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Abdominal
Procedures
HERNIA REPAIR
GENERAL INFORMATION- A hernia is
a "defect", in other words a hole, in an abnormal location. As below,
there are several locations and types of hernias, all requiring different
treatments. The bulge associated with some types of hernias is not the hernia
itself but actually the "hernia contents", in other words the tissue
that is pushing out through the hole.
INGUINAL/FEMORAL HERNIAS-
Indications:
Except in rare circumstances, all groin hernias need to be repaired. This is not
because of pain or a bulge, but because of the risk that the hernia contents
will become caught and stangulate. This is referred to as incarceration and
strangulation, respectively, and frequently requires an emergency operation with
the possible removal of dead tissue.
Pre-Operative
Evaluation: A history and
physical examination confirm the presence of a hernia.
Procedure:
The contents of the hernia are returned to the abdomen and the hernia defect (ie
the hole) is sewn closed, usually using a piece of synthetic mesh to reinforce
the repair.
Length of
Stay: Outpatient.
Recovery:
1–2 weeks except no lifting over 5-10 pounds for six weeks.
INCISIONAL AND VENTRAL
HERNIAS-
Indications: These
are hernias that develop through prior incision sites or on the abdominal wall
(including the "belly button"). They are repaired if they cause pain
or become excessively large.
Pre-Operative Evaluation: A
history and physical examination confirm the presence of a hernia.
Procedure: The
contents are returned to the abdomen and the hole is sewn closed. If the
adjacent tissue is weak or the hole is too large, synthetic mesh is sewn in
place to reinforce the repair.
Length of Stay: Outpatient
except in the case of large hernias which might require a 1-4 day
hospitalization.
Recovery: 1–2
weeks except no lifting over 5-10 pounds for six weeks.
GALLBLADDER
REMOVAL (Cholecystectomy)
Indications: Commonly
patients with gallbladder problems have nausea, vomiting, or various types of
pain due to their gallbladder not functioning properly. In the majority of
patients the problem is the presence of stones within the gallbladder (cholelithiasis)
although in some patients the problem is that the gallbladder doesn’t
contract, (or squeeze) normally. This is termed biliary dyskinesia, and is
another indication for gallbladder removal.
Pre-op Evaluation: Blood
work to evaluate the liver enzymes are checked in all patients. The gallbladder
is imaged using ultrasound or in some cases a CAT scan. If biliary dyskinesia is
suspected a HIDA scan is performed to evaluate the gallbladder function.
Procedure: In the vast majority of patients, the
gallbladder can be removed laparoscopically using small incisions, a television
camera, and long thin instruments. In some patients a longer, traditional
incision is required.
Length of Stay: Outpatient or sometimes
overnight stay after laparoscopic surgery, three to five days after open
surgery.
Recovery: Activity as tolerated after
laparoscopic surgery except no driving on prescription pain medication. After
open surgery no driving for two weeks and no lifting over five pounds for six
weeks.
COLON REMOVAL
(Colectomy)
Indications:
Colon cancer and repeated or severe infections of the small outpouchings of the
colon called diverticulae (diverticulitis) require the removal of the affected
portion of the colon. Additionally, there are inflammatory conditions that may
require removal of part or all of the colon.
Pre-Operative Evaluation
Except in emergencies, all patients undergo a barium enema or colonoscopy to
evaluate the colon. In some cases a CAT scan and/or blood tests are used to
evaluate other organs in the abdomen. Additionally, a bowel prep is taken before
surgery to clean out the colon.
Procedure: The
affected portion of the colon is removed and the intestine is then sewn back
together. In some situations, as discussed with the patient before surgery, the
intestine cannot be sewn back together and instead a temporary or permanent
colostomy is created.
Length of Stay:
Variable depending upon overall patient health however the average stay is about
five days.
Recovery: 4 to
6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks.
STOMACH
PROCEDURES
GASTRECTOMY
Indications:
Gastric (stomach) cancer and severe, recurrent ulcer disease are the two most
common indications for gastrectomy.
Pre-Operative Evaluation:
All patients undergo either endoscopy of the stomach called EGD or less commonly
an upper GI barium study. Additionally, in the case of cancer, a CAT scan and
blood tests are usually performed.
Procedure: The
affected portion of the stomach is removed and the remaining stomach is then
sewn to the intestine. For cancer the lymph nodes surrounding the stomach are
also removed.
Length of Stay:
Variable depending upon overall patient health however the average is about five
days.
Recovery: 4 to
6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks.
ULCER
REPAIR
Indications:
Patients with an ulcer that fails to heal
despite exhaustive medical treatment require scheduled ulcer repair. Patients
with an ulcer that perforates (forms a hole in the intestine) or bleeds
repeatedly or excessively require emergency surgery.
Pre-Operative Evaluation: In
emergency situations patients only need a few simple X-rays and occasionally an
upper endoscopy called an EGD. In elective situations all patients receive
either an upper endoscopy or upper GI barium study. In some cases blood tests
are used to look for the causes of the ulcers.
