University Health System Blog

Dr. Kayvan Khiabani answers the question: What is migraine headache surgery and am I a good candidate?

Migraine headache surgical procedures can eliminate or significantly reduce the frequency and intensity of migraine pain. These surgical procedures focus on removing the triggering sites where nerves are being compressed, causing migraine headaches. The forehead, temples and back of the neck are among the most common trigger points that are decompressed during surgery.

If you’ve been a diagnosed of by your physician as having migraine headaches and have tried other treatments with no or limited success, then you may be a candidate for migraine headache surgery. If you’ve had a good response with Botox injections for relief of migraines, then you probably are an excellent candidate for this migraine headache surgery procedure.

Some of common side effects like a decreased ability to frown and a youthful look, akin to what is experienced after cosmetic Botox injections, are tradeoffs that are considered an advantage by most people. Other common side effects may include temporary hollowing of the temple and numbness in the forehead and scalp.

Kayvan Khiabani, M.D., has an expertise unique in migraine headache surgery. He is an associate professor of surgery at the University of Nevada School of Medicine where he heads the section of microneurovascular surgery.

Dr. Shawn Tsuda answers the question: “I have acid reflux. How do I know if I’m a good candidate for surgery?”

Gastroesophageal reflux disease, also known as GERD, is a common problem and can affect people’s lives from occasional mild discomfort to severe, disruptive pain. The potential complications include erosive esophagitis, increased risk for esophageal cancer, strictures impairing swallowing and the cost of medications used over years.

The majority of patients can control their symptoms with lifestyle changes, such as avoiding foods that cause reflux, not eating too close to going to bed, sleeping with one’s head up, as well as, medications, primarily H2 blockers and proton pump inhibitors.

However, some patients may have already developed complications from GERD or are refractory to even the most aggressive medication regimens. In other cases, a hernia of the stomach through the diaphragm, called a hiatal hernia, may be a contributing factor. For these patients, surgery may be the best option.

After appropriate studies that involve examining the acidic levels of the stomach and the function of the esophagus, a laparoscopic procedure called a Nissen fundoplication can be performed.  This involves wrapping the top of the stomach around the esophagus, preventing acid reflux.

This procedure can be successful up to 90 percent of cases.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine in Las Vegas. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery and consults patients at the school’s Patient Care Center in Las Vegas.

Have a health question? University Health System doctors answer select questions from readers like you.

Last week KLAS-TV Channel 8 News aired a series of informative features on University of Nevada School of Medicine surgeons who staff the trauma center at University Medical Center in Las Vegas.

On Monday the news program reported on a local man who survived a spinal injury thanks to the work of trauma surgeons. Jay Coates, D.O., assistant professor of surgery at the School of Medicine, details step-by-step the critical process of stabilizing a patient rushed into a trauma center.

Tuesday’s report focuses on a local woman who fell during a hike, suffering a shattered skull and a collapsed lung. Michael Casey, M.D., professor of surgery at the medical school, recounts the minutes between life and death while saving a trauma patient.

On Wednesday Deborah Kuhls, M.D., associate professor of surgery at the School of Medicine, describes the story of a teenage girl who was struck by a car as she was playing outside.

John Fildes, M.D., professor and vice chair of surgery at the School of Medicine, was cited in Thursday’s feature on a man who survived a motorcycle crash.

The fifth and final report on Friday is the story of a Las Vegas man involved in a near-fatal car crash that  offers Dr. Kuhl’s insight from a trauma surgeon’s perspective.

University of Nevada School of Medicine trauma and critical care surgeons are some of the leading experts in their field and help lead the trauma center at UMC, the fifth busiest in the country.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. William Zamboni, chair of surgery and chief of plastic surgery at the University of Nevada School of Medicine, appears on the FOX-5 Las Vegas afternoon show “More” with a segment on patients having plastic surgery while awake (video). The segment aired today.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

William Zamboni, M.D., chair of surgery at the University of Nevada School of Medicine and FOX 5 Las Vegas anti-aging editor, answers the question: How much plastic surgery is too much? [video] The segment aired on the program, More, on Feb. 15.

Edgar Antonio Nunez is creative director at University Health System, the clinical practice of the University of Nevada School of Medicine. For media inquiries, contact him by email or call 702-671-2230.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “What happens if I regain the weight I lose after gastric bypass surgery? Can the surgery be redone?”

