Posted by Stony Brook Surgery on November 25, 2013
National GERD Awareness Week takes place each year during the week of Thanksgiving (this year November 24-30), a time when heartburn, the most common symptom of GERD, or gastroesophageal reflux disease, can easily arise and put a damper on festivities like family meals and football parties.
Over 30 million Americans suffer each month from acid reflux caused by GERD. Its symptoms include heartburn, regurgitation, sore throat, cough, and chest pain. When left untreated, reflux disease can lead to serious complications, such as esophagitis, stricture, Barrett's esophagus, and esophageal cancer.
The stomach is lined to handle stomach acid, but the esophagus is not. The esophagus — a muscular tube that connects the mouth to the stomach — is responsible for pushing food into the stomach to be digested.
An occasional bout with acid reflux should not cause any damage to the esophagus. However, if stomach acid consistently escapes from the stomach into the esophagus (because of a weakened sphincter muscle), the acid can eventually injure it.
The International Foundation for Functional Gastrointestinal Disorders, in honor of this year's GERD Awareness Week, offers the following 15 suggestions for curbing GERD symptoms this holiday season:
Surgeons of our General Surgery Division are the first on Long Island approved to perform the minimally invasive LINX procedure to treat GERD. "This new procedure represents a substantial advancement in our ability to treat patients who suffer from GERD," says Mark A. Talamini, MD, professor and chairman of surgery. Read more about LINX »
Not only do we use leading-edge technology for treating GERD, we also use leading-edge technology for diagnosing laryngo-pharyngeal reflux (LPR) caused by GERD. LPR can occur without heartburn, making it difficult to diagnose. This is why it is sometimes referred to as "silent reflux."
As part of the laryngology program of our Otolaryngology-Head and Neck Surgery Division, we perform Restech pH (acidity) testing for LPR. Laryngologist Elliot Regenbogen, MD, assistant professor of surgery, who uses the new Restech technology, says, "It is a very useful diagnostic tool, and it enables us to provide the most proper treatment to patients." Read more »
To learn more about GERD, see Dr. Dana A. Telem's FAQs blog about acid reflux. For information about surgery for reflux disease, call to 631-444-4545 to schedule a consultation with one of our gastrointestinal specialists.
Posted by Stony Brook Surgery on November 20, 2013
Stony Brook University Hospital Meets Quality Standards Established by the American College of Surgeons
The Stony Brook Bariatric and Metabolic Weight Loss Center has just been fully accredited by the Bariatric Surgery Center Network (BSCN) Accreditation Program of the American College of Surgeons (ACS). The accreditation demonstrates our center's commitment to delivering the highest-quality care for its bariatric surgery patients.
To earn the accreditation, Stony Brook University Hospital met the essential criteria that ensure its ability to support a bariatric surgical care program and the institutional performance requirements outlined by the BSCN Accreditation Standards.
Accredited bariatric surgery centers provide both the hospital resources necessary for optimal care of morbidly obese patients and the support and resources necessary to address the entire spectrum of care and needs of bariatric patients, both pre- and post-operatively.
"We are very pleased to receive accreditation from the American College of Surgeons," says Aurora D. Pryor, MD, professor of surgery, chief of general surgery, and director of the Bariatric and Metabolic Weight Loss Center. "They were very impressed with our entire staff and the Stony Brook facilities. Our group should be commended for their team effort and attention to detail as acknowledged by the surveyor."
Dr. Pryor emphasizes, "Accreditation is an important way for patients to verify that a practice has access to all the key resources necessary for optimal care, and we are proud to be acknowledged here for our excellence at Stony Brook Medicine."
Accreditation by the American College of Surgeons is an important way to verify that
Bariatric surgery centers that are accredited under ACS BSCN program standards are part of the Metabolic Bariatric Surgery Accreditation Quality Improvement Program (MBSAQIP) administered by the American College of Surgeons. In March 2012, the ACS and the American Society of Metabolic and Bariatric Surgery announced plans to combine their respective national bariatric surgery accreditation programs into a single unified program to achieve one national accreditation standard for bariatric surgery centers. This transition is now in process.
