The EsophyX device represents over a decade of innovative engineering design to achieve restoration of the antireflux barrier through a non-invasive surgical procedure. It functions as an extension of the surgeon's hand with proprietary fasteners to create a serosa-to-serosa fusion and reconstruct a full valve. Clinical studies show the EsophyX procedure results in a similar valve and lower esophageal sphincter pressure as laparoscopic surgery, significantly improving patients' quality of life and allowing 85% to remain off daily PPIs one year later.
This document describes a new surgical technique for treating mallet fractures using a modified 1.3mm hook plate. Key points:
- The technique involves using a hook plate modified with two hooks that are passed through small incisions in the tendon and grab the dorsal fracture fragment.
- A screw is used to reduce the fragment and provide compression at the fracture site, employing the tension band principle.
- The plate provides anatomic reduction and stable fixation, allowing early mobilization of the DIP joint.
- The technique is described as providing good clinical and radiographic outcomes for mallet fractures involving over 30% of the articular surface.
Pv0811 elce degloving injuries in horse -initial treatmentMinakata Jin
- Degloving injuries in horses often involve large areas of damaged skin and underlying tissue on the distal limbs, exposing bone or tendon.
- Initial treatment includes cleaning and debriding the wound under sedation or anesthesia. Broad-spectrum antimicrobials may be given and the wound should be dressed and drained.
- Primary closure is recommended when possible to aid healing, using a tension-relieving suture pattern to minimize tension on the skin edges without compromising drainage.
This document discusses minimal invasive spine surgery (MISS) and less invasive spine surgery (LISS) techniques. It provides an overview of the concepts and objectives of MISS/LISS, which aim to achieve the same effectiveness as traditional techniques but with less tissue disruption. The document then reviews literature on fusion rates and clinical outcomes for different fusion techniques. It also discusses debates around disc arthroplasty versus fusion and strategies for reducing tissue injury during arthrodesis procedures like using minimally invasive retractors. Several clinical cases demonstrating the MISS/LISS technique using percutaneous pedicle screws are presented. The document emphasizes that while technology can help, minimally invasive techniques also require skill to avoid potential complications if not performed appropriately.
This article reports on 5 consecutive cases where unsplinted dental implants were used to successfully retain maxillary overdentures with partial palatal coverage. A total of 25 textured implants were placed with a minimum of 4 implants per patient. After 12-48 months, none of the implants lost osseointegration and marginal bone levels remained stable. Patients were able to maintain soft tissue health around the unsplinted implants and reported being comfortable with the functioning of their maxillary overdentures. The preliminary results suggest that unsplinted implants can successfully retain removable maxillary overdentures with limited palatal coverage.
1. Dr. Souvik Paul discussed flexor tendon injuries and repairs, including the anatomy of the flexor tendons and pulley system, classification of tendon injuries, and surgical techniques for primary and secondary repairs.
2. Flexor tendon injuries are evaluated based on history, exam, and special tests to determine the extent and timing of repair. Various graft options can be used for repairs involving tendon loss.
3. Postoperative rehabilitation protocols emphasize protected early motion to regain function while avoiding adhesion formation. Implant-assisted repairs and staged reconstruction procedures are options for more complex injuries.
The document discusses a new bone ring technique for vertical bone augmentation and immediate implant insertion that shortens treatment time compared to traditional two-stage augmentation, presenting a case study demonstrating the procedure. It also examines micromovements at the implant-abutment interface from different implant systems and the potential clinical relevance, and presents a rationale for esthetic tissue preservation when immediately inserting an implant after extraction by simulating a tooth replantation.
Short Implants and their role in prosthetic replacement of missing toothSivaRaman Sms
This is an seminar on short implants related to implant dentistry .
This gives the insight on what has happened since the evolution of short implants and its role in implantology .Their role as replacement of missing tooth in the atrophied maxillary and mandibular posterior regions
This document describes a new surgical technique for treating mallet fractures using a modified 1.3mm hook plate. Key points:
- The technique involves using a hook plate modified with two hooks that are passed through small incisions in the tendon and grab the dorsal fracture fragment.
- A screw is used to reduce the fragment and provide compression at the fracture site, employing the tension band principle.
- The plate provides anatomic reduction and stable fixation, allowing early mobilization of the DIP joint.