Procedure:
Depending upon the individual situation this ranges from simply patching the
hole with adjacent fatty tissue (Graham patch) to cutting the nerves which cause
ulcers (vagotomy) and rerouting the intestine (pyloroplasty) to removing the
part of the stomach which produces the acid (antrectomy) and rerouting the
intestine.
Length of Stay:
Variable depending upon overall patient health and whether the surgery was
elective or emergent. The average for elective surgery is about five days
whereas for emergency surgery this may be longer.
Recovery:
4 to 6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6
weeks.
LAPAROSCOPIC
NISSEN FUNDOPLICATION (Anti-Reflux Repair)
Indications: Patients
with persistent, severe reflux of acid from the stomach up into the esophagus (gastroesophageal
reflux or GERD) which does not respond to aggressive medical treatment. This may
include patients whose symptoms persist despite medication or just as
importantly patients whose symptoms improve but continue to have irritation of
the esophagus despite medication.
Pre-Operative Evaluation: All patients
receive upper endoscopy (EGD) as well as a measurement of how well the esophagus
moves (esophageal manometry). Additionally, some patients require a measurement
of how much acid enters the esophagus (24 hour pH probe).
Procedure: Through
five 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.
Length of Stay: Average
is two days.
Recovery: Usually two to three weeks with
regards to activity. Recovery varies with regards to how quickly certain types
of foods are eaten. Nearly all patients can permanently stop their anti-ulcer
medications (Maalox, Pepcid, Zantac, Prilosec, etc).
STAPLED GASTROPLASTY
(Anti-Obesity Procedures)
Please refer to the obesity
procedures section
SPLEEN
PROCEDURES
SPLENECTOMY (Removal)
Indications: There are two categories of
indications for splenectomy. In some situations the spleen is diseased (Hodgkin’s
lymphoma, splenic cysts or abscesses) or injured (trauma) whereas in other
situations the spleen is removing more blood cells than it should (certain
leukemias and lymphomas, certain blood clotting problems and some red blood cell
abnormalities).
Pre-Operative Evaluation: This
varies depending upon the indication. Most patients will require several blood
tests as well as a CAT scan. With leukemias and some lymphomas, most patients
will require a sampling of their bone marrow.
Procedure: The
entire spleen is removed and the abdomen is inspected for any additional
collections of splenic tissue (accessory spleens) which, if present, are also
removed.
Length of Stay: Variable
depending upon overall patient health however the average is about five days.
Recovery: 4 to
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.
SPLENORRHAPHY
(Repair)
Indications: Spleens
that have been injured and are bleeding require splenorrhaphy (repair of the
spleen) or if this is not successful a splenectomy. Most commonly these injuries
are from car or bike accidents, falls, kicks, etc.
Pre-Operative Evaluation: All
patients require blood tests to verify that they are bleeding internally despite
blood transfusions and medications. Frequently a CAT scan is used to locate the
spleen as a cause of internal bleeding.
Procedure: The cracks in the spleen, which cause
the bleeding, are repaired using sutures. Frequently this doesn’t completely
stop the bleeding and additional techniques must be used including
blood-clotting agents applied to the bleeding areas, mesh wrapped around the
spleen to hold it together or removal of small fragments of the spleen.
Length of Stay:
The average is about five days however this is variable depending upon overall
patient health including additional injuries sustained at the time of the
accident.
Recovery: 4 to
6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks
PANCREATIC
PROCEDURES
Indications: Most
commonly pancreatic surgery is for cancer; however, severe or recurrent
inflammation of the pancreas (pancreatitis), persistent pain coming from the
pancreas, and fluid collections arising from the pancreas (pseudocysts) can also
require surgery.
Pre-Operative Evaluation: All
patients require a CAT scan and blood tests. Some will also require a special
endoscopy (ERCP) to evaluate the ducts in and around the pancreas.
Procedure: This
varies with the indication. For cancer, the entire pancreas along with part of
the stomach, adjacent intestine, and bile duct are removed (Whipple procedure).
For pain from the pancreas, only part of the gland itself is removed. For
pseudocysts or recurrent pancreatitis, the gland is opened and adjacent
intestine is sewn in place.
Length of Stay: Variable
depending upon which of the above operations is performed however all require
stays of at least five days.
Recovery: 4 to
6 weeks with no driving for 2 weeks and no lifting over 10 pounds for 6 weeks.
PERITONEAL
DIALYSIS CATHETER PLACEMENT
Indications: Patients
with kidney failure who need dialysis and can perform the steps required for
using the abdomen to dialyze.
Pre-Operative Evaluation:
First a kidney specialist (nephrologist) determines that the patient needs
dialysis. The abdomen is evaluated by history and physical examination to be
sure there is no problem that excludes a patient from this type of dialysis.
Procedure: Under
general anesthetic, the catheter is passed through a tunnel created under the
skin and then into the lower portion of the abdominal cavity.
Length of Stay: Outpatient
Recovery: 2 to
3 days. The catheter can be used within 3 to 4 weeks.
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