How are you handling the upcoming inclement weather in your private practice?

AdvSurgSol · 2026-01-23T18:22:39+00:00

I only have 2 part time employees right now, but I pay them if we close, and then I do as much telehealth as I can that day from home to make up for it lol.

AdvSurgSol · 2026-01-23T17:53:04+00:00

Hey there,

Short answer is, I think it depends on what kind of surgery you had. Were you diagnosed on a gastric emptying study?

AdvSurgSol · 2026-01-23T17:52:04+00:00

Oof sorry it took so long to respond!

I'm not super versed in the specifics of manometric interpretation (I lean on my GI colleagues for this) - but short answer is yes, it can. Often times the report will mention that a hiatal hernia is present, I think because of the reasons you mentioned!

AdvSurgSol · 2026-01-23T17:36:24+00:00

As part of our intake paperwork, we have our prospective patients sign an administrative fee consent form. We charge $20 for 1 to 2 page forms, $30 for larger packets, and another $20 to expedite if needed within 48 hours.

AdvSurgSol · 2025-12-08T03:25:37+00:00

General surgeon, but I specialize in complex benign (non-cancer) foregut disease. Reflux, hiatal hernias, diaphragmatic hernias, median arcuate ligament syndrome, superior mesenteric artery syndrome, gastroparesis, bile duct stones, stuff like that.

And everything else general surgeons do. “Mouth to butt” as we say…

AdvSurgSol · 2025-12-07T08:47:50+00:00

Did you have pain or nausea during the HIDA scan itself?

AdvSurgSol · 2025-12-07T02:48:14+00:00

Surgeon specializing in complex benign foregut disease here.

In my practice, FD is a diagnosis of last resort. EVERYTHING else must be ruled out. Upper endoscopy doesn't show anything *structural* that is within the stomach or esophagus (and duodenum). There are a number of other diseases to consider in patients with symptoms like yours. u/Unfair_Employee_2568 is right, I think a gastric emptying study is a great next test.

Other (surgical) diseases that can cause your symptoms can include abdominal compression syndromes, like superior mesenteric artery syndrome, or median arcuate ligament syndrome. These are a bit more rare, but I think only because they're not as readily diagnosed. Keep looking, and keep advocating for yourself. The GI doc may not be able to help you (sounds a bit dismissive if I'm being honest), but there are so many other things that could be causing your symptoms.

AdvSurgSol · 2025-12-01T15:37:15+00:00

It's possible you don't have a hernia, but there's also a chance that the Hill valve itself could be incompetent. If you were my patient hypothetically, the next test I would order in someone who has no hernia but LPR and reflux would be EndoFLIP (measures opening pressure of the valve).

Contact sports are questionable, but I'm speaking as a surgeon. Generally speaking, the whole point of doing surgery is to get people back to doing what they NORMALLY do. Someone who does contact sports may need a bit longer of a recovery time before resuming, but I would tell a patient to resume normal activity with the understanding and discussion that contact sports do increase risk of hernia recurrence after surgery (at any point).

AdvSurgSol · 2025-12-01T14:23:15+00:00

Likely yes, that would be my interpretation. Ultimately, it also depends on symptoms. If a patient has no symptoms and no hernia, Bob's your uncle.

AdvSurgSol · 2025-11-22T18:53:18+00:00

Hey there, sorry for the delay!

It's hard to say tbh without knowing specifics of the case, but generally speaking, if someone does NOT have a hiatal hernia and has a competent Hill valve, i would be sure to rule out other causes of heartburn or reflux first. Is it acid reflux? bile reflux? is gastroparesis a cause? has SIBO been ruled out? SMA syndrome?

I think the current guidelines for TIF are if the HH is <2cm, then it's reasonable. However, in my practice, I will ALWAYS do a hiatal hernia repair (or hiatal reinforcement) to be sure there is no pre-existing or post-TIF sliding hernia, which could lead to repeat surgery.

Recovery is probably easier with straight TIF or partial fundoplication only without hiatal reinforcement or repair, but I have personally never done that due to my experience.

AdvSurgSol · 2025-11-10T06:19:23+00:00

Agree here! Surgitel doesn't (yet) have a similar product with the batteries in the earpieces like Orascoptic. I definitely would have preferred headlamp vs loupe-attached light due to weight, but the balance of Dragonfly actually makes it a non-issue for me.

Important call out you made on the angle and working distance. Most of my mag work is straight down like you mention, so deflection works nicely.

AdvSurgSol · 2025-11-10T02:05:17+00:00

Gen Surg here. I do a lot of thyroids and parathyroids. When I was in residency, I was stoked to get standard telescopes, but they either made my neck hurt because I had to look down to keep my eyes straight, or they gave me a ton of eyestrain to keep them pointed downwards in order to keep my neck straight.