- The technique is described as providing good clinical and radiographic outcomes for mallet fractures involving over 30% of the articular surface.
Pv0811 elce degloving injuries in horse -initial treatmentMinakata Jin
- Degloving injuries in horses often involve large areas of damaged skin and underlying tissue on the distal limbs, exposing bone or tendon.
- Initial treatment includes cleaning and debriding the wound under sedation or anesthesia. Broad-spectrum antimicrobials may be given and the wound should be dressed and drained.
- Primary closure is recommended when possible to aid healing, using a tension-relieving suture pattern to minimize tension on the skin edges without compromising drainage.
This document discusses minimal invasive spine surgery (MISS) and less invasive spine surgery (LISS) techniques. It provides an overview of the concepts and objectives of MISS/LISS, which aim to achieve the same effectiveness as traditional techniques but with less tissue disruption. The document then reviews literature on fusion rates and clinical outcomes for different fusion techniques. It also discusses debates around disc arthroplasty versus fusion and strategies for reducing tissue injury during arthrodesis procedures like using minimally invasive retractors. Several clinical cases demonstrating the MISS/LISS technique using percutaneous pedicle screws are presented. The document emphasizes that while technology can help, minimally invasive techniques also require skill to avoid potential complications if not performed appropriately.
This article reports on 5 consecutive cases where unsplinted dental implants were used to successfully retain maxillary overdentures with partial palatal coverage. A total of 25 textured implants were placed with a minimum of 4 implants per patient. After 12-48 months, none of the implants lost osseointegration and marginal bone levels remained stable. Patients were able to maintain soft tissue health around the unsplinted implants and reported being comfortable with the functioning of their maxillary overdentures. The preliminary results suggest that unsplinted implants can successfully retain removable maxillary overdentures with limited palatal coverage.
1. Dr. Souvik Paul discussed flexor tendon injuries and repairs, including the anatomy of the flexor tendons and pulley system, classification of tendon injuries, and surgical techniques for primary and secondary repairs.
2. Flexor tendon injuries are evaluated based on history, exam, and special tests to determine the extent and timing of repair. Various graft options can be used for repairs involving tendon loss.
3. Postoperative rehabilitation protocols emphasize protected early motion to regain function while avoiding adhesion formation. Implant-assisted repairs and staged reconstruction procedures are options for more complex injuries.
The document discusses a new bone ring technique for vertical bone augmentation and immediate implant insertion that shortens treatment time compared to traditional two-stage augmentation, presenting a case study demonstrating the procedure. It also examines micromovements at the implant-abutment interface from different implant systems and the potential clinical relevance, and presents a rationale for esthetic tissue preservation when immediately inserting an implant after extraction by simulating a tooth replantation.
Short Implants and their role in prosthetic replacement of missing toothSivaRaman Sms
This is an seminar on short implants related to implant dentistry .
This gives the insight on what has happened since the evolution of short implants and its role in implantology .Their role as replacement of missing tooth in the atrophied maxillary and mandibular posterior regions
This document discusses various considerations for treatment planning and prosthodontic rehabilitation of edentulous mandibles with dental implants. It covers factors such as biomechanics, esthetics, oral hygiene access, and amount of keratinized tissue. Minimum implant number, length, and spacing are outlined. Techniques for impressions, soft tissue grafting, and fixed prosthesis options like PFM and hybrid are described.
The TIF procedure achieves the objectives of a fundoplication without the risks and recovery time of more invasive laparoscopic or open procedures. It elongates the esophagus, creates a 270-320 degree esophagogastric valve, and tightens the phrenoesophageal membrane similarly to fundoplication techniques. By objective measures, TIF improves LES parameters and reduces acid exposure like expected from a fundoplication.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Incisor intrusion with invisalign treatmentJorge Melgar
This case report describes the intrusion of extruded upper incisors in a 43-year-old female patient with periodontal disease using Invisalign removable aligners. Scaling and root planing were performed before starting 15 aligners for the upper arch and 10 for the lower over 8 months. A frenectomy was done during the 6th aligner to reshape gingival margins. Post-treatment radiographs and clinical examination showed intrusion of the upper incisors and reduction of infrabony defects. The aligners provided light, continuous forces for tooth movement of 0.25mm per aligner while allowing for proper oral hygiene. This demonstrated Invisalign can be effective for orthodontic intrusion in adult period
Tissue expanders are valuable adjuncts in reconstructive maxillofacial surgery. They allow surgeons to replace lost or excised tissue with similar texture and thickness from neighboring tissue. Tissue expansion works by applying mechanical forces that induce controlled in situ skin growth. This stretches the skin beyond its limits, invoking biological pathways that increase cell growth and collagen synthesis, resulting in a net gain in skin surface area. Tissue expanders are silicone implants placed subcutaneously that are inflated over time to generate new tissue. They improve surgical outcomes by reducing the need for skin grafts and flaps.
