Guest guest Posted April 1, 2012 Report Share Posted April 1, 2012 wrote: > > When I met with my surgeon, he asked me if I had heard about POEM. > ... His concern was that you then have a stitched up hole in your > esophagus ... > One of my concerns is that the surgical instruments go through the mouth and esophagus with all the contamination that may be found there before going through that hole to be left behind and stitched in. So far this doesn't seem to have been a problem but it would give me pause if I was considering it. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2012 Report Share Posted April 1, 2012 I have to agree with H. on this, I would not want to be a guinea pig for any surgeons learning curve! Sounds to me like this procedure can cause complications in the future if there is a problem or need for a redo or dilitation?  Julee in Oregon ________________________________ From: heroldkelly <heroldkelly@...> achalasia Sent: Sunday, April 1, 2012 2:39 PM Subject: POEM/TEEM concerns  When I met with my surgeon, he asked me if I had heard about POEM. Knowing I have been living with achalasia for 20 years, he thought I may have, but since I had not, he discussed it with me more to inform me about it instead of offering it. He said it is the " new thing " among some doctors, but that the number one concern with surgeons performing HMs is the risk of perforating the esophagus. In this surgery, they purposely perforate your esophagus to perform the surgery. His concern was that you then have a stitched up hole in your esophagus for the immediate future and that that location could become a weak point if you have further issues with esophageal stretching in the long run. Since achalasia never goes away, that is why he said he can't see doing the surgery in his practice, but that we will never know how good it is until data is collected. So, to those of you brave enough to try it out, thanks for being guinea pigs! I just guess I don't want to try it out yet since I feel I have so much life left to live. After all, I hope to live another 60 years if possible! (Don't know how easy that will be after 2 HMs, but I gotta try! ) H.Buffalo City, WI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2012 Report Share Posted April 1, 2012 What exactly is POEM? From: Montoya <medhelpinfo@...> Subject: Re: POEM/TEEM concerns " achalasia " <achalasia > Date: Sunday, April 1, 2012, 8:10 PM  I have to agree with H. on this, I would not want to be a guinea pig for any surgeons learning curve! Sounds to me like this procedure can cause complications in the future if there is a problem or need for a redo or dilitation?  Julee in Oregon ________________________________ From: heroldkelly <heroldkelly@...> achalasia Sent: Sunday, April 1, 2012 2:39 PM Subject: POEM/TEEM concerns  When I met with my surgeon, he asked me if I had heard about POEM. Knowing I have been living with achalasia for 20 years, he thought I may have, but since I had not, he discussed it with me more to inform me about it instead of offering it. He said it is the " new thing " among some doctors, but that the number one concern with surgeons performing HMs is the risk of perforating the esophagus. In this surgery, they purposely perforate your esophagus to perform the surgery. His concern was that you then have a stitched up hole in your esophagus for the immediate future and that that location could become a weak point if you have further issues with esophageal stretching in the long run. Since achalasia never goes away, that is why he said he can't see doing the surgery in his practice, but that we will never know how good it is until data is collected. So, to those of you brave enough to try it out, thanks for being guinea pigs! I just guess I don't want to try it out yet since I feel I have so much life left to live. After all, I hope to live another 60 years if possible! (Don't know how easy that will be after 2 HMs, but I gotta try! ) H.Buffalo City, WI Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2012 Report Share Posted April 2, 2012 On 4/1/2012 7:37 PM, Philip wrote: > > What exactly is POEM? > POEM and TEEM are both types of NOTES (Natural Orifice Translumenal Endoscopic Surgery). In POEM (Per-Oral Endoscopic Myotomy) the surgical instruments go in through the mouth " peroral " a " natural orifice " . In TEEM (Trans-Esophageal Endoscopic Myotomy) the surgical instruments go in through the esophagus " transesophageal " . Which means they also go through the mouth to get to the esophagus so TEEM is also peroral. Both POEM and TEEM do the surgery from inside the hollow part of an organ, the esophagus, so they are " translumenal " . There may be some differences in choice of instruments and fine points of technique between surgeons doing a heller myotomy with POEM, TEEM or other types of NOTES, but both POEM and TEEM would be NOTES. The idea with any NOTES is that it can be done without making incisions on the outside of the body. In the case of doing a heller myotomy it also has the benefit of not having to cut the outer muscle layer, just the circular muscle. At least that is expected to be a benefit but time will tell. If it is, I don't see why the tunnel technique used in POEM could not be done from a laparoscopic method. If it can then the main difference from other myotomies will be that POEM and TEEM are done from inside the esophagus and not from outside. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2012 Report Share Posted April 2, 2012 This surgery from what I have been told is fairly new. There is not a lot of studies done on the rates of success. I would not want to be one of a doctors first failures in trying a new method of surgery. in Georgia Sent from my iPhone On Apr 1, 2012, at 22:37, Philip <blaze_philip@...> wrote: > What exactly is POEM? > > > > From: Montoya <medhelpinfo@...