'patient centered approach'

This is an operation for achalasia of the cardia, a condition in which the muscle in the lower oesophagus fails to relax and therefore hinders the passage of food and fluid into the stomach. Treatment with Botox injections or balloon dilatation of the affected part of the oesophagus can be attempted but are often short-lived and surgery is frequently required as a more lasting solution. Under general anaesthesia, 5 small keyhole incisions are made on the abdomen and laparoscopic instruments are introduced. The lower oesophagus is approached and a lengthwise cut is made in the muscle layer of the lower oesophagus. Care is taken to cut only the muscle layer, leaving the inner lining of the oesophagus intact. As this procedure is often complicated by acid reflux after the operation, a partial or complete fundoplication is also performed at the same time to minimise this. Intake of food should become more comfortable soon after surgery and a near-normal diet can be maintained.

Approximately one third of patients will develop an incisional hernia after abdominal surgery. An incisional hernia occurs at or in close proximity to a surgical incision through which intestine, organ or other tissue protrudes. Incisional hernias result from a weakening of the abdominal muscle due to a surgical incision. An incisional hernia can occur for a number of specific reasons; individuals who participate in excessive or premature physical activity after surgery, gain considerable weight, become pregnant or increase abdominal pressure in any other way before the incision is fully healed are especially at risk for an incisional hernia. Incisional hernias are most likely to occur within three to six months post-surgery but can happen at any time.