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Common General Surgery Procedures

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Below is a list of the most common general surgical procedures we perform: 


Open Breast Biopsy/Lumpectomy

Open breast biopsy is a procedure used when your doctor feels a lump. A needle-directed biopsy is used when the doctor cannot feel a lump, but there is an abnormality in the mammogram that warrants biopsy. Both procedures are technically similar and have the same inherent risks. Though the anesthesia is usually local (numbing medicine injected at the site of incision) with intravenous sedation, a general anesthesia can also be used. This can be discussed with the anesthesiologist at the time of surgery. Once proper anesthesia is obtained, a small (usually around 1.5 inches) incision is made in the breast. If possible, the surgeon will try to make the incision at the border of the areola (the darker area around the nipple). That way, the scar will be less noticeable. Then, the abnormal tissue is identified and removed. If this is needle-directed, the tissue at the tip of the needle is removed and the tissue is sent for a mammogram. If the abnormality is in the tissue, then the surgeon is finished removing tissue. The skin is usually closed using absorbable sutures.

The recovery period
Most discomfort is in the first two days after the operation. This discomfort is often less if the patient wears a sports bra or other supportive attire. Under-wire bras are not recommended during the initial post-operative recovery. After 48 hours, the dressing can be removed. If the surgeon has applied a plastic dressing, then you may shower even before these 48 hours are up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Also, it is common to feel a lump at the site of the operation. This does not mean that the lump was missed. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Follow-up
Unless otherwise directed, you should follow up in two weeks following surgery for a check of the incision and to review the pathology findings. If you feel that you need to be seen earlier than this, feel free to call the office.


Core Breast Biopsy 

The Core breast biopsy helps doctors accurately diagnose breast abnormalities.It is performed in less than 1 hour, requires only a single ¼ inch incision, and requires no stitches. It is done in the office under local anesthesia. 

This offers women an alternative to an open surgical biopsy, the most common biopsy method, which can leave scars and result in disfigurement of the breast. The procedure is performed using ultrasound guidance to allow greater accuracy in needle placement. Women are able to resume normal activity immediately following the procedure with only a small adhesive strip to cover the incision site. More detailed information can be found at www.sanarus.com


Varicose Veins

Disorders of the veins of the lower extremities such as varicose veins or spider veins are extremely common.  If a normal vein gets stretched out beyond its normal size, it will never return back to its original size.  Once the normal vein is enlarged, it is very easy for it to continue to enlarge.  If this vein is located under the skin it can grow to quite substantial in size and is termed a varicose vein.  If it is a normally a small vein located within the skin, this is usually termed a spider vein.  Both varicose veins and spider veins can form very large networks.  As these veins enlarge they quite commonly become painful and symptomatic.

The causes of varicose veins and spider veins are commonly related to pregnancy, prolonged standing or walking, a previous deep vein clot, or even a hereditary disposition.  Sometimes, a cause for varicose veins cannot be determined.

Treatment
Initially, treatment for enlarged veins of the lower extremities includes compression.  This could be with the elastic bandages or with fitted compression stockings.  Unfortunately, these treatments can be quite cumbersome and in warm weather can be very uncomfortable.  Because of this, there is a high failure rate with conservative treatment.

Fortunately varicose veins and spider veins are easy to treat.  Larger varicose veins can be treated with VNUS closure. This is an alternative to vein-stripping. This is often followed by ambulatory (stab) phlebectomy which removes the visible varicose veins under the skin. Finally, Sclerotherapy is used for the spider veins in the skin.


VNUS Closure

For many of the 25 million people suffering from symptoms associated with superficial venous reflux and varicose veins, the Closure procedure offers a minimally invasive alternative to vein stripping.  When compared to stripping, it causes minimal pain. Most patients are able to resume normal activities very quickly.

