Anti-Reflux Surgery (Laparoscopic Nissen Fundoplication)

 

Performed for patients with reflux (GORD) disease not controlled with gold standard medical treatment. Surgery performed via a laparoscopic approach in hospital from 2-3 days and full recovery in 6 months.

Laparoscopic Gastric Bypass (RYGB)

  • This surgery works with a restrictive component and a gut-hormone component. 
  • Similar to the sleeve, hunger hormones are dampened and satiety hormones enhanced. 
  • Patients are less hungry and sated (full) with small amounts of food.
  • Weight loss is significant and rapid occurring over 12 months. 
  • The average weight loss is 75% of excess weight.


Advantages

  1. Long-track record
  2. Reversible
  3. Good weight loss
  4. Good quality of eating


Disadvantages

 

  1. Risk of small bowel obstruction
  2. Risk of stomal ulcer
  3. Dumping syndrome
  4. Risk of micronutrient deficiencies

Gallstone Surgery - Cholecystectomy

  • The gallstone is a pear-shaped organ and the gallbladder stores and concentrates bile, which helps in digestion of fats and waste products.
  • Gallstones occur in the gallbladder due to an imbalance in the bile of bile salts, cholesterol or bilirubin and this results in a blockage of normal bile flow. Stones may also case gallbladder inflammation, known as cholecystitis.
  • Treatment for gallstones is known as a Laparoscopic Cholecystectomy and this procedure is performed on patients when gallstones are causing pain. .
  • Symptoms include pain in the mid or upper-right section of the abdomen that may come and go or may range from mild to very severe.
  • Other symptoms may include nausea and vomiting, frequent diarrhoea or light-coloured chalky stools, darker urine than usual and sometimes jaundice or shaking and fever. However quite often patients may not notice gallstones and they do not need any treatment until they produce symptoms.
  • Occasionally cholecystectomy if required for polyps of a certain shape/size.
  • Sometimes cholecystectomy offered for patients with biliary pain, even in the absence of gallstones.

Gastric Sleeve Surgery/Laparoscopic Sleeve

  • In this procedure, approximately 80% of the stomach is removed leaving a banana-shaped stomach
  • The surgery is done laparoscopically and results in a 2-3 day hospital stay
  • Patients return to work in two weeks
  • Weight loss is rapid and complete in about 12 months
  • The average weight loss is 65-70% of excess weight
  • The surgery works by restriction (smaller stomach) and gastrointestinal hormonal changes
  • There is a dampening (reduction) in the hunger hormone ghrelin and an increase in satiety hormones such as GLP-1 and PYY
  • The end results in less hunger and earlier satiety with a meal

Advantages

Rapid and significant weight loss in 12 months
No foreign body
No intestinal surgery
Both a restrictive and hormonal procedure
Good quality of eating

Disadvantages

Non-reversible
Potential micronutrient deficiency
Gastro-oesophageal reflux in 15% of patients

Laparoscopic Adjustable Gastric Band
  

Placing an inflatable band around the upper portion of the stomach creating a small gastric pouch above the neck of the stomach. The AGB works by reducing hunger. The mechanism for this is not well understood.

Advantages

  1. Very safe to insert
  2. Short hospital stay (24 hours)
  3. Reversible
  4. Low risk of micronutrient deficiencies

Disadvantages

 

  1. Slow weight loss
  2. Poor weight loss in many
  3. Food intolerance, reflux, vomiting
  4. Device failure
  5. High re-operation rate

Mini-Gastric Bypass (MGB)

This procedure creates a long, narrow tube of the stomach, and is a somewhat technically easier and hence a lower risk option than the traditional gastric bypass.

It is also sometimes called Omega Loop Gastric Bypass or One Anastomosis Gastric Bypass.

A Mini-Gastric Bypass procedure involves the stomach being divided with a laparoscopic stapler, so that most of the stomach is no longer attached to the oesophagus and will no longer receive food. The new stomach will be shaped like a small, long tube along the right border of the stomach.

Food will now move through the new tube stomach into the attached loop of jejunum. The main benefit of this procedure over the traditional RYGB is one small bowel anastomosis rather than two. The surgery is therefore a little easier and said to eliminate internal hernia (which complicate the RYGB). Initial studies show a similar weight loss can be achieved with less re-routing of the intestines with this procedure.

This procedure is best suited for people who have severe diabetes mellitus (on insulin) and no gastro-oesophageal reflux. The MGB is contraindicated (not done) in patients with GERD.

Ask Dr John Jorgensen which procedure is best suited to your situation.

Hernia

Hernia repair involves a surgical correction of a hernia - a bulging of internal organs or tissues through the wall that contains it.

 

Here are the hernia procedures Dr Jorgensen commonly performs:

 

 

Laparoscopic Hiatal Hernia Repair

  • This procedure is for patients where a significant portion of the stomach has herniated into the chest, causing obstructive symptoms such as difficulty in swallowing, early satiety, pain and vomiting or shortness of breath.
  • The procedure is done laparoscopically and has a 2-3 day post-operative stay.
  • Full recovery takes up to 4 weeks.

 

Inguinal Hernia

  • Inguinal or groin hernias cause bulges along the groin area that may appear to get bigger when you stand up or cough, or may be sensitive to touch.
  • Fullness in the groin, sharp pain or pain when exercising, coughing or bending over may be other symptoms.
  • They are best repaired with a laparoscopic approach as this results in a rapid recovery.
  • Occasionally, open surgery is indicated if previous pelvic surgery has been performed.
  • Prosthetic mesh is used for laparoscopic or open repair.

