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Do you have questions about the surgical procedures, treatments or services that we offer?
Below is a list of some frequently asked questions, but please feel free to call our office if you need additional information. We are always pleased to assist you.
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The appendix is a tube of lymphatic tissue and muscle that produces mucus for the
cecum, the first part of the colon.
Appendicitis occurs when the appendix becomes inflamed due to bacteria buildup either in a blockage (i.e. buildup of mucus or fecal matter in the appendix, or lymphatic tissue in the
cecum) or a rupture. Uncontrolled inflammation can cause the appendix to rupture, spreading infection into nearby tissues (called a peri-appendiceal abscess). While the body is sometimes able to contain the infection on its own or with the aid of antibiotics, untreated appendicitis can lead to widespread infection, intestinal blockage, nausea, vomiting, and sepsis (a potentially lethal condition).
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In a minimally invasive laparoscopic appendectomy, an endoscope and a few surgical instruments are inserted through a series of small incisions so the appendix can be removed with less pain and a shorter recovery period. The camera on the endoscope allows the surgeon to confirm the presence of appendicitis and perform the surgery without making a large incision. Patients return home in as little as one day, although a week's recovery may be necessary if the appendix is perforated or peritonitis has occurred.
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Traditionally, cholecystectomy (surgery to remove the gallbladder) involved the creation of a five- to eight-inch long incision in the abdomen below the ribs. Laparoscopic technology now allows the same procedure to be performed through a series of small incisions, with a camera on the laparoscope providing the surgeon with a real-time view inside the patient's body. Laparoscopic surgery provides benefits for the patient such as less post-operative pain, shorter recovery and faster return to normal activities since the incisions are small and the abdominal muscles are not cut.
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During normal ingestion and digestion, food travels from the mouth through a tube of muscle called the esophagus to the stomach, where it remains until it is pushed into the intestine. Muscles in the lower part of the esophagus just above the stomach, called the lower esophageal sphincter (LES), tighten to keep food and digestive acid in the stomach. In people with gastroesophageal reflux disease, these muscles loosen and allow acid to escape (reflux) into the esophagus, the sensitive lining of which is then damaged or burned.
Prolonged acid reflux, known as gastroesophageal reflux disease (GERD), reduces the LES' ability to contract, causing acid to remain in the esophagus longer and leading to extended burning. This in turn causes scarring, nerve damage, tightening of the esophagus, the formation of ulcers, and bleeding.
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The most common symptom is heartburn, the burning sensation felt in the center of the chest when acid and partially digested food move from the stomach to the esophagus. Other signs that you may have GERD include:
- Belching
- Regurgitation of food
- Nausea and vomiting
- Vomiting blood
- Hoarseness or change in voice
- Sore throat
- Difficulty swallowing
- Cough or wheezing
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Heartburn affects almost everyone at some point in their lives. Heartburn that is experienced several times in a 24-hour period, that occurs many times a month, or that causes hoarseness, coughing, bleeding or swallowing difficulties, is not normal and should be examined.
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Preventative and non-surgical treatments for acid reflux include:
- Diet modification
- Cessation of smoking and alcohol consumption
- Examination of medications for caffeine, alcohol, etc.
- Loss of excess weight
- Avoidance of tight clothing and frequent bending
- Sleeping with the head of the bead elevated
Medications are typically prescribed when preventative measures prove ineffective, before surgery is recommended. The most common types of medication are H-2 blockers (Axid, Pepcid, Tagamet, Zantac), drugs that increase peristalsis and tighten the LES (Reglan) and proton pump inhibitors (Prevacid, Prilosec or Protonix).
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A hernia occurs when tissue or part of an organ, usually the intestines, protrudes through a weak point or tear in the abdominal wall, forming a sac. The protruding tissue may lose blood supply and become obstructed, resulting in health problems as serious as life-threatening gangrene.
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Hernias may be caused at birth when the abdominal lining does not close properly (this occurs in about 5 in 100 children); or they may occur later in life from a number of causes, including heavy lifting. The exact cause is often unknown, although risk factors for developing a hernia seem to include:
- Family history of hernias
- Cystic fibrosis
- Excess weight
- Chronic cough
- Chronic constipation from straining to have bowel movements
- Enlarged prostate from straining to urinate
- Undescended testicles
Hernias sometimes result from abdominal operations. These are called incisional hernias.