Using a catheter based approach and VNUS’ patented radiofrequency technology, the Closure system occludes the saphenous vein thereby eliminating reflux.  This prevents blood from flowing downstream back into the leg and prevents blood from filling varicose veins. The Closure procedure is an outpatient or day-surgery treatment which can be performed under local anesthesia.  Multiple papers in prestigious scientific journals have been written about the closer procedure.  Results indicate that after the Closure procedure, over 90 percent of veins are reflux free and 87 percent of limbs are absent of varicose veins.  94-100 percent of varicose veins are invisible after the procedure by ultrasound. More information can be found at www.vnus.com


Ambulatory Phlebectomy

In some patients, there are varicose veins that will not respond to VNUS Closure, stripping or sclerotherapy. These veins can commonly be treated with ambulatory phlebectomy. This is simply the removal of varicose veins through tiny incisions in the leg. This can be performed in the office, or in an outpatient facility under sedation. The procedure usually lasts 15-60 minutes, depending on the number of veins to be removed. 

After the procedure, the doctor will have you wear elastic ACE wraps to compress the leg. These should be worn for 3 days but may be taken off to shower.


Sclerotherapy and Ultrasound-Guided Sclerotherapy

Sclerotherapy is simply injection of a compound into the vein to cause that vein to shut down completely.  Once that vein shuts down, the blood supply to the vein is gone and the body will eventually absorb it and it will no longer be present. Because all of these veins are superficial veins they can be spared and usually do not play a significant part in the blood supply from your leg.

Injection into the veins is accomplished through a very tiny needle.  Most people feel a slight amount of burning as the injection occurs.  This rapidly goes away after the injection is stopped.  Rarely, people will feel a slight amount of dull ache after the procedure which is transient and is usually eliminated by ibuprofen (Motrin, Advil).

Our surgeons now offer state-of-the-art ultrasound guided sclerotherapy. This injects deeper veins that may not be visible on the surface but are contributing to varicose or spider veins. The vascular ultrasound locates the vessel and guides the surgeon for precise injections.

After the procedure, the lower extremities will be wrapped in an elastic bandage which is kept in place for three days.  This can be taken off while sleeping or showering but should be applied throughout the rest of the day.  If the varicose veins are severe, your doctor may recommend fitted compression stockings to be worn for a prolonged period of up to six weeks after the procedure to help maximize the effect of sclerotherapy.

Results
Sclerotherapy is effective around 90 percent of the time in eliminating the vast majority of the unwanted veins.  It is unlikely that sclerotherapy will completely remove every trace of varicose vein or spider vein, but most people are quite satisfied with the results.  Most importantly, symptoms from these veins are very commonly eliminated.

It may take more than 1 session of sclerotherapy to reach maximal effectiveness.  In some cases more sessions may be required.  Each session should be separated by at least six weeks to allow for the natural resolution of these veins to occur prior to the next session.

Complications
The most common complication from sclerotherapy is a darkening of the spider veins.  This is called post-inflammatory hyperpigmentation.  This is an uncommon complication but often this will resolve over time as the inflammation around vein goes away.  Small ulcers at the injection site can also occur and is minimized by proper injection technique.  Still, the rate of ulcer formation at injection sites is around 0.1 percent.  These ulcers can be treated and will resolve with proper wound care management.  Infection is extremely rare.  Clots in the deep vein system are also extremely rare but possible.

Fees
We do not accept insurance for sclerotherapy.  Please contact our office for specific fees.  The appointment usually lasts 30 minutes.


Laparoscopic Cholecystectomy

Removal of the gallbladder is a very common procedure as about 600,000 gallbladders are removed in the United States every year! The gallbladder is responsible for storage of a small amount of bile for use after a fatty meal. However, when the gallbladder gets stones that have formed, it will often get symptoms of pain and bloating. These are signs that more serious complications such as infection and bile duct blockage may also occur. The vast majority of gallbladders are removed with the laparoscope. Your body should adapt easily to not having a gallbladder. Anesthesia must be a general anesthesia for the laparoscopic surgery. This can be discussed with the anesthesiologist at the time of surgery. Once proper anesthesia is obtained, a small (usually around 0.5 inches) incision is made in the abdomen just above the belly button. Three more small incisions are made in the abdomen. The laparoscope is placed in the larger incision and the operating instruments are placed in the smaller incisions. The gallbladder is detached from the liver and the blood supply. The skin is then closed using absorbable sutures. 

