General Surgery Procedures
Gallbladder Surgery
The Gallbladder is like a little balloon attached to the undersurface of the liver. Bile, which dissolves the fat in food, is produced by the liver, travels down the ducts and is stored in the gallbladder. The gallbladder receives a signal, “CCK”, from the stomach when we eat, especially with fatty foods. The gallbladder then squeezes the bile through the ducts into the intestine where it mixes with the food.
Stones in the gallbladder can block the exit, causing pain, nausea, vomiting and bloating. The same symptoms occur if there are no gallstones but the gallbladder is not working well. Repeated episodes cause the gallbladder to become thickened, inflamed and diseased.
These problems are resolved by removing the gallbladder and stones contained. It is done as a day surgery, laparoscopically, with small cuts less than the width of a dime using a camera and clever instruments.
Abdominal Ventral Hernia Repair
Ventral hernias occur on the abdominal wall when there is a defect in the strength layer of the abdominal wall known as the fascia. This leads to tissue or organs coming through or “herniating” through the defect in the fascia. A serious concern is that an organ such as the bowel may get trapped in the defect leading to blockage then death of the bowel. Commonly, the hernia contains omentum or other fat, which causes pain.
Most ventral hernias occur from defects that develop along an incision from prior surgery. A natural defect at the umbilicus from birth may expand with time. Frequent coughing, lifting heavy weights, jumping, and increasing abdominal girth may cause a weakness or defect to expand, creating a hernia or making it bigger.
Ventral hernias can be repaired laparoscopically using a few small incisions on the side of the abdomen. The tissues or organs herniating are pulled back into the abdomen and an underlay patch called a mesh is used to cover the defect with a wide overlap, reinforcing the strength layer. This has proven to be more durable than surgeries that involve suturing the edges of the defect together, creating tension in the tissue.
Inguinal Hernia or Groin Hernia Repair
These hernias in the groin area are far more common in men. A bulge in the groin that is more prominent at the end of the day or after lifting or standing for a long time is associated with discomfort or sometimes pain. It disappears by morning after lying down or can be pushed back in. This is caused by a defect in the strength layer or fascia in the groin, allowing tissue from within the abdomen to directly herniate or push through. More commonly, a natural defect through which the cord and vessels pass to the testicles becomes enlarged, allowing other tissue to herniate from the abdomen into the groin and scrotum. Rarely, a hernia may occur in a space near the big vessels as they pass from the abdomen into the thigh.
Laparoscopically, using one incision the width of a dime and two others half that size, working between the layers of the abdominal wall, the herniating tissue is pulled back into the abdomen. A wide patch or mesh is then placed, covering the defect and the other potential areas of weakness. The laparoscopic approach allows for a quicker recovery, coverage of the three potential hernia sites in the groin, and repair of hernias in both groins using the same small incisions.
Nissen Fundoplication for GERD & Hiatal Hernia
Esophageal Reflux is a common condition causing heartburn, which in a lot of patients is controlled with medications. However, when symptoms are severe, such as coughing, feeling of choking, patient refluxing when sitting up and/or patient's symptoms are not responding to medications and lifestyle modification, surgery should be considered.
Factors that contribute to reflux are an esophagus that does not reach 2 to 4cm into the abdomen; where positive pressures prevent reflux or a hiatal hernia; and where the opening of the esophagus passes into the abdomen is lax and the top of the stomach goes up into the chest. Hiatal hernias, when large, can also cause chest pain mimicking cardiac pain.
Laparoscopic Nissen Fundoplication is the surgery for reflux and hiatal hernia. The aim of the surgery is to: bring the lower end of the esophagus 2-4cm down into the abdomen where the positive pressure helps keep it closed to reflux; close the opening of the diaphragm around the esophagus preventing herniation of the stomach; and create a valve that prevents reflux by wrapping the upper stomach around the lower end of the esophagus.
Colon Surgery for Diverticular Disease & Cancer
Diverticulosis is a common condition that affects the large bowel or colon. Diverticula are “outpouchings” or little bubbles on the surface of the colon that develop over time as a result of a low fiber diet. They cause problems by bleeding or by getting infected, creating an attack. This occurs most commonly in the left lower area of the abdomen and involves a part of the colon called the sigmoid colon. Repeated attacks wear out this portion of the colon and it becomes thickened, loses its elasticity and is prone to even more attacks. Surgery is recommended at this point.
Laparoscopically, using only three small incisions the width of a pencil and a 2 inch cut to remove the affected colon, this surgery can be safely accomplished with only a two night hospital stay. Laparoscopic surgery is also used to remove parts of the colon for colon cancer or large polyps
Other General Surgical Procedures
Other general surgical procedures involving the head and neck, breast, abdomen and gastrointestinal tract, removal of lumps and cysts are also performed.
