This is probably one of the most common general surgical procedures done in this country. Many individuals have gallbladder disease. Most gallbladder surgery is done for people who have symptomatic gallstones. Symptoms usually involve right-sided abdominal pain, commonly occurring 30 minutes to an hour after a meal. The pain can be associated with fever and chills, nausea and vomiting and a bloating sensation. The pain can also radiate into the back or the neck. A lot of individual think the are having a heart attack. (It is very important to contact your family physician or go to your local emergency room if you are experiencing symptoms, because some people are actually having a heart attack).
The procedure involves four small incisions, less than one-half inch in length. A TV camera is then inserted into the abdomen through one of these holes. Instruments are then inserted into the other holes, and the gallbladder is detached from the liver and removed through one of these holes. In the past, all gallbladders were removed thru a large incision under the right ribs. This led to a significant amount of discomfort after the operation. With the laparoscope, the recovery time is shorter and there is much less discomfort. This is usually done as an outpatient procedure and the recovery is usually 1 week.
This is the most recent surgery that is being done for colon disease, even cancer. We trained during the time laparoscopic surgery was at its prime time. We did not have to return to weekend classes to learn the most up to date laparoscopic techniques that are available. The reason to mention this is that these techniques have been around for several years, but not every surgeon is specialized to do these procedures. We of course are and have done several of them.
A camera is inserted into the abdominal cavity just like the above procedures. Depending on where the disease process lies, 2-3 other small incisions are made either on the right or left side of the abdomen. The colon is mobilized from its connection and blood supply. The diseased segment is removed using a specialized stapling device. The colon is then placed in a bag and removed from your abdomen. Stapling devices are then used to reconnect the two ends of the colon.
A bowel preparation is needed much like you go thru when having a colonoscopy. Most patients will require extended observation in the hospital. We must wait until bowel function returns before we can send a patient home from the hospital. The recovery is usually 3-4 weeks.
DIAGNOSTIC LAPAROSCOPY:
Sometimes we need to find out what may be causing a patient a certain symptom such as chronic abdominal pain, or one of your doctors may want a lymph node biopsy, or a biopsy of the liver or the lining of the abdominal cavity. This is usually done with the TV camera and one or two other small incisions. Most patients go home from the hospital the same day. Recovery is usually one or two days.
NISSEN FUNDOPLICATION (anti-reflux procedure for heartburn and/or reflux):
Some doctors call this GERD or Gastro Esophageal Reflux Disease. This is a very common disease in America. Surgery is usually reserved for those patients that have failed medical management of this disease, such as has been on an H2 blocker and/or a Proton Pump inhibitor such as tagamet or nexium. Some patients have narrowing of the esophagus, barrett’s esophagus or even aspiration of acid into the lungs causing cough or wheezes. Young patients in their 20’s and 30’s are also another population of patients that commonly have this procedure. The reason young patients are candidates is that we do not have good long term data on the safety of proton pump inhibitors and young patients may have to take these medications for many years. Surgery is another option.
The procedure is similar to the gallbladder procedure. A camera is inserted into the abdomen thru small holes. Many patients have a hiatal hernia which is a hernia in the diaphragm (the breathing muscle). The hernia is closed with stitches and the upper portions of the stomach is wrapped around the swallowing tube to recreate a “flapper” valve in the lower portion of the swallowing tube. Unlike the gallbladder surgery, nothing is removed, just repositioned.
Several studies are required preoperatively to see if your are a candidate for this procedure. We also offer a short pamphlet which explains the procedure in great detail and has drawings showing what is exactly done. Most of these procedures require an overnight stay in the hospital. Patients usually require a soft diet postoperatively and need to avoid such foods as crackers, cornbread, and red meat for several weeks. People usually return to work and normal activities in 2-3 weeks.
SPLENECTOMY:
Malignancies, hypersplenism, ITP, TTP are common indications for this procedure. Once again a TV camera is inserted into the abdominal cavity and using a specialized stapling device, the spleen is detached from its blood supply, then placed in a bag and removed. Most patient require a few days in the hospital and recovery is 4-6 weeks.
VENTRAL/INCISIONAL HERNIA REPAIR
The front of your body is called the ventral surface whereas the back is the dorsal surface. A ventral hernia is a hernia (a hole in the muscle) on the front of your body. Most of the time this is a result of an “open” operation, however some patients may be born with this hole. The hole allows the abdominal contents (usually the fat tissue or small intestine) to protrude thru this hole. This can be a dangerous situation. Most of the time these hernias were repaired with the “open” technique. This meant reopening a previous scar, then closing the hole. Now, we repair these with the “patch” technique. This is similar to patching a tire. We use the TV camera once again and make 2-3 small openings. The hole is the covered with prosthetic mesh which is inserted thru one of these holes. The mesh is rolled like a cigar and can be easily inserted into the abdominal cavity. This procedure is usually done as an outpatient, but overnight stay is sometimes required.
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