|
PROCEDURES
Cholecystectomy
(Surgical removal of the
gallbladder)
Cholecystectomy (ko-le-sis-tek`-tuh-me)
is the surgical removal of the gallbladder. It is
important to remember that each
individual is different, and the indications for and the outcome of
any operation, is dependent upon the
patients individual condition.
ABOUT THE GALLBLADDER
The gallbladder is
a small pear-shaped organ which lies on the underside of the liver, in the right
upper portion of the
abdomen. It is connected by ducts (or tubes) with the liver and with the
upper portion of the small
intestine (duodenum).
The liver produces bile,
a substance which is essential for digesting fats. The bile is secreted
into
a duct which runs into the first
part of the intestine. The gallbladder is a branch of this bile duct,
and its function is to store some of the
bile. When food is eaten, especially fatty or greasy foods,
the gallbladder
contracts and forces bile out into
the duct leading into the intestine. When the
gallbladder is removed,
this function is taken over by the liver
and its ducts. The gallbladder
therefore is a non-essential organ.
GALLBLADDER DISEASE
Frequently, the
bile in the gallbladder forms stones which can block the gallbladder. In
some
individuals, a problem exits in
the function of the gallbladder and it does not empty bile into the
intestine as it should. The exact
causes of these conditions are not known, but they are frequently
associated with diets that are
high in fatty and greasy foods.
Anyone can develop gallbladder
disease, but it is more common in females and people who are
overweight.
SYMPTOMS OF GALLBLADDER DISEASE
Sometimes, persons with gallstone
disease have few or no symptoms. Most however, will
eventually develop one or more of the
following symptoms:
1. Frequent
bouts of indigestion, especially after eating fatty or greasy foods, or certain
vegetables such as cabbage, radishes, or pickles;
2. Nausea, heartburn, and
bloating;
3. Attacks of sharp pains
in the upper right part of the abdomen. This pain occurs when a
gallstone becomes lodged in the duct from the gallbladder to the
intestine. The pain may
radiate to the back, shoulder, or mid-chest areas.
4. Pancreatitis
(inflammation of the pancreas) may occur and can be life threatening.
5. Jaundice (yellowing of
the skin) may occur if a gallstone becomes stuck in the common bile
duct which leads into the intestine, blocking the flow of bile from both the
gallbladder and the
liver. This is a serious complication and may require an immediate
emergency operation.
DIAGNOSING GALLBLADDER DISEASE
Gallbladder disease
is frequently diagnosed with ultrasound, a safe and painless technique that
uses high frequency sound waves
to project an image of the gallbladder onto a special screen.
HIDA Scan (a type of nuclear
scan) is used to diagnose malfunctioning of the gallbladder in the
absence of stones.
ABOUT THE OPERATION
Removal of the gallbladder
is one of the most frequently performed of all operations; it is
considered to be a very low risk procedure
in otherwise healthy individuals.
LAPAROSCOPIC CHOLECYSTECTOMY
A procedure using
video technology is now available for most patients who require gallbladder
surgery. Four small incisions are
made in the abdomen to allow the insertion of specialized
instruments including a
laparoscope (high resolution video camera). The gallbladder is
then dissected free and
eventually removed from the abdomen. The primary advantages are that
the post-operative discomfort is
generally less, and patients can return to normal activities sooner,
usually within a week. Patients
are usually discharged on the day of the surgery. Occasionally, an
overnight or longer admission may
be necessary. Rarely, technical factors during laparoscopic
cholecystectomy necessitate
converting the procedure to the more traditional "open"
cholecystectomy.
RECOVERING FROM THE OPERATION
The great majority of patients
experience no further symptoms once the gallbladder has been
removed. Rarely, mild residual symptoms
may occur. These can usually be controlled with a
special diet and medication. Occasionally,
there may be other problems, in addition to the
gallstones, which can cause trouble post-operatively.
OUT-PATIENT HERNIA
REPAIR
WHAT
IS A HERNIA?
A hernia is the
protrusion of an abdominal organ through the abdominal wall. Defects in
the
lining of the abdominal cavity can
occur through inherited weaknesses or acquired defects.
Any part of the abdominal wall can
develop a hernia, although the most common site is in the
groin. Hernias also occur at
previous surgical incision sites. Hernias cause bulging or
swelling and generally cause
discomfort. They can also cause injury to the organ that
protrudes through the defect.
Surgical repair is almost always indicated. In general, hernias
can be repaired by simply repairing
the defect in the abdominal wall. There are several
techniques to repair hernias.
Usually, they are Out-Patient procedures.
CONVENTIONAL
HERNIA REPAIR
The conventional method consists
of making an incision over the site of the hernia, returning the
protruding tissue to the
abdominal cavity, then repairing the defect or weakness in the abdominal
wall by sewing stronger
surrounding tissues over the defect. Artificial material ("mesh")
can be
inserted to help repair
the defect. Most Surgeons now use plastic mesh for adult hernia repairs, as
this gives a stronger repair and a
faster, more comfortable recovery.