ACS BSCN accreditation is awarded in categories, each with its own criteria that must be met. Facilities undergo a site visit by an experienced bariatric surgeon, who reviews the facilities' structure, process, and data quality. Because optimal surgical care requires documentation using reliable outcomes measures, accredited bariatric surgery centers are required to report their outcomes data to the MBSAQIP Data Registry Platform.
In the United States, more than 15 million people suffer from severe obesity, and the numbers continue to increase. Obesity increases the risks of morbidity and mortality because of the diseases and conditions that are commonly associated with it, such as type 2 diabetes, hypertension, and cardiovascular disease, among other health risks. At present, weight loss surgery provides the only effective, lasting relief from severe obesity.
Therefore, the ACS believes it is of utmost importance to extend its quality initiatives to accrediting bariatric surgery centers so that it can assist the public in identifying those facilities that provide optimal surgical care for patients who undergo this surgical procedure.
The American College of Surgeons is a scientific and educational association of surgeons that was founded in 1913 to raise the standards of surgical education and practice, and to improve the quality of care for the surgical patient. Its achievements have placed it at the forefront of American surgery, and have made the college an important advocate for all surgical patients. With more than 79,000 members, the college is the largest organization of surgeons in the world.
For more information about the Stony Brook Bariatric and Metabolic Weight Loss Center, call Catherine Tuppo, program coordinator, at 631-444-BARI (2274).
Posted by Stony Brook Surgery on November 15, 2013
Posted by Stony Brook Surgery on November 13, 2013
Minimally Invasive Procedure Represents Latest Advance in Treatment of Acid Reflux
The Department of Surgery's General Surgery Division is now performing an innovative new procedure at Stony Brook University Hospital to implant a small magnetic band to help prevent gastric reflux in patients who suffer from gastroesophageal reflux disease (GERD), commonly known as heartburn, or acid indigestion, the most common symptom of GERD.
Our surgeons are the first on Long Island to be specially trained and certified to use the LINX® Reflux Management System. Use of this innovative system further demonstrates our department's commitment to using leading-edge technology to lead the way in patient care.
The new minimally invasive surgical procedure represents the latest advancement in the treatment of GERD. Surgeons implant the LINX band — a small, flexible band of titanium beads with magnetic cores — around the patient's esophagus just above the stomach. The magnetic attraction between the beads strengthens the weakened esophageal sphincter's barrier function. The procedure usually takes less than an hour to perform.
The band is strong enough to allow food and liquids to pass normally to the stomach, but immediately closes after swallowing to restore the magnetic barrier to reflux. Following the procedure, patients are able to resume a normal diet, and will typically resume normal activities in less than a week.
Studies have shown the banding procedure decreases esophageal acid exposure, improves reflux symptoms
"This new procedure represents a substantial advancement in our ability to treat patients who suffer from GERD," says Mark A. Talamini, MD, professor and chairman of surgery, and founding director of the Stony Brook Medical Innovation Institute.
Dr. Talamini, who performs the LINX procedure, adds: "In addition to excellent clinical results, LINX provides many lifestyle benefits compared to the traditional surgery for reflux called Nissen fundoplication. Studies show that implanting the magnetic band often reduces or eliminates the need for medications, and offers improved quality of life for our patients."
Also performing the procedure here are fellow general surgeons Aurora D. Pryor, MD, professor of surgery, chief of general surgery, and director of the Stony Brook Bariatric and Metabolic Weight Loss Center; and Dana A. Telem, MD, assistant professor of surgery and associate director of the Bariatric and Metabolic Weight Loss Center.
Drs. Talamini, Pryor, and Telem all have advanced laparoscopic skills, and are leaders in the area of minimally invasive surgery. The LINX band is implanted laparoscopically.
"The LINX procedure, which uses the novel LINX technology, is indicated for patients diagnosed with reflux who continue to have chronic reflux symptoms despite maximum medical therapy," says Dr. Pryor.
"GERD is a caused by a mechanical defect and requires a mechanical solution, which is achieved through the minimally invasive LINX procedure," Dr. Telem says. "As the first surgeons on Long Island approved to perform this procedure, we will be able to directly benefit many patients who suffer from acid reflux."
Over 30 million Americans suffer from acid reflux each month. The symptoms of GERD include heartburn, regurgitation, sore throat, cough, and chest pain. When left untreated, reflux disease can lead to serious complications, such as esophagitis, stricture, Barrett's esophagus, and esophageal cancer.
