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ANORECTAL DISEASE
Hemorroidectomy involves the removal of
enlarged or dilated veins around the anal opening. At that time an
endoscope can be used to examine the rectum and the lower end of the colon.
Carbon dioxide laser energy can be harnessed so that it can be used as a
knife during the operation. It seals the nerve endings and also seals the
blood vessels, which helps to control bleeding and diminishes postoperative
tissue swelling and pain. There is a 4 to 6 week
recovery period, however most people can return to work after 1 to 2
weeks.
Small external
hemorrhoids can be removed under local anesthesia in the office. Small
bleeding internal hemorrhoids can be treated with a rubber band technique,
also as an office procedure.
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Anal Fissures
An anal fissure is a tear in the anal canal caused by hard stool or
forceful diarrhea. Anal fissures fail to heal in some cases because of
spasm in the anal sphincter muscle. Non-surgical treatment involves stool
softeners and steroids or nitroglycerine cream. Surgical treatment involves
division of a small part of the anal sphincter which prevents spasm. Five
percent of post operative patients will have less than complete control of
gas. The non-surgical treatment is over 80% successful. Anal fissure
surgery is an out patient procedure and has approximately one week of down
time.
Anal Fistula
Anal fistulas
develop in 50% of patients after an anorectal
abscess. Surgery is necessary to cure an anal fistula and involves joining
the external and internal openings and making the tunnel into a groove that
heals from within outward. This can be performed as an outpatient with a 1
to 2 week disability period.
HERNIA REPAIR
A hernia is a hole in
the abdominal wall through which a portion of the abdominal contents
protrude. Hernias are classified as inguinal, umbilical, or ventral.
Inguinal Hernia
Inguinal hernias are located in the groin area. They can present as a
tender lump with a pressure sensation while bending over, coughing, or
straining. They are repaired through a 2 to 2 ½ inch incision below the
hair line in the groin under local, spinal, or general anesthesia. The
defect in the abdominal wall is closed or tightened around the spermatic
cord and then reinforced with a flat piece of mesh. This is an outpatient
procedure and patients typically return to work in 1 to 2 weeks and normal
activity in 3 to 4 weeks.
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Umbilical Hernias
Umbilical hernias occur through a weak area behind the belly-button. Repair
and recovery are similar to the inguinal hernias,
however, mesh is rarely required.
Ventral Hernias
Ventral hernias can occur at any location on the abdominal surface. They
usually occur in an area of previous surgery and are also called incisional hernias. Scar tissue is never as strong as
the original tissue and therefore all incisions are at some risk of
breaking down. Often these hernias are massive in size and require a large
piece of mesh to secure the repair. The hospitalization and recovery are
longer than in the repair of smaller hernias.
GASTRIC (STOMACH) SURGERY
Peptic Ulcer
Disease
With the development of
medications which reduce the production of acid by the stomach, operations
for ulcer disease are much less common. Surgery currently is most often
used to treat the complications of ulcer disease, i.e., bleeding,
perforation, or obstruction. The operations typically involve removal of a the acid producing part of the stomach, with or
without division of the vagus nerves. (The vagus nerves carry the messages from the brain which
stimulate the stomach to secrete acid.) The five environmental factor which contribute to ulcer disease are stress,
caffeine, tobacco, alcohol, and aspirin-like medications.
Cancer of the Stomach
Cancer of the stomach is treated by removal of the part of the stomach
containing the cancer. Sometimes removal of the entire stomach is required.
The small intestine is then connected to the esophagus or remnant of the
stomach. New eating habits are necessary after most stomach
operations.
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SMALL BOWEL AND COLON Surgery
Diverticular Disease
Diverticular disease is a product of the
"American" diet. The American diet is very low in fiber and
therefore causes the colon to develop small pockets off of the lurnen due to high pressures. The medical treatment of diverticulosis involves a high fiber diet, or bulk
agents like Metamucil, and the avoidance of foods such as popcorn. Surgery
is considered for the complications of diverticulitis,
ie: chronic pain, bleeding, perforation,
obstruction, or colon fistula formation.
Elective surgery involves removal of a portion of the colon with reanastonosis. Emergency surgery may require
construction of a temporary colostomy. A colostomy is an opening on the
lower abdomen to which a bag is connected to catch the stool (feces). The
hospital stay is usually 4 to 7 days.
Colon
and Rectal Cancer
Colectomy for colon and rectal cancer involves
removing the cancerous part of the intestine and the adjacent lymph nodes.
Colostomy is rarely required. For rectal cancers very near the anus a
permanent colostomy may be necessary to ensure complete removal of the
cancer. Depending on how advanced the cancer is,
chemotherapy or radiation may be required. The hospital stay is usually 5 to
7 days.