THE
LAPAROSCOPIC METHOD
With this newer technique,
a laparoscope (a small operating "telescope") is used to enable
visualization of the relevant structures
through small openings in the abdominal wall. Surgical
instruments
are then inserted through other small openings in the abdominal wall. These are used
to both return the
protruding tissue into the abdomen
and also to repair the defect. A
polypropylene mesh is used to repair
the abdominal wall defect.
It is held in place with
permanent surgical staples. A general anesthetic
is usually required, although
this procedure can
be done with spinal anesthetic, in selected patients.
This method of using mesh
is a very good way to repair inguinal (groin) hernias. It may not
be
available for all patients,
however.
The major
advantages of this method over the conventional method are that post-operative
pain is
much less (there is still some
discomfort), and patients return to normal activity levels much sooner
(usually one to two weeks, rather
than six weeks). Additionally, the opposite groin can usually be
inspected through the same
operating holes to ensure there is no hidden hernia.
FLEXIBLE
SIGMOIDOSCOPY An
estimated 129,400 cases of colon cancer will be diagnosed in 1999. 56,600 cases
will be fatal. The signs
and symptoms of colon and rectal cancer include
* Rectal bleeding
* Blood in stool
* Change in bowel habits
Beginning at age 50, both men and women should have a yearly fecal occult blood
test and digital rectal
examination. A flexible sigmoidoscopy should be done every
5 years in healthy
persons with no symptoms starting at age 50, according to
the American Cancer
Society.
People should begin colorectal cancer screening earlier and/or undergo screening
more often if they
have increased colorectal cancer risk factors:
* A personal or strong family history of colorectal cancer or adenomatous
polyps.
* A personal history of chronic inflammatory bowel disease.
* A family history of hereditary colorectal cancer or polyp syndromes
(familial adenomatous polyposis and hereditary non-polyposis colon
cancer).
The usual initial treatment for colorectal cancer is surgery. For cancers that
are found
early and have not
spread, surgery is frequently curative.
Do not be one
of these statistics. Make your appointment today!
Flexible sigmoidoscopy is performed in our office and takes approximately
five to ten
minutes. No anesthesia is required. You may experience some
abdominal cramping
which readily subsides by the end of the procedure.
Two fleet enemas the morning of the procedure are required. You will receive
additional
instructions at the time you schedule your sigmoidoscopy.
COLONOSCOPY: QUESTIONS AND ANSWERS
WHAT IS COLONOSCOPY?
A colonoscope is a long flexible tube that is about the thickness of a finger.
It
is inserted through the rectum into the large bowel (colon) and allows
careful
examination of the lining of the colon. Any abnormalities seen on a
previous
x-ray can be confirmed and studied in detail. Colonoscopy can identify lesions
that may be missed on x-ray as well. Suspicious areas can be studied in a
greater detail by obtaining a biopsy through the colonoscope. For a biopsy,
a
special instrument is passed through the colonoscope, and a small piece of
tissue is cut from the bowel. This is painless.
WHAT PREPARATION IS REQUIRED?
For an optimal examination, the colon must be completely empty of stool.
Therefore, a special bowel preparation, available to you at our office, is to be
taken before the procedure. You will receive instructions for the colonscopy
preparation during your office visit. It is important for you to complete
the
bowel preparation as ordered.
WHAT SHOULD YOU EXPECT DURING THE PROCEDURE?
While you are lying in a comfortable position, and after being sedated,
the
colonoscope is inserted into the rectum and gradually advanced through the
colon. The lining of the colon is carefully examined. The colon is inflated
with
air to assist in visualization, which may result in discomfort during the
procedure.
WHAT IS POLYPECTOMY?
A polyp is an area of abnormal growth of tissue which may
cause rectal bleeding
or other intestinal symptoms. Most polyps are asymptomatic, however. The
majority of polyps are benign (non-cancerous); a small percentage may
contain
an area of cancer or may develop into cancer. The majority of smaller
polyps
can be removed through the colonoscope. Generally, removal of a polyp is
painless.
COMPLICATIONS FROM
COLONOSCOPY AND POLYPECTOMY
Colonoscopy and polypectomy are relatively safe procedures
and are associated
with very low risk. One potential complication is bleeding from the site of
biopsy
or polyp removal. This is generally very minor and almost always stops on its
own.
Although very unlikely, perforation of the bowel may occur, and usually
requires
emergency surgery for repair. As with any medical procedure, complications
can
occur in unrelated organs such as heart attack, stroke, and even death, although
these are extremely rare.
GASTROSCOPY
WHAT IS A GASTROSCOPE?
A gastroscope is a long flexible tube that is about the
diameter of your little finger.
It is passed through the mouth and throat into the upper digestive tract. It
allows
careful examination of the esophagus, stomach, and duodenum (the first portion
of the small intestine). If necessary, a small piece of tissue (a biopsy) can be
taken
through the gastroscope for examination under the microscope or to test for
ulcer-causing bacteria.
WHAT SHOULD YOU EXPECT DURING THE
PROCEDURE?
