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Pioneer Dr Banato trains Italians in new reflux surgery technique

By   /   October 18, 2009  /   Comments

Palmyra Medical Center hosted a group of Italian surgeons Thursday who came to Albany to train in a groundbreaking incision-less surgical technique for reflux patients. Next month, a large contingent of Brazilian surgeons will undergo similar training at Palmyra under Dr. John Bagnato, who is described by one of the visiting Italians as a “pioneer” in the field.

Palmyra was designated in July as a national training center for surgeons using a new surgical device – EspophyX – for the treatment patients with gastroesophageal reflux disease. Taught by Bagnato, the procedure enables surgeons to create a valve between the stomach and esophagus to reduce or prevent reflux. Palmyra is now linked as a national training center for the new surgery along with the University of Miami, Ohio State University and Northwestern University.

“It is quite an honor to have these international surgeons, who could train anywhere in the world, choose Albany to receive their training for this form of advanced surgery,” Bagnato said. “It demonstrates that we have established a proven team with an outstanding tracking record who can now teach this revolutionary procedure to other surgeons anxious to receive this advanced training.”

Dr. Riccardo Naspetti of Florence, Italy, said he considers Bagnato to be the leading provider of gastroesophageal reflux disease treatment in the world.

“He is like a Michaelangelo. Like a sculptor. He is a pioneer in this kind of surgery,” Naspetti, one of three Italian physicians in Albany last week, said of Bagnato.

The incision-less surgery may be the most significant advancement in the field since the move in the late 1980s to laparoscopic or “band-aid” surgery, which utilizes small incisions and is otherwise less invasive than “open” surgery. By using an endoscope during the incision-less procedure, the surgeon can access the interior of the body through the mouth and avoid making incisions in the body wall. Thus, incision-less surgery prevents scars outside, there are few scars inside, and the surgery also eliminates other complications that occur when skin and muscle walls are cut.

The amount of time required in surgery is generally half the top spent on laparoscopic surgery and recovery time is greatly reduced.

Bagnato says that patients who read about the procedure are most attracted by the elimination of outside scars and quick recovery time.

Susan Mahoney, chief nursing officer at Palmyra, said hosting the Italians “showcases the confidence the medical community places on our hospital and our entire Palmyra team.”

“He is like a Michaelangelo. Like a sculptor. He is a pioneer in this kind of surgery,” Naspetti, one of three Italian physicians in Albany last week, said of Bagnato.

To have European surgeons come to Albany and to Palmyra shows that our technology and our expertise can match any in the country,” she said.

Naspetti says he will leave Albany with the ability to teach the new surgical technique to his colleagues.

“This is the beginning of a partnership that will help improve the quality of lives of many, many people,” he said. “This new technique enables patients to get their life back with less discomfort and a quicker recovery.”

About reflux surgery

Gastroesophageal reflux surgery is typically performed in patients with serious disease that does not respond to drug therapy. Gastroesophageal reflux is classified as the symptoms produced by the inappropriate movement of stomach contents back up into the esophagus. Gastroesophageal reflux surgery has two essential purposes: heartburn symptom relief and reduced backflow of stomach contents into the esophagus.

Heartburn symptom relief

Surgery is usually considered as a treatment option only when drug treatment is only partially effective or ineffective. Surgery is often used in patients with a particular anatomic abnormality called hiatal hernia that causes significant gastroesophageal reflux. In some cases, surgery is also used when the patient cannot or does not want to take reflux medication. Surgery is also more likely to be considered when it is obvious that the patient will need to take reflux drugs on a permanent basis. Reflux drugs, like virtually all drugs, may produce side effects, especially when taken over a period of years.

One of the biggest problems in diagnosing and controlling gastroesophageal reflux disease is that the severity of disease is not directly related to the presence or intensity of symptoms. There is also no consistent relationship between the severity of disease and the degree of tissue damage in the esophagus. When reflux occurs, stomach acid comes into contact with the cells lining the esophagus. This contact can produce a feeling of burning in the esophagus and is commonly called heartburn. Some of the other symptoms associated with this condition include:

  • chest pain
  • swallowing problems
  • changes in vocal qualities

Reduced reflux

The reduction or elimination of reflux is as important, and sometimes more important, than the elimination of symptoms. This necessity leads to one of the most important points in gastroesophageal reflux disease. Long-term exposure to acid in the esophagus tends to produce changes in the cells of the esophagus. These changes are usually harmful and can result in very serious conditions, such as Barrett’s esophagus and cancer of the esophagus. Because of this, all persons with gastroesophageal reflux disease symptoms need to be evaluated with a diagnostic instrument called an endoscope. An endoscope is a long, flexible tube with a camera on the end that is inserted down the throat and passed all the way down to the esophageal/stomach region.

The surgery

All gastroesophageal reflux surgery attempts to restore the normal function of the lower esophageal sphincter (LES). Malfunction of the LES is the most common cause of gastroesophageal reflux disease. Typically, the LES opens during swallowing but closes quickly thereafter to prevent the reflux of acid back into the esophagus. Some patients have sufficient strength in the sphincter to prevent reflux, but the sphincter opens and closes at the wrong times. However, this is not the case in most individuals with gastroesophageal reflux disease. These individuals usually have insufficient sphincter strength. In a small number of cases, the muscles of the upper esophagus region are too weak and are not appropriately coordinated with the process of swallowing.

The development of heartburn does not necessarily suggest the presence of gastroesophageal reflux disease, which is a more serious condition. Gastroesophageal reflux disease is often defined as the occurrence of heartburn more than twice per week on a long-term basis. Gastroesophageal reflux disease can lead to more serious health consequences if left untreated. The primary symptoms of gastroesophageal reflux disease are chronic heartburn and acid regurgitation, or reflux. It is important to note that not all patients with gastroesophageal reflux disease have heartburn. Gastroesophageal reflux disease is most common in adults, but it can also occur in children. The precise mechanism that causes gastroesophageal reflux disease is not entirely known. It is known that the presence of a hiatal hernia increases the likelihood that gastroesophageal reflux disease will develop. Other factors that are known to contribute to gastroesophageal reflux disease include:

  • smoking
  • alcohol ingestion
  • obesity
  • pregnancy

Mitigating the disease

The following foods and drinks are known to increase the production of stomach acid and the resulting reflux into the esophagus:

  • caffeinated drinks
  • high-fat foods
  • garlic
  • onions
  • citrus fruits
  • chocolate
  • fried foods
  • foods that contain tomatoes
  • foods that contain mint
  • spicy foods

Most patients take over-the-counter antacids initially to relieve the symptoms of acid reflux. If antacids do not help, the physician may prescribe drugs called H 2 blockers, which can help those with mild-to-moderate disease. If these drugs are not effective, more powerful acid-inhibiting drugs called proton-pump inhibitors may be prescribed. If these drugs are not effective in controlling gastroesophageal reflux disease, then the patient may require surgery.
Source: Encyclopedia of surgery (www.surgeryenclopedia.com)

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  • Published: 2143 days ago on October 18, 2009
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  • Last Modified: November 5, 2009 @ 8:29 am
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