Appendicitis
Appendectomy involves the emergency removal of the appendix for
inflammation, infection or rupture. The appendix is removed under general
anesthesia through a small incision in the right lower abdomen. If the
appendix has not started leaking infection a 1 to 2 night hospital stay is
required and patients return to school or work after 7 to 10 days. If the
appendix is ruptured a 3 to 5 day hospital stay is required for intravenous
antibiotics.
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Inflammatory Bowel Disease
There are two disease of the gastrointestinal tract which are very poorly
understood and for which there is no good long term medical treatment. Chrohn's Disease usually involves the distal end of the
small intestine, but can be present at any location from the mouth to the
anus. Surgery is indicated for bleeding, perforation, blockage, or fistula
formation. After surgery there is a 60% chance of recurrence within 2
years.
Ulcerative Colitis involves only the colon, rectum,
and anus. Operative treatment is recommended for failure of medical therapy
or because of the increased risk of cancer. The usual operation is total
removal of the colon, rectum and anus with creation of an ileostomy.
Operations for inflammatory bowel disease require a 5 to 7 day hospital
stay with 4 to 6 weeks of recovery.
THYROID RESECTION
The thyroid gland is
important in the regulation of metabolism. Thyroid resection involves
removal of part or all of the thyroid gland for benign or malignant disease.
After thyroid surgery a hospital stay of 1 to 2 night
is necessary. Thyroid hormone pills may be required post operatively.
ATHEROSCLEROSIS AND VASCULAR SURGERY
Atherosclerosis or
hardened arteries is a term to describe the buildup of cholesterol and fat
on the inner wall of an artery. This decreases the blood supply to the
parts of the body "down stream" from that point.
Atherosclerosis can occur in any artery in the body. Risk factors
include family history, smoking, elevated cholesterol, high blood pressure,
diabetes, obesity and stress.
Arteriography
An
Arteriogram is a diagnostic test to look for the location and extent of
blockage in the arteries. This is essential to determine what type of
treatment will be used. It is typically performed as an outpatient
procedure under local anesthesia and with intravenous sedation. A
tiny needle is inserted in the artery and a liquid (dye) is injected into
the blood stream while x-rays are taken. The recovery from an
arteriogram is usually no more than one day.
Angioplasty
(balloon surgery) with stent placement
An
angioplasty involves dilating a narrowed artery with a cigar shaped
balloon. Frequently, a small wire basket called a stent
is inserted at the balloon site to keep the artery open. The procedure
is identical to an arteriogram and the patient typically goes home the same
day. Local anesthesia and intravenous sedation are commonly used. The
recovery time is usually one day. The benefits of a successful
angioplasty are usually apparent immediately.
Carotid Surgery
The carotid
arteries are located in the neck and may become clogged or narrowed by
atherosclerosis. The restriction of blood flow to the brain may
greatly increase the risk of a stroke. Carotid endarterectomy
is a procedure in which the artery is opened and the cholesterol buildup is
removed. The hospitalization is usually one to two days and the
recovery is approximately two weeks.
BREAST PROCEDURES
Open Biopsy
This procedure is used to remove the breast lump and a surrounding
rim of "normal-looking" tissue for a microscopic exam. It is
usually done as an outpatient procedure under local anesthesia. A wire
localization procedure may be performed if the lump is hard to locate by or
if areas look suspicious on X-ray. The wire is inserted under x-ray by
using a needle and then in the operating room the wire is followed to the
lump. There is a 2 week recovery period in most cases.
Mastectomy
Removal of a breast. There are 3 types of mastectomy:
Simple: (total) involves removal of the affected breast but
no lymph nodes.
Modified Radified: (most common
type) involves removal of the affected breast and lymph nodes.
Radical: involves removal of the breast, the lymph nodes and
the pectoral muscles beneath the breast.
These procedures usually require a 1-2 day stay in the hospital and a 4-6
week recovery.
Sentinel
Lymph
Node Biopsy
A Sentinel
Lymph Node Biopsy is the removal of the lymph node that specifically drains
the cancer in the breast. This is done by injecting a small amount of dye
and radioactive tracer into and around the tumor. A Geiger Counter is used
to identify the sentinel node and it is then removed. This procedure is
performed in the operating room. It takes about 30 minutes and is performed
as an outpatient procedure.
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Patients have an
immediate recovery from a Sentinel Lymph Node Biopsy as opposed to a
complete axillary node dissection, which takes
1-2 days for recovery and has many painful side effects. This is a new
technique, so few facilities have the ability to perform it. It is not know
yet whether this will reduce the incidence of lymphedema.
Lumpectomy
A lumpectomy is the surgical removal of part of a cancerous lump (or tumor)
in the breast along w/ a small amount of normal surrounding tissue. This
procedure allows women to retain most of their breast. It is done under
general anesthesia with a 1-2 day hospital stay and the patient is usually
back to normal activities within 2 weeks.
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