The recovery period
Most discomfort is in the first week after the operation. After 48 hours, the dressings can be removed. If the surgeon has applied plastic dressings, then you may shower even before these 48 hours are up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Your surgeon will discuss any specific restrictions after the surgery. Most patients are able to return to work after 2 weeks. If you feel up to it, you may return to work earlier. Also, it is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Follow-up
Unless otherwise directed, you should follow up in two weeks following surgery for a check of the incision. If you feel that you need to be seen earlier than this, feel free to call the office. Video: SILS Laparoscopic Cholecystectomy


Laparoscopic Nissen Fundoplication

Nissen Fundoplication is used in patients with gastroesophageal reflux disease (GERD).  During the operation the top part of the stomach, called the fundus, is wrapped around where the esophagus meets the stomach.  Effectively, this will tighten the sphincter muscle that is between the esophagus and stomach and allow this sphincter to function properly again.  The entire operation can be done with the laparoscope.

This operation is usually done during a 23 hour admission.  Nearly every patient can go home the day after the operation.

Recent data suggests that this operation will help in some patients to cause regression of Barrett’s esophagus which is a precancerous change in the lining of the lower esophagus.

This operation is also beneficial not only for those patients who have stopped responding to medical therapy for GERD but also for patients who are relatively healthy and do not want to take a lifetime of antacid medication.  The vast majority of patients after this operation do not need supplementation with antacids or acid suppression pills.

Risks
The main risk from this surgery is over tightening of the gastroesophageal connection which results in food are getting stuck just above the stomach.  It is not uncommon to have a small amount of this initially after the operation because of swelling in the tissues.  In order to prevent this from being a problem we recommend that patients stay on a relatively soft and liquid diet for the first few days.  Eventually the tissue swelling goes down and swallowing returns to normal.  In a very small amount of patients food continues to get stuck at this area and may require eventually require an operation to widen this area.  Other ways to open this narrowing such as a balloon dilatation can also be tried.  The relative risk of this complication is anywhere from 1 to 10 percent.

About 5 percent of people require converting the laparoscopic procedure to an open procedure because of technical difficulties.  The procedure can still be done just as effectively, but because of increased pain the patient will often have to stay in the hospital for more than one night.

Damaging internal organs or tearing the esophagus can happen in one to two percent of patients.  This is usually noted at the time of the operation and can be fixed either laparoscopically or the operation could be converted to an open operation to fix this.

The recovery period
Most discomfort is in the first week after the operation. After 48 hours, the dressings can be removed. If the surgeon has applied plastic dressings, then you may shower even before this 48 hours is up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Your surgeon will discuss any specific restrictions after the surgery. Most patients are able to return to work after 2 weeks. If you feel up to it, you may return to work earlier. Also, it is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Follow-up
Unless otherwise directed, you should follow up in two weeks following surgery for a check of the incision. If you feel that you need to be seen earlier than this, feel free to call the office.


Laparoscopic Ventral Hernia Repair

Ventral hernias are repaired on an elective basis to avoid internal organs getting stuck in the hernia. This can result in strangulation, or death of the internal organ secondary to loss of blood supply to that organ. Every hernia is repaired with mesh when we use the laparoscope. This mesh is made of PTFE which is the material used in Gore-Tex™. The advantage of mesh is a more durable repair and less post-operative pain than the older type of hernia repair without mesh. Recurrence rates for a mesh repair are around 1% compared to around 10% with the older technique. Anesthesia must be a general anesthesia for the laparoscopic repair. This can be discussed with the anesthesiologist at the time of surgery. Once proper anesthesia is obtained, a small (usually around 0.5 inches) incision is made in the abdomen away from the hernia. Two or three more incisions, ¼ inch long, are made in the abdomen. The laparoscope is placed in the larger incision and the operating instruments are placed in the smaller incisions. The hernia is identified from the inside and the hole in the abdominal wall is patched with the mesh. The mesh is attached with multiple small stitches. This results in multiple tiny poke-holes in the skin around the hernia. Any bleeding is stopped with cautery. The skin is then closed using absorbable sutures. A sterile dressing is then applied to the incision.Standard “ports” are placed away from the hernia. Hernia is marked with purple marker above umbilicus.The mesh is sutured before placement into the abdomen. The mesh is sewn and tacked to the underside of the hernia

The recovery period: Most discomfort is in the first week after the operation. After 48 hours, the dressings can be removed. If the surgeon has applied plastic dressings, then you may shower even before this 48 hours is up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Please refrain from lifting anything greater that 20lbs for 4 weeks after surgery. There should also be no vigorous exercise for 4 weeks after surgery. Normal walking and stairs are fine. Normal everyday activity is fine. Most patients are able to return to work after 2 weeks. If you feel up to it, you may return to work earlier. Also, it is common to feel a lump at the sites of the operation and at the hernia site. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.


