General Surgery

Appendectomy

An appendectomy is the surgical removal of the appendix, a tube about six inches long or less that branches off the large intestine. The procedure is performed to treat appendicitis, an inflammation of the appendix caused by infection.

Acute appendicitis is the most common condition of the abdomen to require emergency surgery. Because of the likelihood of the appendix rupturing and causing a severe, life-threatening infection, the usual recommendation is that the appendix be removed as soon as possible.

Appendicitis occurs when the interior of the appendix becomes filled with something that causes it to swell, such as mucus, bacteria, a foreign body, stool, or parasites. The appendix then becomes irritated and inflamed. Rupture occurs as holes develop in the walls of the appendix, allowing stool, mucus, and other substances to leak through and get inside the abdomen.

Because of the risk of rupture, which may occur as soon as 48 to 72 hours after symptoms begin, appendicitis is considered an emergency and anyone with symptoms needs to see a doctor immediately. The two approaches to this procedure are laparoscopic and open.  As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

• Wound infection
• Peritonitis. An inflammation of the abdomen that can occur if the appendix ruptures during surgery
• Bowel obstruction

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Appendicitis may cause pain in the abdomen which may be described as follows:

• May start in the area around the belly button, and move over to the lower right-hand side of the abdomen, but may also start in the lower right-hand side of the abdomen
• Usually increases in severity as time passes
• May become more severe with moving, taking deep breaths, being touched, and coughing or sneezing
• May spread throughout the abdomen if the appendix ruptures

Exploratory Surgery

Exploratory surgery is a diagnostic method used by doctors when trying to find a diagnosis for an ailment. Sometimes, a surgical procedure turns into an exploratory surgery when the surgeon opens the patient up and realizes that the situation is more complicated than it originally appeared, requiring a new evaluation and approach to treatment.

Learn more about Laparoscopic Surgeries

Gallbladder

The surgical removal of the gallbladder is called a cholecystectomy.  The two approaches to this procedure are laparoscopic and open.  The laparoscopic approach is commonly preferred as it is less invasive.  An open procedure is performed when a laparoscopic approach is not an option. In the US, around 600,000 people undergo a cholecystectomy annually.

Indications:

• cholecystitis (inflammation of the gallbladder)
• biliary colic (chronic right upper quadrant pain)
• pancreatitis caused by gallstones
• cholelithiasis (gallstones)

The Procedure:

A laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of operating ports (small cylindrical tubes approximately 5 to 10 cm in diameter) through which surgical instruments and a video camera is placed into the abdominal cavity.  The camera illuminates the surgical field and sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissue. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through the operating ports.  A scalpel is used to make a small incision at the umbilicus (belly button).  After entering the abdominal cavity, the surgeon inflates the abdominal cavity with carbon dioxide to create a working space. The camera is placed through the umbilical port and the abdominal cavity is inspected.  Ports are also placed in the abdominal wall for surgical tools to pass through.  When the gallbladder is identified, a clip is placed between the cystic duct and the cystic artery. Before the surgeon removes the gallbladder, you may have an x-ray called an intraoperative cholangiogram done, which shows the anatomy of the bile duct.  The gallbladder is then dissected away from the liver bed and removed through one of the ports.  In straightforward cases, this procedure can be done in a little over an hour.

In 5 to 10% of laparoscopic gallbladder surgeries in the U.S., the surgeon needs to switch to an open surgical method that requires a larger incision.  Examples of problems that can require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury and bleeding.

What to expect after surgery:

After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine.  Because the gallbladder has been removed, the body can no longer store bile between meals.  In most people, this has little or no effect on digestion. Most people can return to their normal activities in 7 to 10 days.  No special diets or other precautions are needed after surgery.

Risks:

The overall risk of laparoscopic gallbladder surgery is very low.  The most serious possible complications include:

• An incisional infection
• Internal bleeding
• Injury of the common bile duct
• Injury to small intestine by one of the surgical instruments
• Risks of general anesthesia

Lymph Node Biopsy

A lymph node biopsy removes lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. Lymph nodes are part of the immune system. They are found in the neck, behind the ears, in the armpits, and in the chest, belly, and groin.

Pancreas

The pancreas is a critical organ due to its role in digestive and endocrine function.Surgery for pancreatic conditions addresses either tumors of the pancreas or conditions that cause inflammation (pancreatitis).

Pancreatitis may be either acute or chronic.If the condition is severe surgery may be necessary.  Surgery of the pancreas most often involves removing the diseased portion of the organ.These surgical procedures are major operations, requiring several hours in the operating room.Patients remain in the hospital for about a week after the surgery and will need several weeks to more fully recuperate.Other surgical procedures for pancreatitis include fluid drainage from the pancreas or surgical opening of the pancreatic duct. In some cases, the surgical team can perform pancreatic surgery laparoscopically.This makes the duration of surgery and recovery shorter.

Port Placements

A port (or portacath) is a small medical appliance that is installed beneath the skin. A catheter connects the port to a vein. The port is usually placed during a short day-surgery procedure and can be performed with IV sedation and local anesthetic. In the operating room your surgeon will select the appropriate location for your port. The most common area is below the collarbone in your upper chest. The incisions are closed and no tubes or catheters stick out of the skin.

Ports have many uses:

• To deliver chemotherapy to cancer patients
• To deliver antibiotics for long periods of time
• To deliver intravenous nutrition in patients who are unable to eat
• To deliver blood products in patients with blood diseases
• To draw blood for tests.

How Does the Port Work

The port can be used as soon as the operation is over. Sometimes patients will start treatment the same day of the procedure. A nurse will access the port with a special needle called a huber needle. It is placed directly through the skin into the port. Most patients feel a mild pricking sensation during the insertion. This sensation decreases over time.

Complications

As with any surgery, there are risks. Complications are not common but you should be aware of the possibility. Complications can include, but are not limited to:

• Bleeding
• Injury to blood vessels
• Injury to the lung (“pneumothorax”)
• Catheter malfunction
• Catheter infection
• Deep venous thrombosis
• Need for further procedures
• Anesthetic complications

Skin

We treat a wide variety of skin conditions. Many of these treatments are done in our office under local anesthesia, such as excision of skin lesions, excision of small subcutaneous lesions, and drainage of abscesses. Other procedures requiring sedation or general anesthesia are done in the operating room, such as removal of larger masses, melanoma surgery, drainage of larger abscesses or abscess in sensitive areas. We treat the following skin conditions:

• Skin lesions
• Skin cancers
• Melanomas
• Sebaceous cysts
• Lipomas
• Lacerations
• Abscesses

Spleen

The spleen has important functions for the blood and immune systems.It produces white blood cells, filters the blood, stores red blood cells and platelets, and destroys blood cells that are aging.Thus, its removal is to be avoided if possible.

An enlarged spleen (splenomegaly) is most often the cause for removal of this organ. The surgery is called a splenectomy. A variety of diseases and disorders can cause enlarged spleens, including certain infectious or immune-related conditions, liver disease or cancer, as well as hereditary blood disorders.The result may be pain, anemia, bleeding, and other symptoms. When these symptoms become severe, the advantages of retaining the spleen become outweighed by the advantages gained in its removal. Traumatic injury is also frequently the basis for the need for spleen surgery, in part due to the location of this organ in the lower front part of the left chest, which may receive impact in vehicle accidents or other blunt collisions or penetrating wounds of the body. The two approaches to this procedure are laparoscopic and open. 

Individuals can live normal lives without the spleen.However, they may be more subject to certain types of bacterial infections.They must use precautions and remain vigilant for these infections for the balance of their lives.