 

Umbilical/Incisional Hernia

  • Smaller (< 5cm) hernias are best approached laparoscopically if possible.
  • Larger hernias require open surgery.
  • Prosthetic mesh is used with laparoscopic or open repairs.

Oesophagus Surgeries

 

  • Gastroscopy - Video inspection of the oesophagus, stomach and duodenum.
    Usually diagnostic but can be therapeutic with endoscopic excision of polyps, dilation of stricture etc.
  • Laparoscopic Hiatal Hernia Repair - Indicated in patients where a significant portion of the stomach has herniated into the chest and is causing obstructive symptoms such as difficulty in swallowing, early satiety, pain and vomiting or shortness of breath.
    The procedure is done laparoscopically with a 2-3 day post-operative stay.
    Full recovery in 4 weeks.
  • Laparoscopic Nissen Fundoplication (Anti-Reflux surgery) - Performed for patients with reflux (GORD) disease not controlled with gold standard medical treatment.
    Surgery performed via a laparoscopic approach in hospital from 2-3 days and full recovery in 4 weeks.
  • Laparoscopic Heller Myotomy - Surgical division of the lower oesophageal sphincter in patients with achalasia (cardiospasm).
    Done laparoscopically and 2-3 days in hospital stay.
  • Radical Oesophago-gastrectomy - Removal of the oesophagus for cancer. Careful staging (gastroscopy, CT abdomen & chest, PET scan and laparoscopy) of patients.
    Treatment is stage dependent and broadly falls into palliative or curative.
    Patients are discussed in a multi-disciplinary cancer meeting to tailor optimal management. Often pre-operative chemotherapy and radiation are offered.
    Surgery is via abdomen and chest.

Stomach Surgeries

 

Laparoscopic Partial Gastrectomy

  • Usually performed for benign or low grade tumours such as lipase or gastrointestinal stromal tumour (GIST)

Open Radical Gastrectomy

  • Indicated for gastric cancer after careful patient staging
  • Appropriate treatment algorithm based on stage (gastroscopy, CT scan and laparoscopy) and multi-disciplinary cancer meeting assessment
  • Patients often have pre-operative chemotherapy followed by surgery
  • Surgery is usually open surgery

Laparoscopic sleeve gastrectomy

  • In this procedure approximately 80% of the stomach is removed leaving a banana shaped stomach.
  • The surgery is done laparoscopically and results in a 2-3 day hospital stay.
  • Patients return to work in two weeks.
  • Weight loss is rapid and complete in about 12 months.
  • The average weight loss is 75% of excess weight.
  • The surgery works by restriction (smaller stomach) and gastro-intestinal hormonal changes.
  • There is a dampening (reduction) in the hunger hormone grehlin and an increase in satiety hormones such as GLP-1 and PYY.
  • The end results in less hunger and earlier satiety with a meal.

Advantages

  1. Rapid and significant weight loss in 12 months
  2. No foreign body
  3. No intestinal surgery
  4. Both a restrictive and hormonal procedure
  5. Good quality of eating.

Disadvantages

  1. Non-reversible
  2. Potential micronutrient deficiency
  3. Gastro-oesophageal reflux in 15% of patients

Laparoscopic gastric bypass (RYGB)

  • The surgery like the sleeve works with a restrictive component and a gut-hormone component.
  • Again, hunger hormones are dampened and satiety hormones enhanced.
  • Patients are less hungry and sated with small amounts of food.
  • Weight loss is significant and rapid occurring over 12 months.
  • The average weight loss is 75% of excess weight.

Advantages

  1. Long-track record
  2. Reversible
  3. Good weight loss
  4. Good quality of eating

Disadvantages

  1. Risk of small bowel obstruction
  2. Risk of stomal ulcer
  3. Dumping syndrome
  4. Risk of micronutrient deficiencies

 

Laparoscopic adjustable gastric band

  • Placing an inflatable band around the upper portion of the stomach creating a small gastric pouch above the neck of the stomach.
  • The AGB works by reducing hunger.
  • The mechanism for this is not well understood.

Advantages

  1. Very safe to insert
  2. Short hospital stay (24 hours)
  3. Reversible
  4. Low risk of micronutrient deficiencies

Disadvantages

  1. Slow weight loss
  2. Poor weight loss in many
  3. Food intolerance, reflux, vomiting
  4. Device failure
  5. High re-operation rate

 

Gallbladder Surgeries

 

Laparoscopic Cholecystectomy

  • Performed for patients with gallstones that are causing pain. 
  • Occasionally, cholecystectomy is required for polyps of a certain size/shape. 
  • Rarely cholecystectomy is offered for patients with biliary pain, even in the absence of gallstones.

Inguinal Hernia

  • Common groin hernias are best repaired with a laparoscopic approach as this results in a rapid recovery. 
  • Occasionally, open surgery is indicated if previous pelvic surgery has been performed. 
  • Prosthetic mesh is used for laparoscopic or open repair.

Umbilical/Incisional Hernia

  • Smaller (< 5cm) hernias are best approached laparoscopically if possible. 
  • Larger hernias require open surgery. 
  • Prosthetic mesh is used with laparoscopic or open repairs.

 

 

 

 

 

Contact us today!

Call us on 02 9553 7288.  

Location

Suite 19, Level 5, 1 South Street, KOGARAH, NSW, 2217

P: 02 9553 7288
F: 02 9553 1063
info@drjohnjorgensen.com.au

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