ANATOMY OF A DESIGN

ANATOMY OF A DESIGN

UNILLOY CAST IRON POT

Jay Patel, founder of The Japanese Home, on an elegant and highly functional piece of cast iron cookware

The genesis I love cooking and having lived in Japan for several years I came to really appreciate the beauty and utility of their cookware. I started selling Japanese knives 25 years ago. Back then, getting Japanese makers to use their skill to create knives for customers in the West was difficult. Now the landscape is very different. In the UK, the Japanese knife has become a byword for quality. I thought the time had come to look at another range of products to help the cook in the kitchen, and I chose cast iron cookware. I approached the Japan External Trade Organisation and asked to be introduced to small ironworks in Japan. They put me in contact with a company called Unilloy, which been in the same family for about eight generations and is run by a young, innovative and forward-looking son. We arranged a meeting and we spoke about my ideas.

The challenge The main problem with cast iron pots is weight – cast iron is heavy. It works fantastically the pots in sand, as is usual, these pots are cast in stone. This allows you to cast thinner layers, while retaining all the qualities of cast iron. You can also cast with greater precision because stone moulds don’t distort with heat or humidity. The resulting pot is half the weight of a traditional cast iron pot of the same size.

The design Each handle has a downward curve. Not too much but enough to give it the feel of a hook, which means there’s less chance of your hand slipping. Yamada also made the holes in the handles large. The combination of the narrow width of the band and the size of the hole means the handles dissipate heat very quickly, while the body of the pot stays hot, and it also makes it easier to get a secure grip when carrying the pot. The handle on the lid is designed to fits neatly into the hole in the side handles in such a way that you have somewhere to put the lid while stirring your food, and any

well on induction, is wonderful at retaining and distributing heat but it’s just too heavy, especially when full of food. I also saw other issues with most cast iron pots. You always need oven mitts to move them, because the handles stay so hot, but the space in the handles is never large enough to fit the mitt securely, so they always feel a bit unsteady when full. Another problem comes when you have to take the lid off to stir – there is invariably nowhere to put it down and the condensation on the inside drips everywhere.

The process These are Unilloy products – my role was that of a consultant, but the final decisions were theirs. They approached Komin Yamada, one of the best industrial designers in the world, who commands the same level of respect in Japan as Philippe Starck does in the West. Having him agree to design the piece is a huge honour. The design was strongly informed by the manufacturing process. Instead of casting

condensation falls back into the pot. It is little details like this that mark out great design.

The philosophy Exceptional functionality does not have to be obvious. The best design can be so subtle, you don’t even realise that it’s there; you just know you enjoy the results. There is something wonderful about using well designed objects for everyday tasks like cooking – it helps create a sense of ease, and you can lose yourself in the task at hand. Komin Yamada has created a design that addresses all my concerns about functionality. The pot is light, has great heat retention and distribution, it’s easy to move safely around the kitchen. He’s addressed all those things, and yet made something that looks absolutely stunning. This is an example of truly elegant design.

