Louis Jankos

Innovative Collaborative Approach to Polyp Removal Surgery Lowers Risk for Complications

Monmouth Medical Center is Among a Select Group of U.S. Hospitals to Use Approach

Having a colonoscopy wasn't high on Louis Jankos' list of priorities – at age 56, the Millstone Township resident had never had one. Louis' wife, Dianna, knew he should go, and so she made an appointment for him with Steven A. Gorcey, M.D., Chief of Gastrointestinal Endoscopy at Monmouth Medical Center.

During Louis' first appointment, Dr. Gorcey found a series of polyps and was able to remove all but one during the procedure, as it was a flat polyp located in the upper quadrant in a bend in the intestine and couldn't be accessed using a colonoscope.

"Dr. Gorcey said I needed to have it removed in the hospital, and he explained how he'd been performing an innovative procedure with his colleague that could help," said Louis.

Combining two modalities to avoid a major operation, the procedure – an endoscopic mucosal resection (EMR) under laparoscopic visualization– features a collaborative approach by Dr. Gorcey and Roy M. Dressner, D.O., a practicing board-certified colorectal surgeon at Monmouth Medical Center. Monmouth Medical Center is presently the only hospital in New Jersey to perform this combined endoscopic – laparoscopic surgical (CELS) approach.

Usually, when EMR is used to remove lesions from the colon, the surgical endoscopist guides a video colonoscope through the anus. In most cases this can be done without the need for surgical assistance. Some polyps, due to their large size or location cannot safely be removed via the colonoscope alone.

"In the past, polyps like these usually required a resection of part of the colon – a more serious operation involving a hospital stay of several days and, often times, a large scar. In Dr. Gorcey's and Dr. Dressner's collaborative approach, Dr. Dressner makes a series of small laparoscopic incisions in the operating room, while Dr Gorcey performs a colonoscopy. "By combining the laparoscopic and colonoscopic approaches, I can help reposition the polyp for Dr. Gorcey so that it's more amenable to removal," said Dr. Dressner.

According to Dr. Dressner, removing hard-to-reach polyps with a colonoscope poses a risk of puncturing the colon. By performing the procedure laparoscopically, the polyp can be removed safely with a decreased risk for complications – and, because just three 5 mm incisions are made, patients can usually go home the same day. In this case, however, because of the high-risk nature of his polyp, Louis stayed at Monmouth Medical Center overnight as a precaution.

"We're trying to change the whole paradigm in the way benign polyps are managed," said Dr. Gorcey. "By taking this collaborative approach and performing EMR or endoscopic submucosal dissection (ESD) under surgical surveillance, we're negating the risk of perforation and avoiding unnecessary colon resections. My hope is to see more referrals from gastroenterologists before they send patients in for invasive resections."

"Everyone at Monmouth Medical Center was so nice, and Dr. Dressner and Dr. Gorcey were awesome doctors!" said Louis. "Dr. Gorcey actually had pictures so that he could explain exactly what was going to happen in a way I could easily understand."

Louis' pain was minimal, and most of his recovery involved healing of the small incisions. Now, after realizing how lucky he was to have had the polyps removed before they turned into cancer, Louis is an advocate for early screening.

"Get your colonoscopy – the experience wasn't as bad as I thought," he said. "It didn't hurt to have them removed, and now I can rest assured knowing I have a clean bill of health."

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