Open Inguinal Hernia Repair

Inguinal (groin) hernias are repaired on an elective basis to avoid internal organs getting stuck in the hernia. This can result in strangulation, or death of the internal organ secondary to loss of blood supply to that organ. Almost every hernia is repaired with mesh. This is woven polypropylene, or a type of plastic. The advantage of mesh is a more durable repair and less post-operative pain than the older type of hernia repair without mesh. Recurrence rates for a mesh repair are around 1% compared to around 10% with the older technique. Anesthesia can be either spinal, local (numbing medicine injected at the site of incision) with intravenous sedation, or a general anesthesia can also be used. This can be discussed with the anesthesiologist at the time of surgery. Once proper anesthesia is obtained, a small (usually around 1.5 inches) incision is made in the groin. The hernia is identified and the hole in the abdominal wall is patched with the mesh. Any bleeding is stopped with cautery. The skin is then closed using absorbable sutures. A sterile dressing is then applied to the incision.

The recovery period
Most discomfort is in the first week after the operation. After 48 hours, the dressing can be removed. If the surgeon has applied a plastic dressing, then you may shower even before this 48 hours is up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Your surgeon will discuss any specific restrictions after surgery. In general, use common sense and if something hurts, you should probably stop! Most patients are able to return to work after 2 weeks. If you feel up to it, you may return to work earlier. Also, it is common to feel a lump at the site of the operation. This does not mean that the hernia was missed. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Follow-up
Unless otherwise directed, you should follow up in two weeks following surgery for a check of the incision. If you feel that you need to be seen earlier than this, feel free to call the office.


Laparoscopic Inguinal Hernia Repair

Inguinal (groin) hernias are repaired on an elective basis to avoid internal organs getting stuck in the hernia. This can result in strangulation, or death of the internal organ secondary to loss of blood supply to that organ. Almost every hernia is repaired with mesh. This is woven polypropylene, or a type of plastic. The advantage of mesh is a more durable repair and less post-operative pain than the older type of hernia repair without mesh. Recurrence rates for a mesh repair are around 1% compared to around 10% with the older technique. Anesthesia must be a general anesthesia for the laparoscopic repair. This can be discussed with the anesthesiologist at the time of surgery. Once proper anesthesia is obtained, a small (usually around 0.5 inches) incision is made in the abdomen just under the belly button. Two more incisions, ¼ inch long, are made in the abdomen. The laparoscope is placed in the larger incision and the operating instruments are placed in the smaller incisions. The hernia is identified from the inside and the hole in the abdominal wall is patched with the mesh. The skin is usually closed using absorbable sutures. A sterile dressing is then applied to the incision.

The recovery period
Most discomfort is in the first week after the operation. After 48 hours, the dressings can be removed. If the surgeon has applied plastic dressings, then you may shower even before this 48 hours is up. After 48 hours, the incision is water-proof and a shower will not hurt it. Please avoid submersion in a bath or pool for one week from the time of surgery. Your surgeon will discuss any formal restrictions after the operation. In general, use common sense and if something hurts, you should not do it! Most patients are able to return to work after 2 weeks. If you feel up to it, you may return to work earlier. Also, it is common to feel a lump at the sites of the operation. This lump is a combination of normal fluid and scar tissue forming in this area. It usually goes away slowly over the first month or two following surgery.

Follow-up
Unless otherwise directed, you should follow up in two weeks following surgery for a check of the incision. If you feel that you need to be seen earlier than this, feel free to call the office


Hemorrhoids

Hemorrhoids, one of the most common ailments known in both men and women affect more than half the population at some point in their lives. Onset commonly occurs after the age of 30, but hemorrhoids are reported in people of all ages. More than 525,000 patients in the United States are treated annually for symptomatic hemorrhoids. Of these, approximately 10–20 percent will require surgical treatment for their condition.