THE JAPANESE HOME 10 New Quebec Street, W1H 7RN thejapanesehome.com

THE EDIT

SIX DRINKS CABINET ESSENTIALS

BROWN LEATHER ICE BUCKET

LEWIS & CO, £165 lewisandcompany.co.uk

BIRD AND BRANCH OAK TRAY

ANOTHER COUNTRY, £320 anothercountry.com

DECANTER WITH WOOD STOPPER

PHILGLAS & SWIGGOT, £27.95 philglas-swiggot.com

OUTLINE COCKTAIL SHAKER IN MATT GOLD

THE CONRAN SHOP, £45 conranshop.co.uk

MICROPLANE ULTIMATE BAR TOOL

THE JAPANESE HOME, £15 thejapanesehome.com

EMBASSY COCKTAIL GLASS

DAVID MELLOR, £17 davidmellordesign.com

HOME SPA PRODUCTS

ROSE DEEP HYDRATION PETAL-SOFT LIP BALM

FRESH, £19.50 fresh.com

THE EDIT

NEW

BODY SCRUB

LE LABO, £37 lelabofragrances.com

HEI POA PURE TAHITI MONOI OIL, TIARA

THE FRENCH PHARMACY, £9.99 thefrenchpharmacy.co

SOL DE JANEIRO BRAZILIAN BUM BUM CREAM

SPACE NK, £44 spacenk.com

FICO D’INDIA BATH SALTS

ORTIGIA, £28 ortigiasicilia.com

PRIMROSE FACIAL CLEANSING MASQUE

AESOP, £29 aesop.com NEW ARRIVAL

Perfumer H Not a new arrival in Marylebone (the first branch of Perfumer H has been carving its niche on Crawford Street for a while now) but a new arrival on Chiltern Street. From the eponymous perfumer Lyn Harris, this beautiful little store sells fragrances, laboratory candles, pillar candles, incense and soap, as well as olive oil, preserves, honey and tea.

PERFUMER H 19 Chiltern Street, W1U 7PQ perfumerh.com

ACID TEST

Dr Vinay Sehgal, consultant gastroenterologist at The London Clinic, on a nonsurgical procedure for curing acid reflux, and the exciting possibilities it holds

Interview: Viel Richardson Portrait: Christopher L Proctor

Q: What is transoral incisionless fundoplication (TIF) and what is it used to treat?

A: TIF is a procedure for patients with gastroesophageal reflux disease (GERD). It’s performed using an endoscope fed down the throat, which means there is no external incision. GERD is usually caused by a hiatus hernia, when part of the stomach pushes through into the chest, allowing stomach acid to flow up into the oesophagus. This can cause indigestion-type symptoms, but more seriously it can also lead to the development of precancerous cells or even cancer of the oesophagus. The aim of TIF is to stop the acid from continuing to get into the oesophagus.

Q: What symptoms will the patients usually be suffering from?

A: Symptoms of reflux disease classically include heartburn, which is typically worse after eating. Also, regurgitation – so repeating yourself more than is usual. Sometimes people suffer from pain in the upper abdomen or even the chest. Less typical symptoms are a chronic cough, a lot of clearing your throat, which can be worse at night when you lie flat. Patients may also report waking up in the morning with a very bitter taste in the back of the mouth, caused by exposure to acid in the throat, and taking a while to clear the throat in the morning.

Q: Apart from the pain, none of those seem particularly serious. Do people ignore them?

A: They do, and that’s a real issue. People, particularly middle-aged men, tend to simply take over-thecounter antacid medication to relieve their symptoms. The oesophagus is essentially a food pipe to transport food from the mouth to the stomach, and it’s not designed to deal with stomach acid, which is extremely corrosive. So, over time, acid reflux can cause real damage, leading to a change in the environment within the gullet. About 10 to 15 per cent of patients with chronic acid reflux may begin to develop precancerous cells in the lower oesophagus, a condition called Barrett’s oesophagus. I do a lot of work in Barrett’s and it is potentially preventable if we can reverse the injury caused by reflux.

Q: How does the TIF procedure work?

A: It is done under general anaesthetic. First, I perform an endoscopy to confirm the diagnosis and ensure we’re in a position to proceed. The specially designed TIF device will have been mounted onto another endoscope, which we guide down the throat to the location of the hernia. It’s actually a twoperson procedure, with one person operating the endoscope and the other operating the TIF device. The first step is to take the area of the stomach that has come up into the chest and draw it back down into the abdomen. After that, we wrap the top of the stomach around the bottom of the gullet to form a barrier that stops the acid getting through. The TIF device itself has a grasper with which we manipulate the local tissue – we’re not introducing any surgical material to make the wrap. Once the wrap is in place, we secure it with fasteners. Finally, we reconstruct what’s called the ‘flap valve’, which prevents reflux when closed. The nature of the operation means the vast majority of patients will go home the next day.

Q: What happens after the procedure?

A: The patient will need to follow a strict dietary regime for up to six weeks. The first two weeks will consist of a liquid-only diet. Weeks three and four will be a transition to a soft diet. From around week six onward, they can start to rebuild a more normal diet. As well as the diet, most of the patients I see are on medications like proton pump inhibitors, and they will initially stay on them. Continuing to neutralise the stomach acid is necessary to accelerate the healing process and help the reconstructed valve to strengthen. We gradually

taper patients off their medication over an eight-to-12-week period. The patient is monitored closely during recovery – we want to see a slow but steady improvement in their symptoms until everything is healed and the patient can resume a normal, healthy diet.

