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Long Branch, NJ – For most of us, enjoying a hamburger at a local restaurant is nothing remarkable, but to Sarah Gomez, 31, of Beachwood, it’s nothing short of a miracle. That’s because for the past six years, Sarah has suffered from a condition that’s made it virtually impossible for her to eat.
“I woke up one morning six years ago with chest pains, and I wasn’t able to get my usual bowl of cereal down for breakfast,” she explains. That fateful day began a whirlwind of doctor visits, endoscopies and a myriad of other diagnostic tests – all of which, unfortunately, offered no clues as to what was wrong. “I saw a slew of specialists over the next four years, and had too many tests to mention,” she says, “but no one could find anything wrong with me. They told me it was all in my head,” she says.
Frustrated by her condition, and still unable to eat, Sarah dropped more than 30 pounds. Rail thin, suffering from chest pains, persistent vomiting and regurgitation, fatigue, insomnia, malnutrition and dehydration – Sarah, a wife and mother of an active toddler, was miserable.
“I couldn’t eat. I couldn’t sleep. I was exhausted and some days couldn’t get off the couch to care for my son. Not a day went by, that I wasn’t vomiting,” she recalls. “Holidays were a nightmare. I would prepare the food and stay in the kitchen. I stopped going out to restaurants because it was just too embarrassing. Food would just not go down. I would try and eat just a little and it would get stuck in my throat. I would regurgitate what I ate and choke. Even soft foods like ice cream wouldn’t stay down for long. I would wake up at night choking on what little I got down and on my own saliva. I was afraid that I would aspirate and die in my sleep. It’s been a really long road,” she adds.
Two years ago she finally received a diagnosis – Achalasia. Achalasia is a disorder of the esophagus that makes it increasingly difficult to swallow solids and liquids. Relatively rare, achalasia affects just five out of every 100,000 adults nationwide.
When we eat, the muscles of the esophagus contract, propelling food and liquids from the mouth into the stomach. The lower esophageal sphincter, a valve located between the esophagus and the stomach, opens to allow food to pass into the stomach and then closes to keep the stomach contents from refluxing up into the esophagus.
In patients with achalasia, the upper esophageal muscles become progressively weaker and actually cease to propel food or liquid down the esophagus. In addition, the lower esophageal sphincter remains taut, making it almost impossible for food and liquid to enter the stomach. These two problems make it almost impossible to swallow and often progress to persistent vomiting, severe weight loss, malnutrition and dehydration. For people like Sarah, the effects of this disorder are devastating.
Sarah’s relief at finally having a name to put to her condition was short-lived when standard medical treatments – which include balloon dilatation, botox injections and medications – offered her little if any relief. Her doctor recommended surgery – often necessary for achalasia patients once medicinal management has failed.
During the procedure, known as a Heller myotomy, doctors would surgically divide the muscle at the end of the esophagus and beginning of the stomach, allowing food to pass. Part of the stomach would be wrapped around the esophagus to prevent gastroesophageal reflux and hold the esophageal myotomy in place.
Sarah was concerned about the large chest incision, the extensive recuperation it would require and the substantial risk of complications. “I decided to wait and tough it out for a little longer and went online to look for another option,” she explains. Sarah’s research led her to the Center for Minimally Invasive Surgery at Monmouth Medical Center in Long Branch. It was there that she found two extraordinary surgeons who combine their surgical skills and expertise to offer patients innovative options in minimally-invasive surgery.
Dr. Anthony Squillaro, a board certified cardiothoracic and vascular surgeon first teamed up with Dr. Frank Borao in the operating room at Monmouth Medical Center six years ago. Squillaro recognized his colleague’s extraordinary laparoscopic skills and knew their collaboration could benefit his patients.
In addition to holding board certification in general surgery Dr. Borao, Surgical Director of the Center for Minimally Invasive Surgery , specializes in laparoscopic gastrointestinal surgery. He is one of a few surgeons in New Jersey fellowship trained in advanced laparoscopic surgery. “When it comes to laparoscopic surgery, he’s the best on the East coast,” says Dr. Squillaro.
Collaborating in the Center’s state-of-the-art laparoscopic surgical suites, equipped with the latest technology including high definition flat screen monitors, the most advanced laparoscopes, video cameras, light sources and other specially designed surgical instrumentation, the two surgeons now work seamlessly, according to Dr. Squillaro. They offer a host of minimally invasive thoracic procedures and bring hope to patients like Sarah who often don’t know where to turn for help.
“When Sarah first came to see me, she was completely miserable,” says Dr. Borao. “She couldn’t hold down food, was living on a liquid diet, vomiting on a regular basis and truthfully couldn’t go on living that way.” Borao sent her for a consult with his colleague to confirm her condition.
“Sarah really was the epitome of achalasia,” says Dr. Squillaro, “but was at the extreme end of the disease process. She had exhausted all conservative medical therapies up to that point and truthfully, was beyond the point where something should have been done. She found out about Dr. Borao and I, and our approach to thoracic surgery, and it became somewhat of a perfect fit for her.”
“Achalasia is a rare disorder and not a lot of medical centers or surgeons do this surgery laparoscopically,” adds Dr. Borao. “We did four laparoscopic Heller myotomies at Monmouth Medical Center this year so far,” he says, “and, I believe we’re the only team in the region performing this surgery.
“Laparoscopic Heller myotomy is the least invasive, most efficient method to treat patients with advanced achalasia,” he explains. The minimally-invasive procedure requires just four five millimeter incisions which together total under an inch in length, according to Dr. Borao. A far cry from the full-length chest incision that had Sarah hesitant about treatment.
“Once inside the chest, the surgical procedure itself is the same. The major difference is that it spares the patient a thoracotomy – a large chest incision, and the associated pain, which for some patients can last up to three months or longer. The complication rate is also much higher with a traditional incision as well. In this instance, Sarah had no pain after her procedure, zero complications and complete relief from her achalasia,” explains Dr. Squillaro.
“The procedure allowed her to pass food into her stomach,” says Dr. Borao. “For her it was like night and day. She felt the results immediately, had no post operative pain and her symptoms were gone.”
Following a brief hospital stay, Sarah was released with instructions to remain on a soft diet for several weeks. Apprehensive about taking her first bite of food after the surgery, she was both amazed and relieved – her ordeal was finally over.
Since the surgery, Sarah has steadily improved. She’s put on several pounds, is regaining her strength and enjoying her ability to eat once again.
“Her prognosis is excellent,” says Dr. Squillaro. “Living with this disease was miserable for Sarah, and while surgery doesn’t cure achalasia, it has certainly given Sarah the relief she needed.”
“I ate a hamburger for the first time this week,” says Sarah, marking just one month from the date of her surgery. “It was awesome. I get up every morning and eat a bowl of cereal and it is just amazing. I am so very thankful to Dr. Squillaro and Dr. Borao. Every time I take a bite of food I think of them. They gave me a miracle – they gave me back my life.”
The Center for Minimally Invasive Surgery at Monmouth Medical Center offers the most advanced, state-of-the-art laparoscopic surgical procedures to treat a wide variety of medical conditions. The center's highly skilled surgeons offer expertise in the laparoscopic surgical treatment of severe heartburn, morbid obesity, hernias and diseases of the intestine, kidneys, and adrenals.
For more information about the Center for Minimally Invasive Surgery or a referral to a surgeon on staff at Monmouth Medical Center, please call 1-888-724-7123.
Date: November 6, 2008
CONTACT: Kristine A. Brown
Director of Public Relations
732-557-3902
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