Weight re-gain following bariatric surgery remains a concern for many patients who have had, or are considering, surgery for weight loss.

While weight-loss procedures – whether the gastric bypass, adjustable gastric band, or the sleeve gastrectomy – remain the best option for durable weight loss in patients with morbid obesity, regain of most or all of one’s preoperative weight is possible.

While the primary cause of weight re-gain can be from a gastric pouch that is stretched, a gradual re-connection between the remant stomach and “new” stomach, or a band that is too loose or malfunctioning, the most common reasons are poor behavioral choices.

Grazing for food, snacking, eating too close to bed time, lack of exercise, and lack of portion control are the common culprits.

This emphasizes the importance of having weight loss surgery-when indicated-in the context of a comprehensive program that has support groups, personal follow-up with the surgeon, and a committment to life-long care.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at University Health System and the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. Jay Coates answers the question: “What can I expect before and after surgery?”

Few events in life create as much anxiety as having to undergo surgery. To help allay some of your anxieties with ‘going under the knife’ I’d like to offer some general guidelines for undergoing surgery with general anesthesia.

Consent

First of all, before surgery, you must have informed consent. Sounds obvious but some patients may feel too intimidated to ask their surgeon basic questions. What procedure is being preformed? Why is it necessary? Who will be doing it? What are the risks and complications associated with this surgical procedure? Surgery should not be taken lightly. Every surgical procedure has potential risks and complications. Among the most common are bleeding, infection and problems with general anesthesia. Your surgeon and you should review these risks and you should fully understand these risks before undergoing the procedure.

Pre-op clearance

The pre-op clearance answers the surgeon’s basic question of whether the patient is healthy enough to tolerate the surgery. If you’re young and in good general health the surgeon may clear you through with a physical exam. If you’re older or have health problems, your surgeon may want medical clearance from your internist or cardiologist. Your doctor will submit a medical report to your surgeon that indicates what risks, if any, you may encounter while undergoing the physical stress of surgery. If the risks are high your surgeon will discuss these with you and decide whether surgery should still be preformed or if an alternative treatment is a better option.

The night before

No food or drink after midnight the night before the day of the surgery. Patients often wonder why they can’t eat anything past midnight. The answer’s simple actually.

If you’re receiving general anesthesia, you’ll be intubated, meaning you’ll have a breathing tube placed during surgery. The medications that you’ll be given and the intubation procedure itself, could cause you to reflux what you ate the night before. If this happens you can experience aspiration while you’re under, meaning food or liquid from your stomach can come up and then go down the wrong pipe (trachea) and into your airways, possibly causing aspiration pneumonia. The risk of getting aspiration pneumonia is greatly reduced by having your stomach empty. You may have to take pre-operative antibiotics the night before or morning of surgery and perhaps even for a day or so after. These help reduce the chance of infection. There may also be some medications that you’re currently on which you must stop taking from the night before to two weeks before surgery. For instance, you shouldn’t take aspirin 10 days before surgery as it interferes with platelet function, as platelets help your blood clot.

Checking-in

The day of surgery you’ll need to check into the pre-op area of your hospital or surgical center. The nurses will have you change into a gown, place an ID bracelet on you, review any general questions you may have and check your informed consent document and medical clearance. You should be interviewed by your anesthesiologist, who will place you under general anesthesia and intubating you. You’ll repeat a lot of the same information to many different people but this repetition helps to eliminate mistakes. Your surgeon will usually see you before you go to the operating room. If you’re having a procedure like a breast biopsy or hernia repair, you may be asked several times by different people what side of your body the surgery is being done. Again this repetition helps cut down on medical error.

Regardless of the surgical procedure, you should feel confidence in your surgeon and have all your questions answered before surgery. The most common source of conflict between a patient and a doctor is lack of communication. If you don’t feel confident in your surgeon or your questions aren’t being answered, you should look for a second medical opinion and find a surgeon who will take the time to help you understand.

Jay Coates, D.O. is an assistant professor of surgery at the University of Nevada School of Medicine and vice chair of trauma surgery at University Medical Center in Las Vegas.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “Laparoscopic gastric bypass versus the laparoscopic adjustable gastric band: Is one or the other better for long term weight loss results?”