Q: Is TIF now the gold-standard treatment?

A: Surgical fundoplication was always thought of as the gold standard. Typically, fundoplication is a keyhole procedure in which a surgeon will draw the stomach back down into the abdomen and perform the wrap. At the same time, they will perform a diaphragmatic hernia repair, which fixes the defect that caused the hernia to occur. However, surgical fundoplication comes with possible complications. It is possible to overdo the wrap and make it too tight. This can cause difficulties with swallowing and burping, and the patient can get trapped wind, which can be very painful. There is also the possibility of damage. The vagus nerve runs very close to the oesophagus, and if that is damaged inadvertently it can cause symptoms like nausea, or a condition called gastroparesis, where food passes through the stomach much more slowly than it should. It can also cause problems with blood-pressure and heart-rate control. So suddenly, you’re potentially faced with so many complications.

One of the real benefits of the TIF procedure is that the device sits inside the gullet, making it much less likely that the wrap will be made too tight. Several studies have shown that patients have better quality of life scores using TIF than they do with surgical fundoplication. One of the real benefits of this procedure is that it most closely replicates surgical fundoplication without some of the associated risks.

Q: Are there patients for whom TIF is not suitable?

A: The main reason for someone not being suitable is if the hiatus hernia that has caused the problem has grown too big. It has to be under 2cm for this procedure to work. If it’s larger, the patient will be referred to a surgeon for a surgical fundoplication. We would also avoid doing the TIF procedure in someone who has very florid reflux – that is, if long-term exposure to the acid has caused a lot of rawness and inflammation to the tissue. We would treat that first with medications. Before proceeding, we want to make sure any damage is healed and the tissue is healthy.

Q: All procedures involve some risk. What are the risks and side effects of TIF?

A: Patients will initially suffer some pain or discomfort, which is normal and should subside over seven to 10 days. It’s uncomfortable but it can be managed with normal painkillers. The TIF device is quite a large device and at the start of the procedure we dilate the back of the throat with a balloon to make space for it to go down. There is a risk of causing a tear at that point, but it happens in less than 1 per cent of cases, and if we identify it early, we can treat it successfully at the time. That’s the primary risk. During the procedure there’s also a risk of causing some bleeding when you’re manipulating tissue internally, but that can also be dealt with easily at the time.

Q: Where does TIF sit in the GERD treatment pathway?

A: As a physical intervention, TIF is towards the end of the treatments we consider, and it is key that we only offer it to the appropriate patients. The first approach is adjustments in diet and lifestyle. Cutting out certain food and drink, increasing exercise and losing some weight can be surprisingly effective by themselves. After that, there are medications. Proton pump inhibitors, which work by neutralising stomach acid, are very effective. The issue with these medications is that they don’t actually reverse the problem of the acid getting into the wrong place. Also, I see patients in their twenties and thirties with reflux disease, who understandably don’t want to take medications every day for the rest of their life. TIF may be suitable for them.

Q: Are the repairs done with TIF as robust as those done with surgical fundoplication?

A: The device was developed in 2006 and we are on the third generation. In the grand scheme of things, this means it’s not been around as long as the surgical procedure, but there have been a lot of studies looking at the procedure’s efficacy. So far, the data is suggesting that it is just as durable as surgical fundoplication. An important possible reason for this is that the TIF procedure involves performing the same steps over and over again for every patient, it is a very reproducible, it’s a very uniform procedure. This leads to more reproducible and consistent outcomes.

Q: How do you see the procedure evolving?

A: With a TIF procedure, we are not repairing the damage to the diaphragm that caused the stomach to slip up in the first place. Surgeons do that at the same time as doing their surgical fundoplication. There’s a really exciting new technique called ‘combined TIF’ or cTIF. This involves adding a surgeon to the team, who, before we carry out the TIF procedure, performs a diaphragmatic hernia repair using keyhole techniques. In that way, the patient is getting a diaphragmatic hernia repair and a reconstructed flap valve without the same side effects and risks as a full surgical fundoplication. I see this as a hugely exciting treatment option for patients at The London Clinic. You get to address the actual cause of the problem as well as alleviating the symptoms. This is a very exciting time to be working in the field of endoscopy.

THE LONDON CLINIC 20 Devonshire Place, W1G 6BW thelondonclinic.co.uk