| Our
board-certified surgeons specialize in the diagnosis
and treatment of benign and malignant diseases of
the gastrointestinal tract. We have been nationally
recognized for use of innovative, cutting-edge and
minimally invasive surgical techniques to treat gastrointestinal
problems. Most surgeries are performed laparoscopically
using techniques that allow for less pain, shorter
recovery time, fewer scars and a reduced risk of infection.
Acute
Abdomen Surgery
Anti-Reflux (GERD) Surgery
Appendix Surgery
Bowel Surgery
Gallbladder Surgery
Stomach Surgery
Acute
Abdomen Surgery
Acute abdomen, or peritonitis, is an inflammation
or irritation of the peritoneum, the tissue that lines
the wall of the abdomen and covers the abdominal organs.
A collection of pus in the abdomen, called an intra-abdominal
abscess, may cause peritonitis.
Secondary peritonitis is an inflammation
(irritation) of the peritoneum (the membrane lining
the abdominal cavity) caused by another condition,
most commonly the spread of an infection from the
digestive organs or bowels. Bacteria may enter the
peritoneum via a hole (perforation) in the gastrointestinal
tract, which can be caused by a ruptured appendix,
stomach ulcer or perforated colon. The condition can
also occur when pancreatic enzymes leak into the peritoneum
during pancreatitis or when bile leaks from the biliary
tract due to injury, because these chemicals can irritate
the peritoneum. Foreign contaminants can also cause
secondary peritonitis if they get into the peritoneal
cavity. This can occur during use of peritoneal dialysis
catheters.
Symptoms of secondary peritonitis include:
-
Abdominal pain
- Abdominal
distention
- Fever
- Thirst
- Low
urine output
Surgical treatment of secondary peritonitis is usually
necessary to remove sources of infection such as infected
bowel, inflamed appendix, or an abscess. General treatment
includes intravenous fluids, antibiotics, and use
of medications to treat pain.
Spontaneous peritonitis is inflammation
of the tissue that lines the abdominal wall and covers
the abdominal organs. It usually results from ascites,
a collection of fluid in the peritoneal cavity, which
is usually related to liver or kidney failure. Risk
factors for liver disease include alcoholic cirrhosis
and other diseases that lead to cirrhosis, such as
viral hepatitis (Hepatitis B or C). Spontaneous peritonitis
also occurs in patients undergoing dialysis for kidney
failure.
Symptoms of spontaneous peritonitis include:
- Fluid
in the abdomen
- Abdominal
pain and distention
- Abdominal
tenderness
- Fever
-
Low urine output
-
Additional symptoms that may be associated with
this disease:
- Nausea
and vomiting
- Joint
pain
- Chills
Treatment depends on the cause of the peritonitis.
Surgery may be needed in cases where peritonitis is
associated with a foreign object, such as a peritoneal
dialysis catheter. Antibiotics are administered to
control infection in cases of spontaneous peritonitis
in patients with liver or kidney disease, and dehydration
is treated by intravenous therapy. Hospitalization
is common and may be necessary to rule out other causes
of peritonitis such as appendicitis and diverticulitis.
Anti-Reflux
(GERD) Surgery
Gastroesophageal reflux disease (GERD) is a condition
in which food or liquid travels backwards from the
stomach to the esophagus (the tube from the mouth
to the stomach). This action can irritate the esophagus,
causing heartburn and other symptoms. GERD is a common
condition that often occurs without symptoms after
meals. In some people, the reflux is related to a
problem with the lower esophageal sphincter, a band
of muscle fibers that usually closes off the esophagus
from the stomach. If this sphincter doesn't close
properly, food and liquid can move backward into the
esophagus and may cause the symptoms. The risk factors
for reflux include hiatal hernia, pregnancy, and scleroderma.