Vertical ridge augmentation is sometimes required for dental implant placement. The presentation looks at various conventional and newer techniques for ridge augmentation in the oral cavity.
This study evaluated the efficacy of using periotomes for single-rooted nonsurgical tooth extractions compared to traditional extraction techniques. 100 patients were randomly assigned to have a tooth extracted using either a periotome (test group) or traditional methods using forceps (control group). The results found that extractions using periotomes took less time, resulted in less post-extraction pain reported by patients on a visual analogue scale over 7 days, required less analgesic consumption, and caused fewer gingival lacerations compared to traditional methods. The study concluded that the use of periotomes can help reduce post-extraction discomfort compared to conventional extraction techniques.
Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.
Expasyl is a hemostatic paste used for gingival retraction that provides effective retraction with minimal pressure, reducing risk of tissue damage and increasing patient comfort compared to traditional retraction cords. It is extruded directly into the sulcus rather than pressed in, retracting tissue gently. Expasyl controls bleeding and provides a clean, dry field for impressions. Studies show it is highly effective at retraction and hemostasis with minimal trauma to soft tissues.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
The document provides information about a dental implant solutions company. It summarizes their comprehensive treatment, education, and business support solutions. Their treatment solutions include patient-driven implant systems, end-to-end prosthetic options, and site-specific regenerative materials. They offer an extensive educational continuum and business tools to help dental practices succeed.
The document discusses immediate implant restoration using the SKY fast & fixed system. It provides a surgical and prosthetic protocol for placing implants and immediately restoring them with a temporary bridge. This allows training of the bone and saving of soft tissue by avoiding frequent changes to abutments. The system uses transversally and occlusally screwed bridges for immediate restoration and creates fixed provisional restorations on a broad support base.
Surgical mesh is a sterile woven netting used in surgical procedures to repair tissues and provide internal support. It is commonly used in hernia repair and for treating urinary incontinence and organ prolapse in women. Mesh acts as a scaffold to mechanically strengthen weak areas and promote new tissue growth. Materials used for mesh include non-absorbable polymers like polypropylene, absorbable polymers, and biological tissues. Ideal mesh properties include stability, inertness, strength, and flexibility to minimize complications like chronic pain, erosion, and infection. The risk of infection varies based on the mesh filament type and pore size.
New trend in the managment of lumbar canal stenosis nilesProf. Rehab Yousef
2018-04-18 المؤتمر العلمي الثاني للمعهد القومي لعلوم المسنين جامعة بني سويف بعنوان" التحديات والمستجدات العالمية في رعاية المسنين"
http://www.bsu.edu.eg/ShowConfDetails.aspx?conf_id=217
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
This document discusses a study that evaluated the sublay retromuscular technique for ventral incisional hernia repair using lightweight Vypro mesh versus standard heavyweight Prolene mesh. 30 patients with moderate sized hernias were divided into two groups, with one group receiving Vypro mesh and the other receiving Prolene mesh via the sublay retromuscular technique. The study aims to compare postoperative complications, chronic pain, and recurrence rates between the two mesh types.
Nova Medical Centers provides ambulatory spine surgery, also known as day care spine surgery, in Bangalore, Delhi, and Mumbai, India. Advances in surgical techniques and technology have allowed many spinal procedures that previously required long hospital stays to now be routinely performed on an outpatient basis. Key procedures discussed include percutaneous endoscopic lumbar discectomy (PELD) for herniated discs, nucleoplasty for contained disc herniations, kyphoplasty for osteoporotic vertebral fractures, and percutaneous endoscopic transforaminal lumbar interbody fusion (Pe-TLIF) for severe degenerative lumbar disc disease.