The number of weight loss procedures performed over the past ten years has increased by more than a ten-fold in the U.S., exceeding 200,000 operations in 2006. The laparoscopic Roux-en-Y gastric bypass, which provides both restriction and malabsorption of food intake, is still considered the gold standard operation for long-term weight loss.

However, the laparoscopic adjustable gastric band, which uses one of two FDA approved devices for primary restriction of food into the gastrointestinal tract, is the second most commonly performed procedure and is quickly gaining in popularity. There is an abundance of data that supports both the gastric bypass and laparoscopic adjustable gastric band as safe (but not risk-free) procedures with sustainable weight loss and a positive impact on obesity-related diseases such as diabetes mellitus, hypertension and obstructive sleep apnea. (Learn more about weight loss surgery procedures from the U.S. National Library of Medicine).

The amount of weight loss that can be expected on average for the gastric bypass ranges between 60 and 80 percent of excess weight loss, or loss of weight beyond a calculated ideal body weight. The laparoscopic adjustable gastric band has a wider spectrum of success, ranging between 30 and 70 percent of excess weight loss.

Both operations are endorsed by most professional medical societies as acceptable treatments for the severely obese. The choice of operation depends on the patient’s preference, along with his or her surgeon’s counseling on any specific contraindications to either of the operations. An informed decision is essential to undergoing any weight loss procedure.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.

Dr. James Lau answers the question: “What’s the difference between being overweight and obesity?”

Obesity means having too much body fat. It is different from being overweight, which means weighing too much. Both terms mean that your weight is greater than what’s considered healthy.

Obesity most often occurs over time when you eat more calories than you burn or use. The balance between calories-in and calories-out differs for everyone. Genetics, overeating, eating high fat foods and being physically inactive are factors that can make you obese.

It’s important to note that obesity is not just a cosmetic concern. Obesity and carrying excess body fat places you at greater risk of developing high blood pressure, diabetes, stroke, arthritis, certain cancers, and other serious health problems. Losing even five to ten percent of your weight if you’re obese can help delay or prevent some of these diseases.

If your body hasn’t responded to diet and exercise, you may be a good candidate for weight loss surgery, or bariatric surgery, such as the gastric bypass or the lap band using laparoscopic techniques. It’s important to get the facts about your choices if you believe you’re a good candidate for weight loss surgery.

The University of Nevada School of Medicine and University Medical Center sponsors free seminars in Las Vegas on bariatric surgery that Dr. Shawn Tsuda and I personally conduct. These free seminars are usually held once or twice a month at the School of Medicine. For a complete schedule, and for more information, please contact Robin Morello at 702-671-5150.

James Lau, M.D. is an assistant professor and chief of the bariatric surgery division at the University of Nevada School of Medicine Department of Surgery. Dr. Lau is board certified in general surgery and completed fellowship training in bariatric and minimally invasive surgery at Stanford University. He specializes in weight loss surgery.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Shawn Tsuda answers the question: “I’ve heard a lot about minimally invasive surgery. What exactly is it?”

Minimally invasive surgery refers to operations performed with small scars. Typically this can be accomplished laparoscopically, or with the use of a tiny camera and long, narrow instruments. The advantages of minimally invasive surgery include less post-operative pain and quicker recovery. The cosmetic result is also more favorable.

The vast majority of weight loss procedures such as the Roux-en-Y gastric bypass and the adjustable gastric band are performed laparoscopically, along with common procedures like gallbladder removal and hernia repairs.

Recently researchers have been looking into performing “scarless” surgery, also known as natural orifice and transluminal endoscopic surgery (NOTES) or single-incision laparoscopic surgery, through a tiny hole in the belly button. Although these advanced techniques are still in development and not widely performed, it is likely we will continue to see more surgery performed with either reduced scars, one single scar in the belly button, or no scars at all.

Shawn Tsuda, M.D. is vice chief for bariatric surgery at the University of Nevada School of Medicine, in Las Vegas, Nevada. Dr. Tsuda completed his fellowship training in minimally invasive and bariatric surgery at Harvard Medical School. He is board certified in general surgery.

Have a health question? University Health System doctors answer select questions from readers like you.