The LINX device was FDA approved in March 2012 after ten years of development and testing, including two clinical trials with 144 patients. A total of 400 implant procedures were performed over five years of clinical use. In one trial, 90% of patients achieved a reduction in time exposed to acid, with 93% reporting a 50% or greater reduction in GERD over two years. Ninety-two percent of patients were off daily proton pump inhibitors (PPIs), a group of drugs whose main action is a pronounced and long-lasting reduction of gastric acid production, after two years. The number of patients reporting regurgitation dropped dramatically from 57 to 1.
For consultations/appointments with our general surgeons who provide LINX as a treatment option for GERD, please call 631-444-2274. Watch this video (1:24 min) to see how the LINX band works:
Posted by Stony Brook Surgery on November 1, 2013
November is officially Lung Cancer Awareness Month. This all started as Lung Cancer Awareness Day back in 1995. As the lung cancer community and the lung cancer movement grew, the awareness activities increased and grew into Lung Cancer Awareness Month.
Lung cancer is the third most common cancer and the leading cause of cancer death in the United States. It claims the lives of more people than breast, colon, prostate, and ovarian cancers combined.
The good news is that lung cancer found in its earliest stage has an 80% cure rate.
To help save lives through early detection, the Lung Cancer Evaluation Center (LCEC) of the Stony Brook University Cancer Center is now providing lung cancer screening to conform with recent recommendations.
Lung Cancer Awareness Month is observed by Stony Brook Medicine with several special lung cancer-related events that are free and open to the public, here and in the community (read more). These events provide opportunities to learn about the disease and its treatment, plus the benefits of screening and the challenges of research to fight the disease.
Click here to learn about this month's lung cancer-related events at Stony Brook Medicine
"This health observance gives pause to think about a few things that are wrong," says Thomas V. Bilfinger, MD, ScD, professor of surgery, director of thoracic surgery, and co-director of the LCEC. "First, what's wrong is that nearly 160,000 people will die of lung cancer by the end of the year. Second, when it comes to advocacy and research funds raised particularly in the United States, no cancer has such a bad showing."
"This is only partially explained by the complex research questions and the career choices made by young talented scientists who need a topic that leads to faster success than the tackling of lung cancer," Dr. Bilfinger explains. "In the public's view, patients with this disease are commonly assumed to have brought it upon themselves by smoking, therefore undeserving of support. In reality, 10% to 15% and growing of lung cancer patients have never smoked."
At the same time, the most important risk factor for lung cancer is smoking, which results in the majority of all lung cancer cases in the United States. New guidelines recommend annual CT screening of current and former smokers, ages 55-80 with a history of smoking equivalent to a pack-a-day for 30 years or two packs a day for 15 years. The recommendation applies to those who have quit smoking in the past 15 years.
Other candidates for screening include people ages 50-80 that have smoked a pack a day for 20 years, and have one additional risk factor, such as radon exposure, occupational exposure, lung disease, history of cancer or family history of lung cancer.
Since its inception in 2001, the LCEC has evaluated more than 5,000 patients with chest abnormalities. Up until now, the diagnosis of lung cancer has been made when patients have symptoms or through incidental findings on chest x-rays or CT scans done for other reasons. The new screening program, established this fall, aims to save more lives.
Those who qualify for lung cancer screening can make an appointment by calling 631-444-2981. Watch the video (2:11 min) to learn more about our screening program:
Posted by Stony Brook Surgery on October 29, 2013
Only Center of Its Kind in Suffolk County for Patients with Aortic Conditions
We are very pleased to announce the establishment of the multidisciplinary Aortic Center at Stony Brook Medicine, in which our cardiovascular surgeons are leaders. Specialists in cardiac imaging, cardiovascular medicine, anesthesiology, cardiothoracic surgery, and vascular surgery, the center's physicians work closely with each other, and with patients' referring physicians, to provide the most focused solution to a patient's aortic disease.