> > Subject: Re: POEM/TEEM concerns > " achalasia " <achalasia > > Date: Sunday, April 1, 2012, 8:10 PM > > > > I have to agree with H. on this, I would not want to be a guinea pig for any surgeons learning curve! Sounds to me like this procedure can cause complications in the future if there is a problem or need for a redo or dilitation? > > Julee in Oregon > > ________________________________ > From: heroldkelly <heroldkelly@...> > achalasia > Sent: Sunday, April 1, 2012 2:39 PM > Subject: POEM/TEEM concerns > > > > When I met with my surgeon, he asked me if I had heard about POEM. > Knowing I have been living with achalasia for 20 years, he thought I may > have, but since I had not, he discussed it with me more to inform me > about it instead of offering it. He said it is the " new thing " among > some doctors, but that the number one concern with surgeons performing > HMs is the risk of perforating the esophagus. In this surgery, they > purposely perforate your esophagus to perform the surgery. His concern > was that you then have a stitched up hole in your esophagus for the > immediate future and that that location could become a weak point if you > have further issues with esophageal stretching in the long run. Since > achalasia never goes away, that is why he said he can't see doing the > surgery in his practice, but that we will never know how good it is > until data is collected. > So, to those of you brave enough to try it out, thanks for being > guinea pigs! I just guess I don't want to try it out yet since I feel I > have so much life left to live. After all, I hope to live another 60 > years if possible! (Don't know how easy that will be after 2 HMs, but I > gotta try! ) > H.Buffalo City, WI > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 2, 2012 Report Share Posted April 2, 2012 I think there is just a lot of misconception. There is not actually a hole made thru the entire E, it is made between the tissue layers ,in the form of a tunnel, and then they move a few cm down to the GE junction and start snipping away. Here's a little article that I thought did a good job explaining it. http://www.mdnews.com/news/2012_03/05737_marapr2012_poem I have to be completely honest, I feel far from a guinea pig. I believe that my surgeon would never risk any harm being done to me. I'm only 28 years old so I'm sure I have a long road ahead of me as far as dealing with the A. I have done a lot of reading about this and the only negative thing I can find are people's opinions. There may not be any long term data out there yet, but once a upon a time there was no data out there for lapro surgery either. Medicine is such an evolving field and really every surgeon has to start somewhere, even if it's a Dr. right out of med school performing the most basics of surgery. And really, what if this really is just as successful as a lapro HM? Less pain, less time in a hopsital, quicker recovery time and is much less invasive. I meet with my surgeon on friday for the final go ahead. I am definitly going to ask him a few of the concerns peoples have posted on here. > > This surgery from what I have been told is fairly new. There is not a lot of studies done on the rates of success. I would not want to be one of a doctors first failures in trying a new method of surgery. > > in Georgia > > Sent from my iPhone > > On Apr 1, 2012, at 22:37, Philip <blaze_philip@...> wrote: > > > What exactly is POEM? > > > > > > > > From: Montoya <medhelpinfo@...> > > Subject: Re: POEM/TEEM concerns > > " achalasia " <achalasia > > > Date: Sunday, April 1, 2012, 8:10 PM > > > > > > > > I have to agree with H. on this, I would not want to be a guinea pig for any surgeons learning curve! Sounds to me like this procedure can cause complications in the future if there is a problem or need for a redo or dilitation? > > > > Julee in Oregon > > > > ________________________________ > > From: heroldkelly <heroldkelly@...> > > achalasia > > Sent: Sunday, April 1, 2012 2:39 PM > > Subject: POEM/TEEM concerns > > > > > > > > When I met with my surgeon, he asked me if I had heard about POEM. > > Knowing I have been living with achalasia for 20 years, he thought I may > > have, but since I had not, he discussed it with me more to inform me > > about it instead of offering it. He said it is the " new thing " among > > some doctors, but that the number one concern with surgeons performing > > HMs is the risk of perforating the esophagus. In this surgery, they > > purposely perforate your esophagus to perform the surgery. His concern > > was that you then have a stitched up hole in your esophagus for the > > immediate future and that that location could become a weak point if you > > have further issues with esophageal stretching in the long run. Since > > achalasia never goes away, that is why he said he can't see doing the > > surgery in his practice, but that we will never know how good it is > > until data is collected. > > So, to those of you brave enough to try it out, thanks for being > > guinea pigs! I just guess I don't want to try it out yet since I feel I > > have so much life left to live. After all, I hope to live another 60 > > years if possible! (Don't know how easy that will be after 2 HMs, but I > > gotta try! ) > > H.Buffalo City, WI > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 7, 2012 Report Share Posted May 7, 2012 the hole self seals and is also closed by 5 clips. the esophagus is flushed with antibiotic before the procedure and you are on IV antibiotic and oral for 5 days after for precaution. To address you concern regarding infection. > > > > When I met with my surgeon, he asked me if I had heard about POEM. > > ... His concern was that you then have a stitched up hole in your > > esophagus ... > > > > One of my concerns is that the surgical instruments go through the mouth > and esophagus with all the contamination that may be found there before > going through that hole to be left behind and stitched in. So far this > doesn't seem to have been a problem but it would give me pause if I was > considering it. > > notan > > > > Quote Link to comment Share on other sites More sharing options...
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