Hello, my name is Stephen Bowers and I specialize in surgery for conditions of the upper gastrointestinal tract.
This is called foregut surgery. Without being able to enjoy a meal, there can be no joy in life. This is the driving principle of my surgical practice. I focus on restoring the ability to swallow, digest, and comfortably enjoy a healthy diet, and my partners and I at Mayo Clinic do this whenever possible by a method that minimizes the side-effect profile of the operation, whether by minimally invasive laparoscopic or robotic assisted operation, or by endoscopic therapy such as the POEM procedure.
In addition to hiatal hernia, reflux, swallowing disorders and cancers of the esophagus and stomach, bariatric surgery is an essential component of foregut surgery. Bariatric surgery enables patients to regain healthy dietary habits and restore normal weight and health. There are a substantial number of patients for whom the typical anti-reflux operations are not ideal, and in many of these a Roux-en-Y gastric bypass, or as it may be called, a near esophagojejunostomy, may be the ideal anti-reflux operation. There are several clinical scenarios that a patient may fall into where we may recommend the Roux-en-Y gastric bypass as the ideal anti-reflux procedure. In patients who have not previously had gastric surgery and have a large hiatal hernia, but also carry a lot of weight in the abdomen and thus have increased abdominal pressure, that pressure could be a disruptor of the hiatal hernia repair with a typical anti-reflux operation such as a Nissen fundoplication. After multiple failed anti-reflux operations, we may conclude that fundoplication. is just not ideal, or that there's insufficient stomach to make an appropriate anti-reflux valve. The Roux-en-Y gastric bypass is a very effective anti-reflux operation. In addition, it's helpful with resolution of all the other co-morbidities associated with obesity. By decreasing the abdominal pressure with weight loss, the hiatal hernia is less likely to be disrupted after Roux-en-Y gastric bypass and after typically anti-reflux operations.
We want our patients to have healthy dietary habits and to enjoy meals as a fundamental part of a healthy life.