Hemorrhoids are swollen veins. Each of us has veins around the anus that tend to stretch under pressure, somewhat like varicose veins in the legs. It is believed these veins exist to protect and cushion the anal canal. When these veins swell, they are called “hemorrhoids.” One set of veins is inside the rectum (internal hemorrhoids) and another is under the skin around the anus (external hemorrhoids).

Internal Hemorrhoids
Internal hemorrhoids usually are not painful, but may bleed. Sometimes, an internal hemorrhoid may stretch until it bulges outside the anus. This is called a prolapsed hemorrhoid. A prolapsed hemorrhoid can go back inside the rectum on its own, or it can be gently pushed back inside. If the prolapsed hemorrhoid cannot be pushed back inside, consultation with a physician about surgical treatment options is necessary.

External Hemorrhoids
External hemorrhoids involve the veins outside the anus. They can be itchy or painful and can sometimes crack and bleed. If a blood clot forms, one may feel a tender lump on the edge of the anus, and see bright red blood on toilet paper or in the toilet after a bowel movement.

Symptoms of hemorrhoids, both external and internal, include aching after a bowel movement; anal or rectal itching; bright red blood on toilet tissue or in toilet bowl; appearance of anal tissue pads or sensitive lumps. When any of these symptoms are present, it is important to see a doctor to make sure the cause of the discomfort is hemorrhoids and not some other problem. When the patient visits a doctor for anorectal complaints, the evaluation should include observation, palpation, and anoscopic examination.

A person may be more likely to get hemorrhoids as they age or if their parents had them. Pregnant women often get hemorrhoids because of the strain from carrying the baby and from giving birth. For most women, such hemorrhoids are a temporary problem. Being over weight, straining to move your bowels, sitting too long on the toilet, or standing or lifting too much can make hemorrhoids worse. Constipation is the main cause of hemorrhoids.

Tips for hemorrhoid prevention:

  • Include more fiber in your diet. Fresh fruits, leafy vegetables, and whole-grain breads and cereals are good sources of fiber.
  • Drink plenty of fluids (except alcohol). Eight glasses of water each day is ideal.
  • Do not read on the toilet. Sitting and straining too long encourages swelling.
  • Exercise regularly.
  • Avoid laxatives, except bulk-forming laxatives, such as Fiberall, Metamucil, etc. Other types of laxatives can lead to diarrhea, which can worsen hemorrhoids
  • When you feel the need to have a bowel movement, don’t wait for long periods before using the bathroom.

Tips to reduce the pain caused by hemorrhoids:

  • Take warm soaks three or four times a day.
  • Clean your anus after each bowel movement by patting gently with moist toilet paper or moistened pads, such as baby wipes.
  • Use ice packs to relieve swelling.
  • Use acetaminophen (Tylenol®), ibuprofen (Motrin®), or aspirin to help relieve pain.
  • Apply a cream that contains witch hazel to the area or use a numbing ointment. Creams that contain hydrocortisone can be used for itching or pain.

Treatment
Often lifestyle changes, topical medications, and good hygiene are all that is needed to reduce the symptoms of hemorrhoids. Most painful hemorrhoids stop hurting on their own in one to two weeks. If the pain persists, it is time to talk to a physician about other treatment options.

In a certain percentage of cases, surgical procedures are necessary to provide satisfactory, long-term relief. The newest procedure for advanced hemorrhoids is called the Procedure for Prolapse and Hemorrhoids (PPH). PPH is a technique developed in the early 90’s that reduces the prolapse (enlargement) of hemorrhoidal tissue. With the PPH procedure, patients experience less pain and recover faster than patients who undergo the conventional hemorrhoidectomy procedure.

PPH reduces the prolapse of hemorrhoidal tissue by cutting out a band of the prolapsed anal mucosal membrane with the use of a circular stapling device. The PPH procedure essentially “lifts up” or repositions the mucosal, or anal canal tissue, and restores the hemorrhoidal tissue back to its original anatomical position. This reduces blood flow to the internal hemorrhoids. These internal hemorrhoids, then, typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional procedures because it is performed above the “pain” line, or dentate line, inside the anal canal. The advantage is this method affects few nerve endings, while traditional procedures are performed below the dentate line, affecting many sensitive nerve endings.