Obturators for acquired maxillary defectsPriya Gupta
This document provides an overview of obturators for acquired maxillary defects. It discusses the historical development of obturators, objectives and ideal requirements, materials used for fabrication, classifications based on origin of defect and location, indications and functions. It also covers design considerations for support, retention and stability. Obturators are prosthetic devices used to close acquired openings of the hard palate and/or soft palate following surgery or trauma. They aim to restore esthetics and function like speech, swallowing and mastication.
This document discusses the advantages of physician-led hospitals and why physicians must lead in healthcare. It provides examples showing that the top-rated hospitals like Mayo Clinic and Cleveland Clinic have been led by physicians for over 100 years. Physician leadership results in better patient outcomes, satisfaction, economic performance, and physician retention and satisfaction. Studies show physician-led hospitals score higher on quality metrics than non-clinician led hospitals. The document argues physicians possess credibility as leaders since they understand clinical practice from experience. It also discusses the challenges of physician burnout and need for training clinical leaders to succeed in today's team-based healthcare system.
This study evaluated the technical feasibility and safety of using a novel endoscopic suturing device to repair gastrointestinal fistulae in 7 patients. The procedure was technically successful in all patients with no early complications. At follow up of 5.1 months, 6 patients had resolution of symptoms and average weight loss of 22.8 pounds. While the study was limited by its small size and short follow up, the results suggest endoscopic repair of fistulae using this suturing device can be achieved safely and warrants further study.
This document discusses various considerations for treatment planning and prosthodontic rehabilitation of edentulous mandibles with dental implants. It covers factors such as biomechanics, esthetics, oral hygiene access, and amount of keratinized tissue. Minimum implant number, length, and spacing are outlined. Techniques for impressions, soft tissue grafting, and fixed prosthesis options like PFM and hybrid are described.
The TIF procedure achieves the objectives of a fundoplication without the risks and recovery time of more invasive laparoscopic or open procedures. It elongates the esophagus, creates a 270-320 degree esophagogastric valve, and tightens the phrenoesophageal membrane similarly to fundoplication techniques. By objective measures, TIF improves LES parameters and reduces acid exposure like expected from a fundoplication.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Incisor intrusion with invisalign treatmentJorge Melgar
This case report describes the intrusion of extruded upper incisors in a 43-year-old female patient with periodontal disease using Invisalign removable aligners. Scaling and root planing were performed before starting 15 aligners for the upper arch and 10 for the lower over 8 months. A frenectomy was done during the 6th aligner to reshape gingival margins. Post-treatment radiographs and clinical examination showed intrusion of the upper incisors and reduction of infrabony defects. The aligners provided light, continuous forces for tooth movement of 0.25mm per aligner while allowing for proper oral hygiene. This demonstrated Invisalign can be effective for orthodontic intrusion in adult period
Tissue expanders are valuable adjuncts in reconstructive maxillofacial surgery. They allow surgeons to replace lost or excised tissue with similar texture and thickness from neighboring tissue. Tissue expansion works by applying mechanical forces that induce controlled in situ skin growth. This stretches the skin beyond its limits, invoking biological pathways that increase cell growth and collagen synthesis, resulting in a net gain in skin surface area. Tissue expanders are silicone implants placed subcutaneously that are inflated over time to generate new tissue. They improve surgical outcomes by reducing the need for skin grafts and flaps.
Vertical ridge augmentation is sometimes required for dental implant placement. The presentation looks at various conventional and newer techniques for ridge augmentation in the oral cavity.
This study evaluated the efficacy of using periotomes for single-rooted nonsurgical tooth extractions compared to traditional extraction techniques. 100 patients were randomly assigned to have a tooth extracted using either a periotome (test group) or traditional methods using forceps (control group). The results found that extractions using periotomes took less time, resulted in less post-extraction pain reported by patients on a visual analogue scale over 7 days, required less analgesic consumption, and caused fewer gingival lacerations compared to traditional methods. The study concluded that the use of periotomes can help reduce post-extraction discomfort compared to conventional extraction techniques.
Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.