Your throat is sprayed with a local anesthetic to numb it to
prevent gagging. You
will be monitored and receive oxygen during the procedure. Intravenous sedation
is then given for relaxation. Although you may be quite sleepy, you will not be
completely anesthetized. The gastroscope is then inserted through the mouth and
into the esophagus, stomach, and duodenum. The procedure is extremely well
tolerated with little or no discomfort. Breathing will not be affected.
ARE THERE ANY COMPLICATIONS FROM
GASTROSCOPY?
Gastroscopy is a very safe procedure, and it is associated with very low
risk.
Complications can occur but are quite rare. One possible complication is a
perforation through the wall of the esophagus or stomach which may require
surgical repair. Bleeding, usually minor, may occur from the site of biopsy or
polyp removal. Other extremely rare complications can occur due to unrelated
diseases such as heart problems or arteriosclerosis. Death is an extremely
remote possibility.
WHAT PREPARATION IS REQUIRED?
For an optimal examination, the stomach must be completely empty. You
should have nothing to eat after 12:00 o'clock midnight the evening before
the examination. VARICOSE VEINS
Varicose veins are a common North American problem. The incidence
increases as the socioeconomic level of the community increases. Women
are more likely to be affected than men, and the disease tends to run in
families.
There are several causes of varicose veins, but usually, there is a defect in
the valves within the veins. These valves normally prevent blood from flowing
backwards away from the heart. In people with varicose veins, the valves are
defective, and blood is allowed to pool in the legs, leading to elongation of
the
veins and their "wormy" appearance. This defect in the valves may be
related
to hormones, trauma, blood clots, or to age-related deterioration. Some
people are born with defective valves.
The main symptom of varicose veins is their unsightly cosmetic appearance.
However, complaints such as swelling, aching, and throbbing, as well as night
cramps, may be due to varicose veins, but the symptoms may also be due to
arthritis, knee problems, or hip disease. Definite complications of varicose
veins are thrombosis or clotting of the veins, rupture, and the development of
skin ulcers. Untreated vein problems in the legs may lead, over the long-term, to
venous stasis, which results in thickened brown skin on the lower leg, and also
ulcers which may be difficult to heal.
The treatment of varicose veins consists of either surgery or injection or a
combination of surgery and injections. Regardless of the type of treatment
chosen, varicose veins tend to reoccur. Veins that begin in the groin and extend
all the way down the inside of the leg, or those that begin at the back of the
knee and extend down the calf, are most readily treated by some form of surgery.
These veins arise directly from incompetence or breakdown of valves at the groin
or at the knee. Varicose veins can also be treated by compression
sclerotherapy.
Sometimes, a combination of surgery and compression sclerotherapy are
recommended for varicose vein therapy.
COMPLICATIONS OF SCLEROTHERAPY
Allergic reactions to the medication have been reported, but are rare. There is
a
limitation on the amount of medication that can be injected at one time.
Therefore,
patients that have numerous or severe varicosities may require several
treatments.
It is extremely rare, but blood clots in the deep veins of the legs may develop
after compression sclerotherapy. This complication, know as deep venous
thrombophlebitis, is increased in patients who smoke, and greatly increased in
smokers on the birth control pill.
SPIDER VEINS
Spider veins are small cutaneous veins which occurs on the legs. These are
most common in females and are quite often first seen during pregnancy or
with the onset of menstruation. These are a cosmetic problem only, and
injections are not a covered benefit of most insurance companies. It is
reasonable to expect good but not necessarily perfect improvement with
injection of spider veins. Again, there may be brown pigmentation which,
in some individuals, may be permanent. The small spider veins are injected
with an irritating solution. There is some initial discomfort which lasts for
several hours and then resolves. The spider veins will be purple. They will
gradually fade to a brown line. There is no restriction on activity after
injection
of spider veins, and the spider veins do not have to be wrapped. Scabs may
develop, but generally these will heal nicely if they are left alone. To prevent
hyperpigmentation, direct sun exposure should be avoided for three months.
INSTRUCTIONS FOR SCLEROTHERAPY
If elastic bandages are used, they must be worn night and day for one week.
After 48 hours, the bandages may be removed for bathing and then reapplied.
After the first week, they must be worn whenever the patient is standing or
walking, for another two weeks. There is minimal discomfort from the
injections. There may be some aching or discomfort in the leg for the first 24
to 48 hours. This can be handled with elevation and the use of aspirin (or
aspirin-like compounds such as Advil) or Tylenol. There
are no restrictions in activity after sclerotherapy.
In
fact, walking and exercise increase the pumping action of the muscles in the
legs, which benefits varicose veins. If the wrappings are too tight or too loose
during the first week, they should be removed and reapplied so they are
snug
but not uncomfortable. After the initial three weeks, if tenderness is
still
present, continue wrapping until it resolves. If scabs develop, do not rub or
scratch them as this may lead to infection and scarring. To prevent
hyperpigmentation, direct sun exposure should be avoided for three months.
Use protective clothing or sunscreen, with a SPF of at least 20. Lanolin or
Vitamin E cream (rather than lotion) can be applied to the skin of the legs
to reduce itching and maintain skin softness. |