For patients with a lesser degree of prolapse (internal hemorrhoids that have fallen outside the anus), rubber band ligation is widely used for the treatment of internal hemorrhoids. In this procedure, the hemorrhoidal tissue is pulled into a double-sleeved cylinder to allow the placement of latex/rubber bands around the tissue. Over time, the tissue below the bands dies-off and is eliminated during a bowel movement. Rubber band ligation can be performed in a doctor’s office and requires little preparation. Often, however, there is the need for more than one procedure to resolve a patient’s condition.

In cases involving a greater degree of prolapse, a variety of operative techniques are employed to address the problem. In traditional hemorrhoidectomy, surgery is used to remove the hemorrhoids. A hemorrhoidectomy removes excessive tissue that causes the bleeding or protrusion. It is done under anesthesia and may require hospitalization and a period of inactivity. Laser hemorrhoidectomies do not offer any advantage over standard operative techniques. They also are quite expensive, and contrary to popular belief, are no less painful.

Other treatments include cryotherapy, BICAP coagulation, and direct current. Cryotherapy, popular 20 years ago, consists of freezing hemorrhoidal tissue. It is not recommended for hemorrhoids because it is very painful. BICAP, also known as bipolar diathermy coagulation, and direct current, which is low current electric stimulation, are techniques that shrink the hemorrhoids and cause the hemorrhoidal tissue to die. None of these treatments has gained widespread acceptance.

Although anorectal conditions are benign and easily treated, patients may delay seeking medical advice because of embarrassment of hemorrhoids or fear of cancer. As a result, many patients first see their physician when the problem is advanced, requiring extensive treatment, and causing greater patient distress than if the conditions had been adequately diagnosed and managed at an earlier stage.


Procedure for Advanced Hemorrhoids (Involves Less Pain and a Quicker Recovery)

According to the American Society for Colon and Rectal Surgeons, the average person with symptomatic hemorrhoids suffers in silence for a long period before seeking medical care. Embarrassment, fear of extreme pain and long recovery associated with traditional hemorrhoidectomy, and fear of cancer all play a role in the delay in seeking treatment.

Now there is a breakthrough, less painful procedure for advanced hemorrhoids called the Procedure for Prolapse and Hemorrhoids (PPH) that eliminates the need for traditional hemorrhoidectomy for many patients. PPH is a technique developed in the early 90’s that reduces the prolapse (enlargement) of hemorrhoidal tissue. With the PPH procedure, patients experience significantly less pain and recover faster than patients who undergo conventional hemorrhoidectomy procedures.

Results from PPH Clinical Trials
Compared to traditional hemorrhoidectomy, several studies have demonstrated that patients undergoing the PPH procedure:

  • experienced significantly less pain
  • experienced a quicker return to normal activities, including work
  • spent less time in the hospital
  • experienced less post-operative pain
  • experienced less post-operative bleeding
  • experienced less post-operative itching
  • experienced less post-operative incontinence and constipation

How PPH Works
Using a stapling device, the PPH procedure essentially “lifts up” or repositions the mucosa, or anal canal tissue, and reduces blood flow to the internal hemorrhoids. These internal hemorrhoids, then, typically shrink within four to six weeks after the procedure. The PPH procedure results in less pain than traditional procedures because it is performed above the “pain” line, or dentate line inside the anal canal. The advantage is that this method affects few nerve endings, while traditional procedures are performed below the dentate line, affecting many sensitive nerve endings.

PPH Indications
PPH is indicated for patients with:

  • Second degree hemorrhoids after failure of multiple rubber band ligation
  • Third and fourth degree hemorrhoids
  • Rectal mucosal prolapse

The PPH procedure was first introduced in Italy in 1997 and in the last four years has become very popular all over the world. In Dec. 1998, the procedure was launched in other European countries. The procedure was first introduced in the United States in Oct. 2001.


