Hernia Repair

Hernia Repair

GENERAL INFORMATION

A hernia is a “defect” or weakness in the abdominal wall. There are several locations and types of hernias, all requiring different types of surgery. The bulge associated with most hernias is not the hernia itself, but the hernia contents protruding through the defect. The common areas where hernias occur are in the groin (inguinal or femoral), belly button (umbilical), above or below the belly button (ventral), and the site of a previous operation (incisional). Hernias are repaired to prevent the hernia from becoming larger and uncomfortable and to prevent the contents from becoming entrapped (incarcerated) or strangulated.

PRE-OP PREP: Labs and other studies are ordered prior to surgery based on the patient’s age and the presence of any existing medical problems. Patients should not eat or drink anything after midnight the night before surgery. Drugs such as aspirin, blood thinners (Coumadin, warfarin, Pradaxa, Xarelto, Eliquis), Plavix, and anti-inflammatory medications (Ibuprofen, Naproxen) should be stopped before surgery. Ask your doctor how long you should be off your medication. A bowel prep may be given to patients with incisional or ventral hernias.


OPEN INGUINAL/FEMORAL HERNIAS

Indications:

Except in rare circumstances, most groin hernias require repair.

Pre-Operative Evaluation:

A history and physical examination confirm the presence of a hernia.

Procedure:

Depending on whether you and your surgeon decide to pursue a laparoscopic or open repair, the procedures(s) are somewhat different. A 2-3 inch incision is made in the groin. The contents of the hernia are returned to the abdomen and the hernia defect is repaired using a synthetic mesh patch.

Length of Stay:

Outpatient.

Recovery:

1–2 weeks.


LAPAROSCOPIC INGUINAL HERNIA REPAIR

Indications:

Groin hernias can also be repaired laparoscopically.

Pre-Operative Evaluation:

A history and physical examination confirm the presence of a hernia.

Procedure:

The defect(s) are repaired using a synthetic mesh that covers all of the defects from the “inside” behind the muscles of the abdominal wall. The mesh material is fixed to the abdominal wall in a way that eliminates the defects.

Length of Stay:

This procedure is usually done as an outpatient, with an overnight stay in the hospital occasionally necessary for ventral and incisional hernias.

Recovery:

Appropriately selected patients may have less pain and quicker recovery when compared to the open procedures.


OPEN INCISIONAL AND VENTRAL HERNIAS

Indications:

These are hernias that develop at previous incision sites or on the abdominal wall (including the “belly button”). Most of these hernias require repair.

Pre-Operative Evaluation:

A history and physical examination confirm the presence of a hernia.

Procedure:

An incision is made over the hernia. The contents are returned to the abdomen and a synthetic mesh patch is usually used to complete repair.

Length of Stay:

Outpatient except in the case of large hernias which might require brief hospitalization.

Recovery:

1–2 weeks. No lifting over 5-10 pounds for six weeks.


LAPAROSCOPIC VENTRAL/INCISIONAL HERNIA REPAIR

Indications:

Ventral and incisional hernias can be repaired laparoscopically.

Pre-Operative Evaluation:

A history and physical examination confirm the presence of a hernia.

Procedure:

The defect(s) are repaired using a synthetic mesh that covers all of the defects from the “inside” behind the muscles of the abdominal wall. The mesh material is fixed to the abdominal wall in a way that eliminates the defects.

Length of Stay:

This procedure is usually done as an outpatient, with an overnight stay in the hospital occasionally necessary for ventral and incisional hernias.

Recovery:

Appropriately selected patients may have less pain and quicker recovery when compared to the open procedures.

Gallbladder Removal

Gallbladder Removal

LAPAROSCOPIC CHOLECYSTECTOMY:gallbladder-300x225

INDICATIONS:

Most gallbladder surgery is done for people who have symptomatic gallstones. Common symptoms include right-sided or upper central abdominal pain, which commonly occurs after eating fatty or greasy foods. The pain can be associated with nausea, vomiting, and / or a bloating sensation. The pain can also radiate into the back and/or right shoulder. A small percentage of patients have these symptoms without gallstones, but can be shown to have gallbladder dysfunction. Gallbladder dysfunction is identified on a test called a CCK – HIDA which measures how well the gallbladder functions.

PRE-OP EVALUATION AND PREP:

All patients have an ultrasound of the gallbladder, liver and bile ducts. Other imaging tests may be ordered if necessary. Routine blood work and x-ray studies are ordered prior to surgery based on the patient’s age and the presence of any existing medical problems. Patients should not eat or drink anything after midnight the night before surgery. Drugs such as Coumadin, Plavix, Aspirin and anti-inflammatory medications should be stopped before surgery.

PROCEDURE:

Laparoscopic gallbladder removal is performed under general anesthesia and involves four small incisions less than one-half inch in length. A camera is inserted into the abdomen through one of these incisions. The other incisions are used for the insertion of instruments the surgeon uses to remove the gallbladder instead of making a large incision as was commonly done in the past.

