Fall 2013
Additional expertise grows surgery department

synapse: University of Nevada, Reno School of Medicine

Shawn Tsuda

Tsuda demonstrates the LINX System, a flexible band of interlinked titanium beads with magnetic cores. Photo by Edgar Antonio Nunez.

New techniques in bariatric, colorectal surgery procedures

By Anne McMillin

With the goal of providing new services to its growing patient base, the University of Nevada School of Medicine continues to add medical expertise and offerings in the Department of Surgery.

Shawn Tsuda, M.D., FACS, associate professor of surgery and chief of minimally invasive and bariatric surgery, now is certified in the LINX™ Reflux Management System.

Tsuda is the first and only surgeon in the state of Nevada with this certification.

The LINX™ system is a procedure that helps augment the lower esophageal sphincter for patients who have gastroesophageal reflux disease, commonly known as heartburn. A prospective trial featuring LINX™ recently was published in the New England Journal of Medicine.

Gastroesophageal reflux disease, a chronic digestive disease, occurs when stomach acid flows back into the esophagus causing acid reflux and heartburn. It occurs at least twice a week or more frequently. Changes to diet and over-the-counter medications may offer some relief, but typically discomfort persists. In some cases, surgery is required to treat the disease.

"Millions of people have this disease, resulting in millions of prescriptions for treatment. The primary treatment remains medical. However, there is a growing concern for long-term health effects of certain antacids, including infection, bone loss and possibly heart disease," Tsuda said.

Standard surgical treatment involves wrapping a portion of the stomach around the esophagus to reinforce the weakened lower esophageal sphincter. It typically is effective, but potential limitations include complications such as difficulty swallowing, gas bloat and an inability to belch or vomit; loss of effectiveness over time; and a recovery period lasting several days.

The LINX™ system does not require anatomical alteration of the stomach. Patients are placed under general anesthesia during the procedure, which typically lasts less than an hour. Most patients can go home the day after surgery and resume a normal diet; and these two factors alone, according to Tsuda, are extremely appealing to patients considering treatment options. He said in his research on the procedure, he has been impressed with the strong data backing the procedure and that it has been shown to be safe and effective in patients with gastroesophageal reflux disease unmanageable by medical treatment.

With a goal of keeping patients with colorectal diseases in Nevada, the Department of Surgery expanded the division of colorectal surgery under the leadership of Ovunc Bardakcioglu, M.D. with faculty surgeons trained in minimally invasive and robotic techniques.

"Less invasive techniques are very demanding and difficult to learn when colorectal procedures are only done a few times a year by general surgeons. We are not only utilizing, but further developing that expertise here for the benefit of our patients," Bardakcioglu said.

School of Medicine colorectal surgeons, who are all fellowship-trained and board-certified, have expertise in the treatment of colon and rectal cancer, Crohn's disease, ulcerative colitis, diverticulitis, complex anorectal surgery, pelvic floor dysfunction and fecal incontinence.

Primary care for colorectal diseases is offered through an office-based hemorrhoid treatment center and a referral line for screening colonoscopies.

As a part of a tertiary care referral center, School of Medicine surgeons provide advanced options such as laparoscopic surgery, robotic surgery, transanal minimal invasive surgery for advanced polyps and early rectal cancer and sacral nerve stimulation for fecal incontinence. Bardakcioglu is taking it to the next level by developing a colorectal surgery fellowship to further expand the department's ability to train other surgeons in the specialty as one of few training programs in the western U.S.

Being part of an academic medical center means embracing a commitment to research, and Bardakcioglu is doing so by partnering with the school's Department of Physiology and Cell Biology to find opportunities to expand translational research and move it from the laboratory to a clinical setting. Patients have access to ongoing prospective local studies developed by University of Nevada School of Medicine faculty along with national research trials.

"The bottom line is that we want our patients to know they don't have to leave town, because we have the expertise they need right here in Las Vegas at the School of Medicine," Bardakcioglu said.

To schedule an appointment for treatment of any of these conditions, call (702) 671-5150.