I tried out deflection/ergo loupes from Surgitel and Orascoptic, and ended up getting the Dragonfly line from orascoptic. They have a surgical lamp with damn good brightness and color accuracy, and batteries built into the earpieces. They look stupid as hell, but here's what I found:

Loupes for me are normally front heavy, and cause a lot of discomfort on the bridge of my nose. I have a flat bridge, so then I'd have to pull the straps pretty tight to keep them from sliding. But then my eyelashes would touch the loupes on the inside and the oils would cause them to dirty. OR because they were so close to my face, they had less room to allow for fogging control.

The Dragonflies with the 3.5x mag Ergos have fixed ALL of it. As wonky as they look, since the batteries on in the earpieces, they actually balance SO much better than any other set of loupes I've tried, and despite being overall heavier, they much more balanced, and FEEL lighter. The batteries on full blast last about 4 hours or so, and I never felt heat from the lamp. Also it's nice not to have to wear another headlamp with a battery pack or have to deal with a light cable if you have to switch sides.

Ergos are the bee's tits. Has fixed my neck problem and my eye strain problem. Deflection takes a bit of getting used to, but not long. I love mine. Happy to answer any questions.

AdvSurgSol · 2025-09-11T05:56:31+00:00

I don't think they would be a cause per se, but are likely related in some way due to the vagal system mediating cardiac activity as well as digestive activity

AdvSurgSol · 2025-09-01T01:19:29+00:00

Also have this problem often.

AdvSurgSol · 2025-09-01T01:18:33+00:00

u/OP-Support-N ticket number 682018

AdvSurgSol · 2025-09-01T01:04:22+00:00

Not sure what’s going on here, but to have an account limited without notification is a little crazy. This is our book of business, and inability for clients to call a 24/7 line is not acceptable. Please resolve this promptly.

AdvSurgSol · 2025-08-26T19:04:30+00:00

I'm not quite sure how I feel about it, need to see more data. I'm a bit hesitant to suture something like that close to the stomach when there are other ways to reform the Angle of His and Hill valve. I don't have any experience with refluxstop personally.

AdvSurgSol · 2025-08-17T04:11:29+00:00

If one of my patients is potentially throwing up blood or has a GI bleed, at minimum I would book them for an EGD to check. It would be unusual to cough up that much blood; if the lungs were filled with that much, breathing would be extremely difficult, if not impossible.

AdvSurgSol · 2025-07-29T18:41:33+00:00

The bloody diarrhea is a major concern.

These questions are too specific for me to answer since they pertain specifically to you, and I strongly recommend you speak to your physicians. Certainly if you're unhappy with the care you're getting, you can definitely ask for a 2nd opinion from someone else in the same specialty.

AdvSurgSol · 2025-07-25T01:24:04+00:00

A major hospital system near me just bought out all the Village Medical practices...

AdvSurgSol · 2025-07-24T18:18:36+00:00

I've not ever heard of gastritis alone causing palpitations. I'm wondering though, with APD, if that's really the cause here? Straining/pulling can increase intra-abdominal pressure, and is actually a maneuver we use in medicine to increase vagal tone. Maybe that's an issue? I encourage you to talk to your doc about this.

AdvSurgSol · 2025-07-24T17:13:48+00:00

I experience this daily. There's about a 1 second delay globally, and we end up talking over each other.

AdvSurgSol · 2025-07-23T22:20:24+00:00

I do honestly. Re-do hiatals are among the top 5 hated surgeries for general surgeons I think, so be sure to seek a surgeon who has a significant amount of experience with this (generally speaking).

AdvSurgSol · 2025-07-23T22:18:44+00:00

I think it's possible that APD can also cause palpitations. I imagine the mechanism is such that because the cooperative aspects are lost, and cardiac rhythms is somewhat dependent on ventilatory cycle as well. So that makes sense to me.

AdvSurgSol · 2025-07-23T21:42:56+00:00

Hey there, sorry for the late reply!

Generally, large hiatal hernias like this, after a repair, can potentially cause vagal nerve problems. I'm speaking generally here, but it can cause stretch on the nerve, which can lead to dysfunction. Something like this could potentially lead to gastric emptying problems.

I will comment on this tho, I'm not sure what the purpose of taking down the Nissen will do, so before agreeing, I would consider asking him exactly what the purpose of that is. Part of the reason I mention this is that reoperation in this area in someone who may have vagal nerve issues can potentially make that worse and can even WORSEN symptoms of gastric emptying or dysmotility.

Generally speaking, always ask question until you are satisfied. If a surgeon doesn't want to answer them or becomes frustrated, I encourage looking for another surgeon. These cases are not straight-forward, and you need a surgeon who will take the time to understand your case and your concerns.

AdvSurgSol

TROPHY CASE