Expasyl is a hemostatic paste used for gingival retraction that provides effective retraction with minimal pressure, reducing risk of tissue damage and increasing patient comfort compared to traditional retraction cords. It is extruded directly into the sulcus rather than pressed in, retracting tissue gently. Expasyl controls bleeding and provides a clean, dry field for impressions. Studies show it is highly effective at retraction and hemostasis with minimal trauma to soft tissues.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
The document provides information about a dental implant solutions company. It summarizes their comprehensive treatment, education, and business support solutions. Their treatment solutions include patient-driven implant systems, end-to-end prosthetic options, and site-specific regenerative materials. They offer an extensive educational continuum and business tools to help dental practices succeed.
The document discusses immediate implant restoration using the SKY fast & fixed system. It provides a surgical and prosthetic protocol for placing implants and immediately restoring them with a temporary bridge. This allows training of the bone and saving of soft tissue by avoiding frequent changes to abutments. The system uses transversally and occlusally screwed bridges for immediate restoration and creates fixed provisional restorations on a broad support base.
Surgical mesh is a sterile woven netting used in surgical procedures to repair tissues and provide internal support. It is commonly used in hernia repair and for treating urinary incontinence and organ prolapse in women. Mesh acts as a scaffold to mechanically strengthen weak areas and promote new tissue growth. Materials used for mesh include non-absorbable polymers like polypropylene, absorbable polymers, and biological tissues. Ideal mesh properties include stability, inertness, strength, and flexibility to minimize complications like chronic pain, erosion, and infection. The risk of infection varies based on the mesh filament type and pore size.
New trend in the managment of lumbar canal stenosis nilesProf. Rehab Yousef
2018-04-18 المؤتمر العلمي الثاني للمعهد القومي لعلوم المسنين جامعة بني سويف بعنوان" التحديات والمستجدات العالمية في رعاية المسنين"
http://www.bsu.edu.eg/ShowConfDetails.aspx?conf_id=217
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
This document discusses a study that evaluated the sublay retromuscular technique for ventral incisional hernia repair using lightweight Vypro mesh versus standard heavyweight Prolene mesh. 30 patients with moderate sized hernias were divided into two groups, with one group receiving Vypro mesh and the other receiving Prolene mesh via the sublay retromuscular technique. The study aims to compare postoperative complications, chronic pain, and recurrence rates between the two mesh types.
Nova Medical Centers provides ambulatory spine surgery, also known as day care spine surgery, in Bangalore, Delhi, and Mumbai, India. Advances in surgical techniques and technology have allowed many spinal procedures that previously required long hospital stays to now be routinely performed on an outpatient basis. Key procedures discussed include percutaneous endoscopic lumbar discectomy (PELD) for herniated discs, nucleoplasty for contained disc herniations, kyphoplasty for osteoporotic vertebral fractures, and percutaneous endoscopic transforaminal lumbar interbody fusion (Pe-TLIF) for severe degenerative lumbar disc disease.
Obturators for acquired maxillary defectsPriya Gupta
This document provides an overview of obturators for acquired maxillary defects. It discusses the historical development of obturators, objectives and ideal requirements, materials used for fabrication, classifications based on origin of defect and location, indications and functions. It also covers design considerations for support, retention and stability. Obturators are prosthetic devices used to close acquired openings of the hard palate and/or soft palate following surgery or trauma. They aim to restore esthetics and function like speech, swallowing and mastication.
This document discusses the advantages of physician-led hospitals and why physicians must lead in healthcare. It provides examples showing that the top-rated hospitals like Mayo Clinic and Cleveland Clinic have been led by physicians for over 100 years. Physician leadership results in better patient outcomes, satisfaction, economic performance, and physician retention and satisfaction. Studies show physician-led hospitals score higher on quality metrics than non-clinician led hospitals. The document argues physicians possess credibility as leaders since they understand clinical practice from experience. It also discusses the challenges of physician burnout and need for training clinical leaders to succeed in today's team-based healthcare system.
This study evaluated the technical feasibility and safety of using a novel endoscopic suturing device to repair gastrointestinal fistulae in 7 patients. The procedure was technically successful in all patients with no early complications. At follow up of 5.1 months, 6 patients had resolution of symptoms and average weight loss of 22.8 pounds. While the study was limited by its small size and short follow up, the results suggest endoscopic repair of fistulae using this suturing device can be achieved safely and warrants further study.