The leaders of the Aortic Center's team are: Apostolos K. Tassiopoulos, MD, professor of surgery and chief of vascular surgery; Thomas V. Bilfinger, MD, ScD, professor of surgery and director of thoracic surgery; James R. Taylor Jr., MD, professor of surgery, chief of cardiothoracic surgery, and co-director of the Stony Brook University Heart Institute; Shang A. Loh, MD, assistant professor of surgery; Harold A. Fernandez, MD, professor of surgery and deputy chief of cardiothoracic surgery, and co-director of the Heart Institute; Allison J. McLarty, MD, associate professor of surgery; Sandeep Gupta, MD, assistant professor of surgery; and William E. Lawson, MD, professor of medicine, interim chief of cardiovascular medicine, and co-director of the Heart Institute.
"The creation of the Aortic Center formalizes the longstanding, multidisciplinary teamwork that has made Stony Brook a leader in the treatment of aortic problems, as well as the region’s referral center for complex and high-risk cases," says Dr. Tassiopoulos. "Our goal is to provide a highly accurate diagnosis of all aortic conditions and treatment plans deploying the most effective, least invasive therapies available."
Patients don't have to travel far to receive the very best in
"The Aortic Center's extensive experience with minimally invasive interventions permits treatment of a wider range of aortic patients, resulting in shorter hospital stays and fewer postoperative complications," says Dr. Bilfinger.
As an academic medical center, we are involved in some of the key clinical trials for new aortic procedures and devices. Access to these advances enables us to offer lifesaving options to patients who might otherwise be untreatable because of their age, co-morbid conditions, or complex anatomy.
Using Leading-Edge Technology
The Aortic Center, which is closely allied with the Heart Institute, is Suffolk County's only facility offering patients comprehensive and coordinated care for the full range of aortic conditions. Our sophisticated technologies — in the hands of our specialists — help define aortic problems and the optimal treatment plan. Advanced diagnostic capabilities include:
The Aortic Center's physicians are experienced in treating patients with co-existing conditions and other high-risk factors. They offer diagnosis and treatment for all aortic diseases, including:
Our minimally invasive interventions allow us to treat a wider spectrum of patients, with shorter hospital stays, and fewer postoperative complications. Our advanced interventions include:
To fulfill our mission of excellence in patient care, our physicians consistently take part in vascular quality initiatives that result in exceptional clinical outcomes for our patients — outcomes that rival those of some of the largest medical facilities in the northeast region of the United States.
We are committed to providing patients with an appointment within 1 week
The Aortic Center's team includes two clinical navigators who are hands-on every step of the way, to help ensure that patients and their families have the support and resources they need. Before, during, and after surgery, these navigators act as liaisons between the patient and attending physician to provide a seamless course of care.
Illustrated patient education materials are given to all patients and families to help them better understand their aortic condition and potential treatment options.
With the increasing number of minimally invasive techniques established for aortic repair, surveillance imaging with duplex ultrasound (sonography) or CT angiography is now a mainstay of follow-up care. And often surveillance imaging continues for life. After the patient's surgery, we recommend an interval surveillance regimen, and we work closely with the patient and his/her family and with the referring physician, to help ensure optimal lifelong care.
When a patient needs to be transferred to Stony Brook University Hospital, we are available 24 hours a day, seven days a week to provide immediate care. The hospital's Patient Transfer Center is a comprehensive emergency medical service system that is staffed by a team of specially-trained healthcare professionals.
One of the goals of the Aortic Center is to educate patients and provide primary care providers with resources that facilitate early recognition of patients at risk, timely diagnosis of aortic conditions that are often silent, and medical control of risk factors so that we reduce the number of aortic emergencies in our area.
For consultations/appointments with the surgical specialists of the Aortic Center, please call 631-444-2683.
Posted by Stony Brook Surgery on October 8, 2013
For nearly a decade the Centers for Medicare and Medicaid Services (CMS) — the federal government agency that oversees Medicare and Medicaid insurance plans — has required that centers performing bariatric or weight loss surgery be accredited for these surgeries. Accreditation led to improved facilities and surgical technique across the country. However, early this year the continued need for Center of Excellence programs was questioned.
Center of Excellence programs were designed to assure that healthcare facilities had the resources as well as outcomes to predict better patient care. The oversight programs required wide doorways, appropriately designed furnishings, care plans, appropriate staffing, and high surgical volumes. The major limitation was that the programs did not need actual good outcomes to be designated as a Center of Excellence.
The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) have been addressing these limitations by a new accreditation system that is currently being rolled out. This new program still requires appropriate resources and staffing at participating hospitals. However, it also asks surgeons to engage in actual quality tracking.
