Procedures
Procedures
Operative, endoscopic, and diagnostic procedures explained step by step. What each one is, who it suits, and what recovery actually involves.
Metabolic
Procedures that treat metabolic disease by changing physiology, not just capacity.
- Robotic Sleeve GastrectomySleeve gastrectomy is currently the most commonly performed metabolic operation, treating metabolic disease in addition to decreasing a patient's weight.
- Roux-en-Y Gastric BypassGastric bypass creates a small stomach pouch and connects it directly to the small intestine. It changes how much you can eat at once and it changes the hormonal signals that control hunger and blood sugar. It is one of the longest studied metabolic operations.
- Robotic SurgeryDr. Good has performed nearly 2,000 robotic procedures and has trained other surgeons on the robotic platform as a proctor for Intuitive Surgical since 2014. Robotic surgery uses small incisions, magnified three-dimensional visualization, and articulated instruments that rotate like the human wrist. These features can assist the surgeon with visualization and instrument control in confined operative spaces. The surgeon makes every decision and every movement.
- Revisional Metabolic SurgeryRevisional metabolic surgery is a second operation after a previous bariatric procedure. It is considered for complications, for reflux that developed afterward, or when the metabolic response has faded. This page is a general explanation of the category.
- Gastric Lap-BandLap-Band is a brand name for an adjustable gastric band. The practice is happy to evaluate any patient who has a gastric band or is considering one. Evaluation comes first, just as it does for every other condition we treat.
Endoscopic
Performed through a flexible scope. No incisions in the abdominal wall.
- Endoscopic Sleeve Gastroplasty (ESG)Endoscopic sleeve gastroplasty is a procedure performed on the stomach from the inside, using sutures placed through a flexible endoscope. There are no incisions and no tissue is removed. Dr. Good is one of very few surgeons in Colorado who performs both ESG and TORe.
- Transoral Outlet Reduction (TORe)An endoscopic suturing procedure for people who have had a gastric bypass. The outlet from the stomach pouch is made smaller from the inside, through the mouth, with no incisions.
- Upper Endoscopy (EGD)An upper endoscopy is performed under sedation using a thin, flexible camera placed through the mouth and into the stomach. It directly evaluates the esophagus and stomach for surgical preoperative planning, hiatal hernia assessment, and possible pH testing to evaluate and diagnose abnormal acid reflux.
- Diagnostic Endoscopy for Preoperative Evaluation and PlanningDiagnostic endoscopy evaluates the esophagus and stomach for surgical preoperative planning. A pH testing capsule may be placed when needed to measure acid exposure in the esophagus.
Reflux Diagnostics
Measurement before treatment. These studies decide what the plan should be.
- Reflux Diagnostic EvaluationA reflux evaluation is a sequence of tests that answers three questions. Is acid reaching the esophagus, has it caused damage, and does the esophagus move normally. The answers decide the treatment.
- Bravo pH MonitoringBravo is a small wireless capsule attached to the esophageal lining during endoscopy that records acid exposure for 48 to 96 hours, capturing more days of data than a traditional catheter study. A catheter-based pH-impedance study runs 24 hours and additionally measures non-acid and gaseous reflux, which makes it the test used while a patient is still on medication to evaluate refractory symptoms.
- Esophageal ManometryEsophageal manometry measures the strength and coordination of the muscle contractions that carry food to the stomach. It is the test that finds a motility disorder hiding behind reflux or swallowing symptoms.
- pH Impedance TestingpH impedance testing measures both acid and nonacid material moving up the esophagus. It is the study of choice when symptoms continue despite acid suppression, or when the main complaint is regurgitation or cough.
- Barium Swallow StudyA barium swallow is an x-ray study taken while you drink a contrast liquid. It shows the shape of the esophagus and stomach and how they move, which makes it useful for hiatal hernia, narrowing, and swallowing complaints.
General Surgery
Gallbladder, appendix, hernia, and repair at the hiatus.
- Gallbladder RemovalRemoving the gallbladder is the definitive treatment for symptomatic gallstone disease. It is performed through small incisions, and digestion continues without it.
- Hernia RepairHernia repair closes a defect in the abdominal wall and reinforces the area so it holds. Hernias of all kinds are repaired here, and the approach is chosen for the hernia rather than by habit.
- AppendectomyAppendectomy removes an inflamed appendix. It is usually urgent rather than elective, and it is most often performed laparoscopically through small incisions.
- Hiatal Hernia RepairHiatal hernia repair returns the stomach below the diaphragm and closes the enlarged opening it moved through. It is considered when the hernia is causing symptoms that testing has tied to it.
- Fundoplication for RefluxFundoplication is an antireflux operation in which the upper stomach is wrapped around the lower esophagus to reinforce the barrier between them. This page explains the procedure and when it is considered.
- LINX Device for RefluxAn anti-reflux option that reinforces the barrier between the stomach and the esophagus with a small, flexible ring of magnetic beads. It is an alternative to a fundoplication.