This document summarizes the market for obesity products and treatments. It discusses how the field is moving "back to basics" to better understand the physiological mechanisms behind obesity and weight loss. This new understanding may help develop more effective minimally invasive solutions. The US market for minimally invasive bariatric devices is expected to grow moderately over the next five years, reaching over $500 million by 2016, driven by factors like the growing obese population. However, current treatment options have only achieved limited success in treating obesity.
This document provides details about an upcoming symposium on endosurgery to be held on September 19th, 2011 at the Apollo Hospital in New Delhi. The symposium will focus on flexible surgery techniques that minimize surgical trauma through natural orifices. Experts will present on robotics, endoscopic stitching and resection devices. The program will include training discussions on weight regain after bariatric surgery and a debate on surgical versus endoscopic solutions. Equipment demonstrations and a panel discussion on the future of endosurgery in India are also included. Attendees should include doctors from Apollo hospitals with expertise in gastroenterology, bariatrics, and endocrinology.
Flyer for one day seminar for surgeons and gastroenterologists showcasing innovative technologies in endosurgery and robotic surgery
Sept 19, 2011 New Delhi
This study examined whether placing a biologic mesh during abdominal closure would reduce the risk of developing an incisional hernia compared to primary closure without mesh in high-risk patients undergoing gastric bypass surgery. The study found that patients who received a biologic mesh had a significantly lower rate of developing an incisional hernia (2.3%) compared to those without mesh (17.7%). After adjusting for risk factors, placement of a biologic mesh was found to significantly reduce the risk of hernia, while smoking significantly increased the risk. The study suggests prophylactic use of biologic mesh may help reduce incisional hernia rates in high-risk patients.
1. The document discusses endoluminal procedures for weight regain after gastric bypass surgery, including endoluminal gastric pouch reduction (EGPR) and the ROSE procedure.
2. EGPR uses fasteners to narrow the gastric pouch and stoma, resulting in 10-20% excess weight loss typically. The ROSE procedure uses sutures to create folds in the pouch and around the stoma.
3. Studies found these procedures produced 12-25% excess weight loss on average and resolved issues like diarrhea and heartburn in many patients. However, long-term durability is still unknown and behavioral factors impact success.
1) The document describes a prototype endoscopic suturing system that allows full-thickness suturing of the stomach wall for closure of openings (gastrotomies) during natural orifice translumenal endoscopic surgery (NOTES).
2) In vitro tests on isolated pig stomachs showed the system could accurately place running sutures in a pursestring configuration to securely close an 18mm gastrotomy with no leaks.
3) Edge-to-edge closure of gastotomies was also achieved in a leak-proof manner during single intubations using the suturing system.
The OverStitch Endoscopic Suturing System provides physicians the ability to perform running or interrupted stitches within the GI tract. The system is comprised of an Endoscopic Suturing System handle, End Cap, Anchor Exchange, and choice of absorbable or non-absorbable sutures. It is intended for endoscopic placement of sutures to approximate soft tissue and works by delivering anchors and sutures through the endoscope to place stitches. The system is contraindicated for use with malignant tissue or when general endoscopic techniques are contraindicated.
The OverStitch Endoscopic Suturing System allows physicians to perform full-thickness endoscopic suturing through a flexible endoscope in a manner similar to hand suturing. It can deploy both running and interrupted stitches with a single insertion of the endoscope. The system mimics the motion of a curved surgical needle and is designed for controlled suture placement. It is a single-use device available with absorbable or non-absorbable suture materials.
The American Society of General Surgeons (ASGS) supports the use of transoral fundoplication by trained surgeons as a treatment for chronic gastroesophageal reflux disease (GERD) in patients who do not get satisfactory relief from proton pump inhibitors or who wish to avoid lifelong medication dependence. The ASGS believes transoral fundoplication adheres to the same surgical principles as traditional fundoplication techniques by creating a full thickness wrap of the stomach around the esophagus. The ASGS position is supported by peer-reviewed literature demonstrating transoral fundoplication offers comparable results to open and laparoscopic surgery, with high patient satisfaction and relief of GERD symptoms.
