to restore the sphincter barrier function and preserve normal physiology which enables belching and vomiting.
Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD. Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them. I thank the patients who have taken time to share their thoughts on the blog.
When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.
There are some exciting developments for patients who are interesting in having a LINX implanted.
Use of MRI and LINX
- Torax, the company who designed and manufactures the LINX device, has received FDA support for the use of MRI with the LINX device. This conditional approval allows for patients to undergo and MRI that is 0.7 Tesla or less. I am trying to clarify with our radiologists what a 0.7 Tesla MRI will cover.
- For medicare patients, LINX now has a dedicated procedure code that allows for payment to cover the cost of the hospital portion of implanting the LINX device. The surgeon’s fee is a separate code and fee and is usually covered.
- For patients with non-medicare insurance, the ...
There is nothing more satisfying for a clinician than when a patient understands their ailment, comprehends the nature of the pathology involved, and is clear on the treatment/procedure they are about to undergo. This "satisfaction" is a joyous emotion reflecting successful communication -- it is what parents feel when their children first begin to read, and what educators aspire to when their students master the material at hand.
It is a privilege to share our most recent contribution to the cardiothoracic surgery community, the TSRA Primer of Cardiothoracic Surgery...