Colon removal (Colectomy): Reasons may vary of why you may need to have your colon removed. Colon cancer is one reason. We know that most colon cancers originate from colon polyps. It is very important for you to have routine physical exams by you family physician and eventually have a colonoscopy. (a colonoscopy is using a lighted scope that has a TV camera on the end to visualize the inside of your colon). Other reasons you may need to have your colon removed is for repeated or severe infections of the small outpouchings of the colon called diverticulae (diverticulitis). Additionally there are inflammatory conditions that may require removal of part or all of the colon.
The procedure: The affected portion of the colon is removed from the body. The two ends that are left are sewn or stapled back together. In very rare situations, the intestine cannot be sewn back together and instead a colostomy is created. Most of the time, this is temporary and can be reversed in the future (this is discussed with every patient prior to the surgery).
The length of stay varies, but usually is 5 to 7 days. Most patient's colons can be removed using the laparoscope. Please see the Tab: laparoscopic procedures.
Gallbladder removal (Cholecystectomy): Typical patient’s with gallbladder disease have nausea, vomiting and abdominal pain after meals. However, even in patient’s with known gallstones, these symptoms are only present in 30% of those patient’s. Anyone that has upper abdominal pain and n/v may have gallbladder disease. An ultrasound and/or HIDA scan may be a diagnostic test that is ordered to see if you have gallbladder disease. Most of these pt’s have been screened and examined by their PCP prior to seeing us.
Preoperative evaluation includes blood work to evaluate the liver enzymes, an ultrasound and/or HIDA scan, and an EKG pending your age.
In the vast majority of patient’s, the gallbladder can be removed laparoscopicaly using small incisions, a television camera, and long thin instruments. In a few patient’s, a longer incision (open) has to be made. Most patient’s go home the day of the procedure and the recovery is usually 1 week.
With all of our operations, we recommend that everyone does quite a bit of walking to help prevent blood clots in their legs and we recommend no driving for at least 5 days, and when you are not on pain medications, and you know you can get on the brake as soon as you need too.
Gastrectomy (removing the stomach): Two of the most common reasons the stomach is removed are stomach cancer and severe, recurrent ulcer disease. The affected portion of the stomach is removed and the remaining stomach is sewn to the intestine. For cancer the lymph nodes surrounding the stomach are also removed. The length of stay is 5-7 days. Recovery usually is 4-6 weeks with no driving for 2 weeks and no lifting over 5 pounds for 6 weeks.
Hernia Repair: A hernia is a “defect” or hole in an abnormal location. There are several locations and types of hernias, all requiring different treatments. You may or may not see a “bulge”. The bulge associated with some types of hernias is not the hernia itself, but actually the “hernia contents”, which a lot of times is the intestines.
Inguinal/Femoral hernias: The contents of the hernia are returned to the abdomen from which they came and the hernia defect is sewn closed with sutures. A piece of mesh is usually used to reinforce the repair. This procedure can be done by either the “open” approach or the “laparosocpic” approach. You and your surgeon will dictate which approach is used. Pt’s usually go home the day of the procedure and recovery usually is 1 week. We encourage you not to do any “heavy” lifting for 6 weeks.
Incisional and Ventral hernias: These are hernias that develop through prior operation sites or on the abdominal wall including the “belly button”). They are repaired mostly because they cause pain. A preoperative evaluation including a history and physical examination confirm the presence of a hernia. The procedure returns the contents to the abdominal cavity and the hole is sewn with sutures. A piece of mesh is usually used to reinforce the repair. This procedure can be done by either the “open” or “laparoscopic” approach. You and your surgeon will dictate which approach is used. Pt’s usually go home the day of the procedure, but occasionally will stay overnight in the hospital. No lifting over 5 pounds is encouraged for 6-8 weeks after surgery.
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Laparoscopic nissen fundoplication (anti-reflux surgery) (hearburn): patients with persistent, sever reflux of acid into the swallowing tube (esophagus) which does not respond to aggressive medical treatment may require this procedure. This may include patients whose symptoms persist despite medication or patients whose symptoms improve but continue to have irritation of the swallowing tube (esophagus) despite medication.
Through 5 very small incisions the abdomen is inflated with carbon dioxide and using a television camera and long, thin instruments the stomach is wrapped around the lowest part of the esophagus to recreate a new “flapper” valve.
Most of the time, patients also have a Hiatal Hernia.. A hernia is a hole in the muscle. This allows the stomach and swallowing tube to slide back and forth into the chest cavity.
Most of the time, this hole is closed during this operation.
Most pt’s go home from the hospital the following day. Recovery is usually 2 weeks with no driving for 1 week and no lifting over 5 pounds for 4 weeks.
Splenectomy (removal of the spleen): There are two reasons we remove the spleen at SAMC. In some situations the spleen is diseased (ITP, Hodgkin’s lymphoma, etc.) or the spleen may be injured (trauma). The procedure is also done using the laparoscope. Please also see the Tab: laparoscopic procedures.
The entire spleen is removed and the abdomen is inspected for any additional collections of splenic tisse (accessory spleens) which, if present, are also removed. The length of stay in the hospital is about 5 days but varies for each patient.
Recovery includes 4-6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks. Patients must receive certain immunizations and follow strict antibiotic precautions after surgery.
Ulcer Repair: patients with an ulcer that fails to heal despite medical treatment may require elective ulcer repair. Patients with an ulcer that perforates (forms a hole in the bowel) or bleeds repeatedly or excessively require emergency surgery.
