Drs. Sharona B. Ross & Alexander Rosemurgy

The Southeastern Center for Digestive Disorders & Pancreatic Cancer Advanced Minimally Invasive and Robotic Surgery

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Trusting Your Tummy

Have you ever:• Had butterflies or a knot in your stomach?• Followed a gut instinct?• Felt you couldn’t stomach a situation?• Experienced a gut-wrenching sensation?

Tummy Talk

• Gas, burping, bloating, heartburn, diarrhea, constipation– We often suffer in silence and hope it passes– Could be something we ate, nerves or a poor

diet– Could be more serious, a symptom of a greater

underlying problem

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Digestive Disorders

• As embarrassing as intestinal symptoms can be, don’t let embarrassment keep you from seeking help – in most cases, treatment is available.

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What You Will Learn Today• The most common digestive disorders:

– symptoms, – causes and – risk factors

• Ways to prevent and treat digestive disorders • How to maintain a healthy digestive system

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Your Digestive System

• Digestion allows our bodies to get the energy and nutrients they need from the foods we eat

Why is a healthy Digestive System so important?

• A healthy digestive system prevents disruption to our daily lives

• Problems of the digestive system can– Make everyday living very difficult, sometimes

impossible – cause pain, discomfort, “accidents”, lead to very serious

health complications 7

Common Types• Gastro-Esophageal Reflux Disease (GERD)

– Esophageal Cancer

• Gallbladder Disease• Pancreatitis• Chronic Constipation• Diverticular Disease• Colorectal Cancer

– Second leading cause of cancer-related deaths

Gastro-Esophageal Reflux Disease (GERD)• Chronic digestive disease • Persistent reflux

– stomach acid flowing up (refluxing) into the esophagus

• Most common symptom is heartburn • Cause of GERD unknown• Treatment:

– Relief of symptoms: lifestyle changes & medicine• Prolong use of PPI medications may result in esophageal

cancer

– Cure: Surgery 9

Gallbladder Disease

• Symptoms: – nausea & vomiting, bloating, constant

right upper abdominal pain lasting for several hours after consumption of fatty foods

• Diagnosis:– History, physical exam, RUQ u/s, HIDA

• Treatment:– Surgery to remove the gallbladder

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Pancreatitis

Acute• Symptoms

– Abdominal pain, fever, nausea, vomiting

• Common causes– gallstones– chronic, heavy alcohol use

• Treatment includes– medications,

hospitalizations

Chronic• Repeated attacks of acute

pancreatitis• Symptoms

– Chronic abdominal pain, nausea vomiting, weight loss, diarrhea

• Common cause– chronic, heavy alcohol use

• Treatment includes– medications, hospitalization,

nutritional support

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Inflammation of the pancreas

Chronic Constipation

• Persistent over years — even decades!• Unresponsive to treatment• More common in women• Treatment/management includes

– adding fiber to your diet– increasing fluid intake– exercising more often

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Diverticular DiseaseDiverticulosis• Small pouches in the lining of the colon • Symptoms:

– bloating, constipation

Diverticulitis• Pouches become inflamed• Most common symptom:

– lower left abdominal pain• Treatments:

– diet changes, medications– For repeated attacksSurgery

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Colorectal Cancer• Most common symptoms

– Blood in stool, unexplained weight loss

• Causes– Causes unknown

• Most common risk factors– Increasing age – Family history – Smoking – Poor lifestyle habits

SEE YOUR DOCTOR

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Recommended Tests & ScreeningsSome Common Tests for Cancer:• Colonoscopy

– Every 10 years

• Flexible sigmoidoscopy– Every five years

• Barium enema – Every five years

• Fecal Occult Blood testing– Annually

New Tests: • Virtual Colonoscopy

– Every five years

SEE YOUR DOCTOR

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General Risk Factors Non-controllable• Increasing age• Genetics• Certain medications• Certain conditions or

diseases

Controllable• Being Overweight• Unhealthy Lifestyle Habits

– Smoking– Sedentary lifestyle– Poor diet and eating habits– High stress levels– Excessive alcohol consumption

• “Trigger” and unsafe foods

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What You Can DO! (Medical)

Partner with your doctor– Physical examination– Complete review of your family medical history– Tests and screening– Clearly describe your symptoms

• Digestive Diary

Your doctor can help you create a customized plan for you

to stay on top of your digestive health.17

Other Tests & ScreeningsDiagnosis of digestive disorders may include the

following:• Blood test• Stool test• Abdominal ultrasound• Barium swallow radiograph• PH monitoring exam• Computerized Tomography (CT) scan• Upper Endoscopy• Biopsy18

What You Can DO! (Non-Medical)• Eat a healthy diet• Stop smoking• Exercise and maintain a healthy weight• Reduce stress• Digestive dos & don’ts

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Digestive Tricks: Dos & Don’tsDO• Get enough sleep• Eat smaller meals• Eat and drink slowly• Get moving after

meals

DON’T• Eat before bed

and/or lie down after eating

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Trust Your Tummy

A healthy digestive system is within your reach:

`live well and trust what your tummy is telling you

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Drs. Sharona B. Ross & Alexander Rosemurgy

The Southeastern Center for Digestive Disorders & Pancreatic Cancer Advanced Minimally Invasive and Robotic Surgery

Surgical Treatment for GERD

• Fundoplication: constructs a valve mechanism which prevents acid from coming up into the esophagus

• Three different operations:– Nissen fundoplication– Toupet fundoplication– Transoral incisionless fundoplication

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Necessary Preoperative Testing

• Upper Gastrointestinal Study– Evaluates the motility of the esophagus

• Bravo/pH Study– Objective study measuring the frequency,

severity, and duration of your reflux

• Endoscopy

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Approaches for an anti-reflux operation:

• Open• Laparoscopic• Laparo-endoscoic Single Site (LESS)

Surgery• Robotic• Transoral

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Conventional Laparoscopy

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What is LESS?

• “Scarless” surgery• LESS surgery goes beyond “no scar”:

– Faster return to normal activities– Less postoperative pain

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What your belly button looks like postoperatively

What is Transoral?

• It is an approach that uses the assistance of endoscopy to undertake the operation through the mouth

• Deployment of “H-fasteners” allows the fundoplication to be secured

• No incision is made

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TIF

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Our Experience

• We have undertaken over 1500 anti-reflux operations

• Since 2008 all the laparoscopic anti-reflux operations have been through LESS

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Results:

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• There is a dramatic and satisfactory amelioration of symptoms

• Postoperatively, when patients were queried if they would still have the operation: 88% said yes

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Why Surgery• Medical Treatment for reflux is only FDA approved

for 2 weeks, not for chronic use– PPI therapy increases the risk of osteoporosis, which

women are already have an increased risk

• Without a mechanistic fix the esophagus is exposed to both acid and bile salts which are both carcinogenic

• 30% of esophageal cancers are attributed to GERD

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Surgical Treatment for Gallbladder Disease

• Operation = Cholecystectomy• Most common operation in the US• Approaches:

– Open– Laparoscopy– LESS – Robotic

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Anesthetics

General Anesthesia

Versus

Epidural Anesthesia

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Epidural anesthesia has lower postoperative pain scores

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LESS Cholecystectomy with Epidural Anesthesia

• Provides the same salutatory benefits of conventional cholecystectomy with added benefits:– Decreased postoperative pain– No general anesthesia side effects– Improved cosmesis– Lower cost

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Drs. Sharona B. Ross & Alexander Rosemurgy

The Southeastern Center for Digestive Disorders & Pancreatic Cancer Advanced Minimally Invasive and Robotic Surgery

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