INPATIENT VS OUTPATIENT:

Gallbladder surgery can usually be done as an outpatient. Some patients require extended observation, with discharge later in the day or the next morning. This occasionally is required in elderly patients, those with other medical problems, or in patients who may be nauseated or uncomfortable postoperatively.

RECOVERY:

This seems to vary from patient to patient. Some patients return to work shortly after surgery, others require several weeks until full recovery. On the average, one to two weeks after surgery patients are ready to resume all normal activities.

Breast Procedures

Breast Procedures

DIAGNOSTIC BREAST PROCEDURES

The diagnosis of a breast problem can usually be completed by taking the history of the patient and having a physical examination by one of our experienced breast surgeons. Mammograms and ultrasounds are also valuable aids in the diagnosis of breast problems. When further diagnostic methods are needed, our surgeons have many techniques available including office ultrasound.

Occasionally various breast biopsy procedures are needed to help determine the diagnosis. We offer a number of minimally invasive biopsy techniques.

Breast Biopsy Techniques

    1. Fine needle aspiration (FNA): FNA is a biopsy technique performed with a very small needle. This needle is passed into the breast while suction is applied. The sample is microscopically analyzed for suspicious cells using a technique similar to Pap smears. It is the least invasive biopsy technique available and takes only 1-2 minutes. The results are available within 48-72 hours.
    1. Ultrasound guided biopsy: This biopsy technique is used in our office frequently. Using our office ultrasound unit, a special biopsy needle is guided into the area of interest. When the needle is in the area of concern, the biopsy needle is activated by the surgeon and quickly harvests a small core sample of breast tissue. This is usually done 2 or 3 times to make sure the region has been adequately sampled. This procedure takes about 5 minutes and is easily tolerated. The results are usually quite precise and are available in 48-72 hours.
  1. Stereotactic biopsy: This technique uses the same type of special biopsy needle as the ultrasound guided biopsy; however, the guidance mechanism used is a digital mammogram technique that is computer aided. This biopsy technique is performed by our surgeons in the radiology suite at the hospital. This technique is usually used in cases where the abnormality can only be seen on a mammogram and may be invisible on ultrasound. It is also done using local anesthetic techniques and requires no preparation. Several biopsies are taken to ensure accuracy and the results are available in approximately 72 hours.

These three techniques are all office or outpatient procedures. All can be done quickly with the patient able to resume normal activities immediately following the procedure.

SURGICAL BIOPSIES are occasionally required when less invasive biopsy techniques are not feasible or insufficient for diagnosis. Occasionally a needle localization wire will be placed by a radiologist before a surgical biopsy. These biopsies are performed at the hospital or at a local outpatient surgery center.

While the vast majority of all breast biopsies are benign (non-cancerous), we occasionally make the diagnosis of breast cancer. Our surgeons offer all accepted procedures for breast cancer treatment. Our breast surgeons chair local and community breast screening and treatment committees. They meet regularly to ensure that the latest and most effective therapies are available including investigational therapies.


THERAPEUTIC BREAST PROCEDURES

A number of surgical options are available to the patient when breast cancer surgery is necessary.

    1. BREAST LUMPECTOMY: This surgery involves removing the cancerous area of the breast plus a surrounding area of normal breast tissue. Every attempt is made to preserve breast shape and size. This approach is appropriate for most small breast cancers and some larger breast cancers. It is accompanied by removal of one or more of the lymph nodes under the arm, where breast cancer tends to spread first (see Sentinel lymph node biopsy). After healing is complete, radiation treatment is given to the remaining breast tissue to minimize the chance of recurrence. Lumpectomy is one of the most popular current surgical treatments for breast cancer. The lumpectomy procedure is usually done as an outpatient. Average recovery time is one week.
    1. MASTECTOMY: This operation is the oldest surgical treatment for breast cancer. This operation involves the removal of all breast tissue; however, in recent years it has been modified to remove only the nipple and a small amount of surrounding skin along with the underlying breast tissue. Additionally, some lymph glands under the arm are removed. No muscles are removed and seldom is radiation required. This operation is used often for very large or extensive tumors, or for patients who are unacceptable candidates for lumpectomy. This surgery is also usually done in conjunction with immediate breast reconstruction, which is performed by a plastic surgeon. There are many different types of breast reconstruction including breast implants and muscle transfer flaps. Consultation with a plastic surgeon is strongly encouraged before proceeding with mastectomy.
  1. SENTINEL LYMPH NODE BIOPSY: Over the past ten years, surgeons have developed a surgical technique to reliably identify the specific lymph nodes draining the area of a breast cancer. These lymph nodes can be precisely identified by an injection of a radioactive tracer and a blue dye into the breast just before surgery. These lymph nodes have a great deal of prognostic significance, but until now were difficult to locate with precision. The lymph nodes undergo special microscopic testing to determine, with the highest possible accuracy, the stage of the breast cancer.In some situations, sentinel lymph node removal will suffice without requiring the standard axillary lymph node dissection. This very new and exciting procedure is available through our breast surgeons and is integrated into our team approach with radiologists, pathologists, radiation oncologists and medical oncologists.