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Venous Closure Procedure for Varicose Veins
More than 25 million people in the US suffer from painful varicose veins. Varicose vein disease is progressive in nature and may worsen if left untreated the Closure procedure treats venous reflux disease in the superficial venous system. This is often the cause of painful varicose veins. The Closure procedure is performed right here in our office. Using an ultrasound machine operated by our own Cathy Pack, a registered ultrasound technician, Juan DeRojas, MD, or Chester Yavorski, M.D, both Board Certified Surgeons, will perform the procedure. A Closure Catheter will be positioned into the vein through a small opening in the skin. The tiny catheter will deliver a radiofrequency (RF) energy into the vein wall. As the energy is delivered and the catheter is withdrawn, the vein wall is heated causing the collagen in the wall to shrink and the vein to close. Once the diseased varicose vein is closed, the blood is re-routed to other healthy veins.
The procedure is quick and nearly pain free. A bandage is placed over the site and additional compression is provided to aid the healing. You can resume normal activities within a day. You may return to work in two days. With minimal scarring, bruising or swelling. For more information call our office for an appointment or a brochure at 570-821-1100. You can also go online at www.vnus.com.
JUAN DEROJAS, M.D.
Gore EXCLUDER—New Procedure for Endovascular AAA Repair
Annually, nearly 15,000 patients in the US die from ruptured abdominal aortic aneurysms (AAA). This is the 13th leading cause of death in the US. according to the Annals of Vascular Surgery the endovascular treatment of abdominal aortic aneurysms (AAAs) has resulted in a decrease of operative complications, patient discomfort, length of hospital stay, blood loss, and the time needed to return to normal activities.
The FDA approved the Gore EXCLUDER, manufactured by W. L. Gore & Associates, on March 23, 2005. The Gore EXCLUDER device provides the biggest benefit among all endovascular procedures. It is an innovative device designed to me a minimally invasive treatment option for patients with AAA disease.
Chester Yavorski, M.D. , a Board Certified Vascular Surgeon, has successfully completed several hundred endovascular procedures for treatment of abdominal aortic aneurysms using the Gore EXCLUDER device. Call for an appointment 570-821-1100.
CHESTER YAVORSKI, M.D.
Gastric Pacemaker for the Treatment of Gastroparesis
“A New Treatment for a Very Difficult Problem”
For years, patients suffering from gastroparesis, the inability for the stomach to contract normally and empty properly, has been a very frustrating problem for patients and doctors a like. A number of medical therapies have shown some benefit in the past, but most medications have now been removed from the market for various reasons leaving very few medical options. This leaves patients to suffer with chronic nausea, vomiting, malnutrition, dehydration with very few alternatives. It also dramatically affects treatment of other illnesses, since the absorption of medications taken by mouth becomes erratic, so medications may sit in the stomach for hours or even days until they are absorbed. The result is frustrated patients and frustrated doctors.
To help this situation, the gastric neurostimulator (pacemaker) has been developed and has shown significant benefits. It is made by Medtronic Corporation, the same company that makes cardiac pacemakers, and works in a similar fashion. Electronic wires are sewn into the serosa (outer covering) of the stomach and then brought out through the abdominal wall to be placed in a battery run electric stimulator that is placed under the skin of the abdominal wall. The stimulator sends repeated shocks of electricity into the muscular stomach wall causing it to contract and empty. The result is restored peristalsis of the stomach and improved movement of food out of the stomach and into the intestinal tract.
While this procedure is very new and available in only a few research facilities throughout the state, it has been available in the Wilkes Barre area for over a year and is being used successfully by Dr. Clark Gerhart, M.D., F.A.C.S. Dr. Gerhart places the leads (wires) into the stomach and using a laparoscopic technique, which does not require a large incision or lengthy hospital stay. The procedure is done as an outpatient allowing patients to return home the same day following the procedure.
“Results have overall been very good,” says Dr. Gerhart. “We have had some dramatic cases where patients who previously vomited every day now are eating with no vomiting. Other patients have had feeding tubes removed.”
Gastric neurostimulator is successful in roughly 60 to 70% of the patients it is used in locally. This is slightly better than the 50% average that has been reported elsewhere. Patients with diabetic gastroparesis in general do better than those where the cause of their gastric motility problems is unknown. Some patients have needed additional surgery while others have been returned to medical therapy. The gastric neurostimulator is not a cure all for gastroparesis, but it is a significant weapon in the arsenal against this very difficult disease,” notes Gerhardt. Patients who are considering placement of gastric neurostimulator should have documented gastroparesis using a solid and liquid nuclear gastric emptying study and should have a thorough evaluation for any other causes of gastric dismotility such as pancreaticobiliary disease, peptic ulceration or gastric outlet obstruction. Once other possible causes are ruled out, they can be considered for placement of the new device.
One of the advantages of the laparoscopic gastric neurostimulator technique the low risk associated with it. Since the stomach is not altered in any way, there is no disruption of the gastrointestinal tract and no risk of leaking. There is a very low incidence of problems with the leads or the stimulator in the abdominal wall, but beyond these and the general risks of surgery, there are very few reasons to not try the device in patients suffering from gastroparesis. There have been no complications related to the device experienced locally. This excellent safety profile suggests that most patients with documented gastroparesis can be offered this as an option knowing that even if it does not completely resolve their symptoms or if the benefit is small, there are very few risks. Overall patients have been very satisfied with many saying it has completely changed their lives allowing them to eat and function normally again.
CLARK GERHART, M.D.
“Surgical Scars Keep
Getting Smaller”
In the late 1980’s, laparoscopic surgery revolutionized the way surgeons operate on patients. Laparoscopy uses small punctures ranging from 5 to 12 mm (1/4 to ½ inch) to enter the body and perform operations. This greatly reduced the pain and recovery time following surgery and now most operations in the abdomen can be performed using the new techniques. In keeping with the “smaller is better”, thinking a new type of surgery called microlaparoscopy has pushed the advantages of laparoscopic surgery one-step further. This uses punctures that are 3 mm in size (roughly 1/8 of an inch) creating even less pain and smaller scars.
“The new techniques are really exciting,” says Dr. Clark Gerhart, M.D., F.A.C.S., specialist in laparoscopic surgery. “There is even less pain than with standard laparoscopy and once the microlaparoscopic scars heal, they are almost invisible.”
Many operations that previously were performed, using standard and open incisions or laparoscopic incisions, can now be done with the microlaparoscopic techniques. The rule of the gallbladder, exploration of the abdomen for diagnosis, appendectomy, and many other procedures can be done with this technique.
“Not only are the instruments smaller, but there are a few new techniques that need to be done to handle the bodies organs with smaller instruments,” says Gerhart. “So it takes some extra experience, but in the right hands it can add a tremendous benefit to the patient’s surgery.”
As technology continues to advance, doctors are looking for more and more ways to enter the body to perform treatments while causing less injury. The result is even greater improvements in overall patient’s care.
BARRY PERNIKOFF, M.D