Symptoms
of GERD include:
- Heartburn
- Involves
a burning pain in the chest (under the breastbone)
- Increased
by bending, stooping, lying down, or eating
- Relieved
by antacids
- More
frequent or worse at night
-
Belching
- Nausea
and vomiting
- Vomiting
blood
- Hoarseness
or change in voice
- Sore
throat
- Difficulty
swallowing
- Cough
or wheezing
An
anti-reflux surgical operation, called Nissen fundoplication,
may help patients who have persistent symptoms of
GERD despite medical treatment. During this surgery,
the upper curve of the stomach (the fundus) is wrapped
around the esophagus and sewn into place so that the
lower portion of the esophagus passes through a small
tunnel of stomach muscle. This surgery strengthens
the valve between the esophagus and stomach, which
stops acid from backing up into the esophagus as easily.
The
surgeons at Surgical Specialists have extensive training
and are highly experienced in the laparoscopic approach
to Nissen fundoplication, meaning less pain and a
shorter recovery time for you.
Appendix
Surgery
The appendix is a small, finger-shaped sac extending
from the first part of the large intestine. An appendectomy
is surgery to remove the appendix when it becomes
inflamed or infected. An infected appendix can leak
and infect the entire abdominal area, which can be
deadly.
An appendectomy is done under general anesthesia,
which means you are asleep and do not feel any pain
during the surgery. The surgeon makes a small incision
in the lower right side of your abdomen and removes
the appendix. If the appendix ruptured or a pocket
of infection (abscess) formed, your abdomen will be
thoroughly washed out during surgery. A small tube
may be left in the belly area to help drain out fluids
or pus.
An
emergency appendix removal will be needed if you have
symptoms of sudden or acute appendicitis. These symptoms
include:
- Abdominal
pain located in the lower right side of your body
-
Fever
- Reduced
appetite
- Nausea
and vomiting
If
you have symptoms of appendicitis seek immediate emergency
medical help. Untreated sudden or acute appendicitis
can be deadly. Do not use heating pads, enemas, laxatives,
or other home treatments to try and relieve symptoms.
Your health care provider will examine your abdomen
and rectum to check for a swollen appendix. Blood
tests, including a white blood cell count (WBC), may
be done to check for infection.
There
is no actual test to confirm appendicitis. It is important
to understand that the symptoms may be caused by other
illnesses. The physician will diagnose the condition
based on your symptoms, medical history, and the results
of the physical exam and medical tests. The appendix
may be removed even when it is not infected to prevent
future problems.
Patients
tend to recover quickly after a simple appendectomy.
Most patients leave the hospital in 1 - 3 days after
the operation. Normal activities can be resumed within
1 - 3 weeks after leaving the hospital. Recovery is
slower and more complicated if the appendix has ruptured
or an abscess has formed. Living without an appendix
causes no known health problems.
Bowel
Surgery
Small Bowel Resection
Large Bowel (Colon) Resection
Bowl Obstruction Removal
Small
Bowel Resection
Small bowel resection is surgery to remove part of
your small bowel, which is located between your stomach
and large bowel (large intestine). The small bowel,
also called the small intestine, is where most digestion
occurs.
Small
bowel resection may be recommended for the following:
- A
block in the intestine due to scar tissue or deformities
- Bleeding,
infection, or ulcers due to inflammation of the
small intestine (regional ileitis, regional enteritis,
Crohn's disease)
- Injuries
- Cancer
- Precancerous
polyps
- Benign
tumors
Small
bowel resection is done while you are under general
anesthesia (unconscious and pain-free). The surgeon
makes a cut in the abdomen and removes the diseased
parts of the small intestine. The two healthy ends
of the intestine are sewn or stapled back together
(resected). The cut in the abdomen is closed.
To
help the small intestine heal, a procedure called
an ostomy may be done. An opening (stoma) is for the
intestine is created through the abdominal wall. The
healthy end of the intestine near the stomach is moved
through the abdominal wall and stitched in place.
A drainage bag (also called a stoma appliance) is
placed around the opening. In most cases, the stoma
is temporary and can be closed with another operation
at a later date. If a large part of the bowel is removed,
the stoma may be permanent.
The
small intestine normally absorbs fluid from food.
With an ostomy, you will have liquid stool (feces)
collect in the drainage bag. The frequent drainage
of liquid stool can cause the skin around the ostomy
to become red and swollen. Careful skin care and a
well-fitting stoma appliance can reduce this irritation.
