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Botox injections and balloon dilation, work well to treat achalasia for a few weeks or years, they are not defini- tive solutions. Surger y, by contrast, cures the condition in more than 75 percent of patients. Heller myotomy, or surgery to correct achalasia, opens the esophageal musculature and releases any scar tissue. " We a ppro a c h la p a ro scopic a l ly through several incisions," Dr. Barkan explains. "The inner layer of the esoph- agus is exposed to release pressure." A n advanced, even less invasive, pro ce du re a dopt e d at W i nt h rop - Universit y Hospita l from surgeons i n Japa n , endo scopic s u rger y for achalasia involves opening the esopha- geal sphincter though an endoscope introduced v ia the mouth. K now n as peroral endoscopic myotomy, this procedure, performed in collabora- tion with Stavros Stavropoulos, MD, Director of Gastrointestinal Endoscopy and the Advanced Endoscopy Program at Winthrop, is now being studied in clinical trials. Winthrop-University Hospital is the first institution in the United States to offer this procedure. Minimally Invasive Surgery for Stomach Conditions Paraesophageal and sliding hiatal hernia s may cause t he unplea sa nt symptoms of heartburn, nausea and gastroesophageal reflux disease. These hernias have a connection with sleeve gastrectomy and other, nonbariatric stomach surgeries, which can exacer- bate any already-present defects. "Not only bariatric surgery patients, but others — for example, those who have had stomach cancer procedures where the intestines have been reat- tached — can develop anastomotic ulcers," Dr. Brathwaite says. "We work closely with our colleagues in gastroen- terology to help these patients. Often, endoscopy and surgery work together in the operating room." "We typically perform laparoscopic su rger y to repa ir h iat a l her n ia s," Dr. Ha ll says. "As we mobilize the stomach following sleeve gastrectomy, we will often see a defect in the dia- phragmatic hiatus. If it is not repaired, the patient may develop severe ref lux. In some cases, in patients who have a banding procedure, the band can even migrate into the chest cavity, causing severe pain with swallowing." To correct this problem, surgeons perform a minimally invasive surgery known as Nissen fundoplication, which may also be used to cure severe GERD occurring without a hernia. Taking a minimally invasive approach, the surgeon creates small ports for cam- era and tools, and then performs a dissection to free the intrathoracic esophag us. The hiatus can then be repaired with sutures. A f ter wards, Dr. Brathwaite was the first surgeon in New York state to perform gastric bypass bariatric surgery using the da Vinci Si robot. S K I L L ED H A N DS WHAT DOES IT take to be an excellent surgeon? Physicians at Winthrop-University Hospital discuss the skills and techniques involved. ALEXANDER BARKAN, MD, FACS: "Experience counts. You have to know anatomy and physiology, the nuances of surgical dilemmas. "You also need to acquire the dexter- ity to use laparoscopic instruments with both hands equally. You must be able to use your non-dominant hand as com- fortably as your dominant hand." KENETH HALL, MD: "The most important key to laparo- scopic surgery is repetition. Over time, you adapt to see what works best for you. Laparoscopic suturing, in particular, requires a lot of hand-eye coordination and dexterity." SPECI A L FE AT UR E 2 0 | Long Island MD NEWS ■ M D N E W S . CO M