Laparoscopic Colon Resection

Segments of the colon or the entire colon can be removed utilizing the laparoscope for a “minimally invasive” approach. The laparoscopic portion of the operation is performed with the aide of a scope in a ½” incision around the umbilicus (belly button). The position of other incisions, or ports, is dependent on the specific operation that is performed. Your surgeon will give you specific details about incision locations at your preoperative appointment.

Another new innovation that our surgeons use is called the hand assist technique. This is used for difficult operations that could not normally be done using the laparoscope. It allows the surgeon to put his hand in the abdomen through a small incision while the remainder of the operation is done laparoscopically. This allows the best of both open and laparoscopic surgery.

The advantage to laparoscopic or hand-assisted laparoscopic surgery is quicker recovery time and shorter hospital stay. We have found that the length of hospital stay has shortened to 1-3 days for laparoscopic colon resection as compared to 3-5 days for the traditional open operation. This is primarily because the post-operative pain is much less and fewer narcotics are used for pain control in the post-operative period.

We generally do not perform laparoscopic colon resection for colon cancer because the scientific data is not there to support that the cancer survival rate is the same as with an open operation. In the near future, we expect the data to support laparoscopic resections for cancer and we will then change our practices accordingly.

Risks of colon resections include but are not limited to infections, damage to internal organs including the ureter (tube that drains the kidney of urine), breakdown or narrowing of the hook up, and recurrence of the cancer. One of the most problems after colon cancer surgery is frequent bowel movements. This usually resolves over time and does not usually require long-term medical treatment. Your surgeon will discuss these issues with you at the time of your preoperative appointment.


Colon Cancer Surgery

Many colon and rectal cancers can be cured by surgical removal of the tumor. Other cancers may require the addition of radiation and/or chemotherapy to cure the cancer. The radiation and chemotherapy is occasionally given prior to an operation but more likely, it is after the operation.

The removal of a segment of colon does not usually require the patient to have a colostomy, as long as the bowel can be cleaned out properly before the operation. Recovery time is usually 3-5 days in the hospital and roughly two weeks at home. However, everyone’s recovery times are different and this is somewhat difficult to predict.

Risks of colon cancer resections include but are not limited to infections, damage to internal organs including the ureter (tube that drains the kidney of urine), breakdown or narrowing of the hook up, and recurrence of the cancer. One of the most problems after colon cancer surgery is frequent bowel movements. This usually resolves over time and does not usually require long-term medical treatment. Your surgeon will discuss these issues with you at the time of your preoperative appointment.

Remember, colon cancer can grow very large without any warning. It can be picked up earlier with routine screening colonoscopy. This allows for a higher cure rate of colon cancer. We recommend routine screening starting at age 50 for people with average risk. Ask your primary doctor for recommendations.


Thyroid Surgery

The thyroid gland is on both sides of the windpipe in the front of the neck. It is sensitive to radiation and occupational exposure to radiation is a risk factor for thyroid cancer.

We perform partial and total thyroid removals for thyroid cancer and for suspicious thyroid lumps or nodules.

The two main complications of thyroid surgery are damage to the recurrent laryngeal nerve and damage to the parathyroid glands. The recurrent laryngeal nerve controls vocal cord movement. The parathyroid glands control calcium metabolism. Our surgeons take great care in preserving these structures at the time of the operation and the risk of their damage is quite low.

Recovery from thyroid surgery is usually very quick. Some patients may go home the same day as surgery or the next morning. We recommend 1-2 weeks off of work for most people.


Lung Surgery

We perform surgery for both malignant and benign lung disease. We also utilize a minimally invasive procedure called thoracoscopy for treatment of some lung diseases. This is through the placement of a scope into the chest much like for our abdominal operations. The scope is inserted between the ribs with the patient fully asleep. Through other small incisions, or ports, the lung or lining of the lung can be biopsied. Also, small segments of the lung can be resected using the scope. This prevents a major incision between the ribs.


Ultrasound

Our surgeons have had additional training in ultrasound techniques.  We have two ultrasound machines available for immediate exams.  We now have the capability to perform ultrasound for breast disease, vascular disease, varicose veins, thyroid evaluations, lymph node evaluations and examination for possible fluid collections under the skin. We also use ultrasound to help in the accurate placement of needles during biopsy procedures.