Three recent studies published over the past four months involving nearly 200 patients in total provide additional evidence of the positive outcomes of transoral fundoplication (TIF) for the treatment of gastroesophageal reflux disease (GERD). The studies demonstrated a high therapeutic response rate with patients getting off daily proton pump inhibitors, significant response to objective reflux measurements, and a low complication rate of around 2%. The largest study to date involving 124 patients showed 75-80% of patients had normalized symptom scores and 97% were off daily PPI medications post-TIF. The growing body of clinical evidence supports TIF as a safe and effective alternative to traditional anti-reflux surgeries for appropriately selected GERD patients.
The document discusses a new treatment for chronic heartburn called EsophyX that is performed at Nuffield Health Leeds Hospital. It is a minimally invasive procedure that uses plastic fasteners to pull up stomach tissue and prevent acid reflux without surgery. The procedure provides relief for over 80% of symptoms and allows patients to greatly reduce or stop medication. One patient, Patrick Senycia, flew from Australia to receive the treatment and has experienced significant reduction in symptoms. The EsophyX procedure is pioneering as one of the most advanced treatments for chronic acid reflux worldwide.
The document discusses a new treatment for chronic heartburn called EsophyX that is performed at Nuffield Health Leeds Hospital. It is a minimally invasive procedure that uses plastic fasteners to pull up stomach tissue and prevent acid reflux without surgery. The procedure provides relief for over 80% of symptoms and allows patients to greatly reduce or stop medication. One patient, Patrick Senycia, flew from Australia to have the procedure done in Leeds and says his symptoms were greatly reduced. The EsophyX procedure is positioned as a promising new option for treating chronic acid reflux when medication is not effective.
Endoluminal procedures like EGPR and ROSE aim to treat weight regain after gastric bypass through minimally invasive techniques. EGPR uses tissue fasteners to reduce the gastric pouch size and narrow the stoma, resulting in 15.5 lb weight loss on average in 6 months. ROSE uses expandable anchors to similarly reduce pouch size and stoma diameter, stopping weight regain in 88% of patients. Both procedures appear safe and can produce near 50% loss of regained weight, though long-term durability is still unknown. Success may depend on factors like a patient's initial weight loss after gastric bypass.
2. Unique Surgical Approach Clinically Safe and Effective
EsophyX TIF Front LineSurgicalManagement
“Front Line Surgical Management” EsophyX™ Getting it Right
Mild
Mild GERD
GERD
Severe
Severe GERD
GERD 85% of patients remain off daily PPIs one year after EsophyX™ TIF 85%
Lifestyle Change Pharmaceutical Surgical
• Less invasive, no incision or dissection
The TIF surgical procedure using the advanced surgical instrumentation of EsophyX you are able to have • Reducing Hiatal Hernias less than 2 cm
now a FRONTLINE SURGICAL MANAGEMENT of GERD. The EsophyX device enables surgeons and advanced
interventional gastroenterologists to offer their patients substantive anatomical repair without incisions
• Stopping and reducing esophagitis
(no skin or internal dissection) to intervene earlier and change patients lives. • Significantly improving patient quality of life
EsophyX™ Advantages *P < 0.01 N = 65
Transoral Approach - TIF Surgical Procedure
• Transoral truly non-invasive, incisionless
• TIF is an evolution of current surgical procedures
• Based upon proven surgical principles
• TIF has the ability to “reconstruct” the major
components of the antireux barrier
• Adaptable, repeatable, adjustable
• Future options not limited The EsophyX™-TIF1.0 procedure resulted in a 53% increase (P<0.001) in
• Serosa-to-serosa fusion mean LES resting pressure (18 mm Hg post-TIF vs. 13 mm Hg pre-TIF)
Delivers similar benets of time proven surgical laparoscopic fundoplication
Vector Volume
In TIF 2.0, the esophagus “emerges” from the repair reecting the
fact that the stomach has been wrapped around the esophagus. The
appearance and location of this valve relative to the EGJ on vector
volume analysis is very similar to that seen for Nissen fundoplication. 12 mo Post - TIF Pre - TIF off PPIs
Reference: Stein HJ, DeMeester TR, Naspetti R, Jamieson J, Perry RE. Three-dimensional
imaging of the lower esophageal sphincter in gastroesophageal reux disease. Ann
Surg 1991; 214; 374-383.
12 months after the EsophyX™ TIF1.0 procedure, 40-65% of patients were able to consume all foods that trigger
heartburn without symptoms while off their PPIs in comparison to 5-40% of patients before the procedure.
Nissen vs. TIF 2