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- The most common hernia repair procedure is traditional (open or "tension-free") surgery. Usually done with local anesthesia, a large, deep incision is made through the muscle. The tissue is pushed back behind the muscle, which is then stitched closed, and plastic mesh is placed over the former hole site for support. Full recovery takes a month to six weeks .
- The more recent, minimally invasive technique of laparoscopy, done under general anesthesia, involves the creation of three small incisions in the abdomen, the injection of carbon dioxide gas to create a "work space" and the use of a laparoscope, a thin instrument with a camera on the end allowing the surgeon to see inside the patient's body without the need for large incisions. Other necessary surgical instruments are employed through the other small incisions. This "transabdominal" method causes less trauma to the body, so post-operative pain is less and recovery is shorter (about a week) than with the open approach. Disadvantages include the risk of organ puncture.
- In extra-peritoneal balloon laparoscopic hernia surgery, the "work space" is created with an inflatable balloon outside rather than inside the abdominal cavity. This reduces the risk of bowel and blood vessel perforation associated with regular laparoscopic surgery. General anesthesia is still required and recovery takes about a week.
- The recently introduced Kugel method combines the small incisions and extra-abdominal "work space" of balloon laparoscopic surgery with the mesh plug repair used in open surgery. The hernia is dissected under general or local anesthesia and recovery time falls between that of open and that of laparoscopic surgery.
- Incisional hernias, like groin hernias may be repaired "open" using mesh sutured to the edges of the hernia. A newer, more effective way, is to repair the hernia laparoscopically. This allows for the placement of a larger piece of mesh, is less uncomfortable and has a faster recovery.
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Warts are normally noncontagious skin growths caused by viruses. Different warts respond to different treatments. Some go away on their own. Salicylic acid products (in the form of drops, gels, pads and bandages) can help self-treatment of many warts by dissolving the keratin protein that makes up the wart and the dead skin above it. Others can be removed via liquid nitrogen freezing or electrical stimulation. CO2 lasers may be used to remove warts. The is a particularly effective method but requires local or general anesthesia.
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Hemorrhoids occur when the veins located around the anal opening become dilated due to pressure associated with constipation.
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Hemorrhoids may be internal (above the dentate line,
which divides sensitive from insensitive anal skin) and painless or
external (below the dentate line) and potentially painful. Internal
hemorrhoids can cause bleeding and may extend beyond the anal opening.
External hemorrhoids, or skin tags, can sometimes be seen or felt and
are especially painful when blood clots and the hemorrhoid swells
(called a thrombosed external hemorrhoid), irritating the skin.
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Minor hemorrhoids can be treated with a diet high in fiber and bulk, creams and suppositories, stool softeners, Sitz (warm water) baths and by blotting the peri-anal area with a wet wipe or toilet paper after a bowel movement. Local anesthetics and analgesics, vasoconstrictors, protectants, antiseptics, keratolytics, astringents, anticholinergics, wound healing agents and corticosteroid products may also provide symptomatic relief. Patients with more severe pain may opt for surgical draining or removal of thrombosed hemorrhoids. Bleeding from internal hemorrhoids can be treated in the following ways:
- Rubber band ligation uses small rubber band to painlessly cut off blood supply to the hemorrhoid, which falls off in a few days.
- Infrared coagulation shrinks hemorrhoids by drying up blood using infrared light. Multiple treatments may be required.
- Injection sclerotherapy causes hemorrhoids to swell and then shrink through the injection of an irritating chemical that closes the blood vessels.
- Surgical hemorrhoidectomy is recommended for large or protruding internal hemorrhoids. The hemorrhoid is removed with a scalpel, cautery device or laser (which causes less pain and shortens recovery time). Local or general anesthesia may be used and hospitalization is usually required, with recovery taking up to two weeks or a month.
- The recently introduced procedure for prolapse and hemorrhoids (PPH) involves the insertion of a circular stapler into the rectum that pushes internal and external hemorrhoids and surrounding tissue up into the anal canal and staples them in place, cutting off blood supply.
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