We do not know how this new program will affect quality and outcomes, but we suspect they will be improved. CMS has spent the last several months reviewing recent research and outcomes, and has determined that having surgery in a Center of Excellence facility by current standards does not necessarily mean improved outcomes. Therefore, CMS is dropping this facility requirement.
What does Medicare's decision mean to us at Stony Brook Medicine?
Stony Brook is currently provisionally approved as a Level 2 Center of Excellence program through the ACS. We are now able to perform weight loss surgery on low-risk patients with insurance through CMS. As the new ACS/ASMBS accreditation program rolls out, we anticipate expanding to high-risk patients, such as those with high body mass index (BMI), older age, or need for revisional surgery as well, in early 2014.
Why are we still pursuing accreditation? Although CMS no longer requires center designation, many other insurers still do. We also feel that participating in the quality program will allow us to continue to offer the highest-quality care and best surgical outcomes within New York. We continue to offer a full range of multidisciplinary strategies for all patients suffering from obesity, and offer the most comprehensive services in our area.
For more information about our Bariatric and Metabolic Weight Loss Center, please visit our website, or call HealthConnect at 631-444-4000 to register for one of our free information seminars (held twice a month). Follow Dr. Pryor on Twitter!
Posted by Stony Brook Surgery on September 24, 2013
Achalasia is a swallowing disorder that affects approximately 1 in 100,000 people in the United States. In patients with achalasia, the esophagus, or food pipe, does not contract appropriately making it difficult to move food down to the stomach.
In addition, the lower esophageal sphincter, a valve that separates the esophagus from the stomach, does not relax appropriately in response to food. This lack of relaxation impedes swallowing and food’s ability to reach the stomach.
Symptoms of achalasia include difficulty swallowing, regurgitation of undigested food, chest pain behind the sternum with swallowing or shortly after meals, and weight loss from an inability to eat.
Diagnosing achalasia appropriately is the key to treatment, as other disease processes may mimic or cause achalasia-type symptoms.
The American College of Gastroenterology just released new guidelines for both the diagnosis and treatment of achalasia. Recommendations for proper diagnosis of this disorder are as follows:
1) An esophageal motility test should be performed on all patients suspected of having achalasia.
An esophageal motility test consists of having a thin tube inserted through the nose while the patient is asked to swallow several times. This probe is designed to measure how muscle contracts in different parts of the esophagus. It is also designed to evaluate the lower esophageal sphincter and determine its resting pressure as well as its ability to relax with swallowing.
2) Esophagram should be performed to confirm radiographic evidence of disease and support the diagnosis.
An esophagram is a test where patients will drink contrast while x-rays are being taken of them swallowing. Characteristic findings, such as an esophagus that is wide and then tapers to a fine point, are used to help support a diagnosis of achalasia.
3) Endoscopy should be performed to rule out other disease.
Endoscopy is a test where, under sedation, a flexible endoscope is place within the esophagus to examine the organ from the inside. This test is necessary to rule out other disease processes, such as tumors, which could cause similar symptoms.
Once a diagnosis of achalasia is made, treatment recommendations are made and range from medication alone to surgery. Treatment is individualized to patient health status and symptom severity. Current recommendations are as follows:
1) Initial therapy should be either graded pneumatic dilation or laparoscopic surgical myotomy with a partial fundoplication (stomach wrap) in patients healthy enough to undergo surgery.
Pneumatic dilation is a procedure where a balloon is placed with an endoscope at the level of the lower esophageal sphincter and inflated in order to break the tight muscle cells.
A surgical myotomy is where five key-hole incisions are made in the abdomen, the esophagus identified, and the muscle of the esophagus split. In this procedure, a stomach wrap is added to reduce the chance of acid reflux after surgery.
Both options have good five-year outcomes. However, the incidence of perforation (a hole in the esophagus made inadvertently) and reflux are higher in patients who undergo pneumatic dilation.
Note: POEM (peroral endoscopic myotomy) is a recently introduced therapy that creates an incisionless myotomy — muscle split — using an endoscope. While promising, this procedure is still new and technically challenging. At this time, POEM should only be performed at select institutions with expertise in this procedure.