Large
Bowel (Colon) Resection
Large bowel resection is surgery to remove part of
your large bowel. The large bowel, also called the
large intestine or colon, connects the small intestine
to the anus.
Large
bowel resection is used to treat a variety of conditions,
including:
- Colon
cancer
- Diverticular
disease
- A
block in the intestine due to scar tissue
-
Ulcerative colitis
- Traumatic
injuries
- Precancerous
polyps
- Familial
polyposis
In
many cases, your bowel is prepared before the surgery
with antibiotics and/or oral medication. The surgery
is performed while you are under general anesthesia.
This means you are unconscious and pain-free. A cut
is made in your abdomen. The diseased part of the
large bowel is removed and the two healthy ends of
the bowel are sewn back together (resected). The cut
is closed. If the entire colon and rectum is removed,
it is called a proctocolectomy.
A
bowel resection may be performed as a traditional
"open" procedure or as a minimally invasive
laparoscopic procedure.
To
help your bowel heal, a temporary opening of the colon
through the abdominal wall may be created. This is
called a colostomy. The end of the bowel near the
small intestine is then passed through the abdominal
wall, and stitched in place. A drainage bag (stoma
appliance) is placed around the opening. In most cases,
the colostomy is temporary and can be closed with
another operation at a later date. If a large portion
of the bowel is removed, the colostomy may be permanent.
The
large bowel absorbs a significant amount of water
from digested food. When the colon is bypassed by
a colostomy, loose or liquid stool (feces) will collect
in the drainage bag. Careful skin care and a well-fitting
colostomy bag are necessary to reduce skin irritation
around the colostomy.
Bowl
Obstruction Removal
Bowl obstruction involves a partial or complete blockage
of the bowel that results in the failure of the intestinal
contents to pass through.
Symptoms
- Abdominal
fullness, gaseous
- Abdominal
distention
- Abdominal
pain and cramping
- Vomiting
- Failure
to pass gas or stool (constipation)
- Diarrhea
- Breath
odor
Obstruction
of the bowel may be caused by paralytic ileus, or
temporary intestinal paralysis. Paralytic ileus, also
called pseudo-obstruction, is one of the major causes
of obstruction in infants and children. The causes
of paralytic ileus may include the following:
- Medications,
especially narcotics
- Intraperitoneal
infection
- Mesenteric
ischemia (decreased blood supply to the support
structures in the abdomen)
- Injury
to the abdominal blood supply
- Complications
of intra-abdominal surgery
- Kidney
or thoracic disease
- Metabolic
disturbances (such as decreased potassium levels)
Mechanical
obstruction occurs when movement of material through
the intestines is physically blocked. The mechanical
causes of obstruction are numerous and may include
the following:
- Hernias
-
Postoperative adhesions or scar tissue
- Impacted
feces (stool)
- Gallstones
- Tumors
blocking the intestines
- Granulomatous
processes-abnormal tissue growth
-
Intussusception
- Volvulus
(twisted intestine)
- Foreign
bodies (ingested materials that obstruct the intestines)
If
the obstruction blocks the blood supply to the intestine,
the tissue may die, causing infection and gangrene.
Risk factors for tissue death include intestinal malignancy,
Crohn's disease, hernia, and previous abdominal surgery.
The objective of treatment is to decompress the intestine
with suction, using a nasogastric (NG) tube inserted
into the stomach or intestine. This will relieve abdominal
distention and vomiting. Surgery to relieve the obstruction
may be necessary if decompression by NG tube does
not relieve the symptoms, or if tissue death is suspected.
Stomach
Surgery
Gastrectomy, surgery to remove part or all of the
stomach, is used to treat bleeding, inflammation,
non-cancerous tumors or cancer. The surgery is done
while you are under general anesthesia (unconscious
and pain-free). The surgeon makes a cut in the abdomen
and removes all or part of the stomach, depending
on the reason for the operation. The intestine is
then re-connected to the remaining stomach (partial
gastrectomy) or to the esophagus (total gastrectomy).
After controlling the blood supply, the opening is
closed with stitches.
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