2) Botulinum toxin (Botox) therapy is recommended for patients not suited to dilation or surgery.
Injection of Botox into the lower esophageal sphincter to freeze, thereby relax, the muscles is a well-established treatment. This option, however, should only be reserved for patients who are not candidates for dilation or surgery, because successful results are short term (six months) and therapy often needs to be repeated. Medications such as calcium channel blockers can also be added for those who fail this treatment and are not candidates for dilation or surgery.
If you have recently been diagnosed with achalasia or have any symptoms associated with it, and would like further information, please call 631-444-4545 to schedule an appointment with one of our general surgeon achalasia specialists.
Posted by Stony Brook Surgery on September 17, 2013
Our Mission of Excellence in Community Service Extends to the "Other" America
Kevin Rosero, a 10-year-old boy from Ecuador who had lived his whole life with a rare massive venous malformation on his face that involved his tongue, pharynx, lip, cheek, eye socket, and temporal bone — a potentially life-threatening condition that could not be treated in his home country — left Long Island today to return home with a transformed face. He looks like a normal boy now, thanks to the surgical care he received at Stony Brook Medicine.
Kevin spent the last eight months on Long Island and underwent ten surgical procedures, two of which were performed by Alexander B. Dagum, MD, professor and interim chairman of surgery and chief of our Plastic and Reconstructive Surgery Division. Ultimately, Kevin's condition was treated.
Kevin came to the United States under the sponsorship of Blanca's House, a Long Island-based nonprofit group that provides medical treatment to the underserved here and around the world. He was cared for at Stony Brook Children's Hospital.
Dr. Dagum had examined Kevin during a 2012 Blanca's House mission to Ecuador (read about this mission) and knew that he — together with cerebrovascular and endovascular neurosurgeon Henry Woo, MD, co-director of Stony Brook's Cerebrovascular Center — and their Stony Brook colleagues could remove the massive venous malformation and reconstruct the boy's face in steps. Blanca's House approached Kevin's family and with their approval arranged for a host family to care for Kevin during his stay on Long Island.
Ten surgeries were performed at Stony Brook Medicine as part of our mission of excellence in teaching,
To celebrate Kevin's victory, his Stony Brook caregivers, his host mom Sheila Campbell of Miller Place, NY, Kerry O'Sullivan from Blanca's House, and members of the Stony Brook men's soccer team gave Kevin a special sendoff last Friday. The soccer team surprised Kevin, a big soccer fan, with a ball signed by the entire team, a Seawolves T-shirt, and an invite to be honorary captain at the game that evening. Kevin brought his charm and enthusiasm to the game, and the Seawolves beat Rhode Island 1-0 (see video clip of Kevin running onto the soccer field with Stony Brook players).
"The malformation made it hard for Kevin to eat and speak, and he was always at risk of bleeding and potentially dying from an airway obstruction or going blind in his left eye," explains Dr. Dagum. "Kevin has done remarkably well, and will live the rest of his life without the malformation and like any normal boy."
"Not only did Kevin endure all these surgeries, his self-confidence and ability to interact with people changed dramatically over the course of this year," says Dr. Woo when describing Kevin, who learned English as a fourth-grader during his stay on Long Island.
Dr. Woo had to perform eight procedures to shut down the vascular malformation. He completed multiple embolizations and sclerotherapy to reduce the size and close off the major venous channels. After Kevin healed from this series of treatments, Dr. Dagum proceeded with a major resection of the remaining cheek, lip, oral, and orbital components of the venous malformation. This was followed by a second surgery to create a normal-looking lip.
Kevin needed to time to heal between each procedure. The surgeries were performed at Stony Brook Medicine as part of our mission of excellence in education, as well as our humanitarian commitment to improving population health both here and abroad.
"Kevin is a remarkable and brave young boy," says Ms. Campbell. "Thanks to Blanca's House and the amazing work of Kevin's Stony Brook doctors, Kevin's life has changed. This would not have been possible without them. He will be going home to his family completely healthy and with a bright future."
Kevin will have follow-up visits with Dr. Dagum in Ecuador, when possible when he is there on future medical missions, to monitor the boy's condition.
To see photos of the press event and soccer game, visit Stony Brook Children's Facebook page. Watch this Fox 5 news clip (2:40 min) which tells the dramatic story and highlights our success: