Trauma and General Surgery

General information:

A hernia occurs when an organ, such as the intestines, protrudes through the abdominal wall, causing a bulge that can be felt through the skin. Though hernias can occur in other areas of the body as well, they are most common in the abdominal wall. Coughing, bending, or lifting heavy objects can increase pain associated with hernias. Hernias can be caused by existing weaknesses in the abdominal wall, increased pressure within the abdomen, straining during bowel movements or urination, pregnancy, strenuous activity, or chronic coughing or sneezing.

Symptoms:

• A bulge on either side of the pubic bone that becomes more obvious when you stand
• A burning, aching, or “dragging” sensation at the bulge
• Pain or discomfort in the groin area, especially when you cough, bend over, or lift heavy object
• Weakness or pressure in the groin area

If the symptoms above coincide with nausea or vomiting, fever, suddenly intensifying pain, darkening or reddening of the hernia bulge, or inability to move bowels or pass gas, call your doctor immediately. These symptoms can be signs of a strangulated hernia, which can be life-threatening.

Surgical Treatment:

Abdominal wall reconstruction surgery corrects abdominal weaknesses caused by recurring hernias, injuries, or non-healing wounds. Abdominal wall reconstruction requires moving abdominal tissues to redistribute the abdominal muscles. Though most hernias are not life-threatening, surgery helps prevent discomfort and potential complications.

Recovery Time:

Most patients will be able to resume normal work after one week. We recommend waiting at least two weeks to resume normal exercise. Consult with your doctor before resuming any activities.

General Information:

The appendix is a long, narrow tube attached to the colon. It is usually located in the lower right quadrant of the abdominal cavity. The appendix can become obstructed, causing swelling and inflammation. If the appendix becomes infected, it must be removed because it can perforate or rupture if left untreated. You can live a normal, healthy life without an appendix.

Symptoms:

• Pain around the navel that moves to the lower right side of the abdominal wall
• Increased pain and pressure on the right side when walking or standing up straight
• Nausea
• Vomiting
• Lack of appetite
• Fever
• Chills
• Fatigue
• Diarrhea or constipation

Surgical Treatment:

Traditionally, the appendix is removed through an incision in the right lower abdominal wall (open surgery). Open surgery may be necessary in certain cases, like a ruptured appendix. In other cases, laparoscopic surgery may be possible (appendix removed via several small incisions using special surgical tools and a camera).

Recovery Time:

Most patients can resume all normal activities within one to two weeks. Scarring is usually minimal.

General Information:

Brachytherapy, also called internal radiation therapy, is one type of radiation therapy used to treat cancer. During the procedure, radioactive material is surgically placed inside your body, allowing for the delivery of a higher total dose of radiation to a smaller area and in a shorter time than is possible with external beam radiation treatment. Brachytherapy often causes fewer side effects and has a shorter treatment time than traditional radiation.

Surgery Details:

In temporary brachytherapy, a delivery device, such as a catheter, needle, or applicator, is placed into the tumor using imaging such as fluoroscopy, ultrasound, MRI, or CT to help position the radiation sources. When the treatment is completed, the delivery device is removed from the patient. In some cases, such as for treatment for prostate cancer, the radioactive material will be placed permanently in the body.

Recovery Time:

The placement of the catheter itself is minimally invasive and requires little recovery time. You may have certain restrictions with who can visit you while you have high levels of radiation in your body. Your treatment team will discuss the side effects of radiation and recovery time associated with brachytherapy.

General Information:

The colon (also known as the large bowel or large intestine) is a tubular muscle that absorbs water and prepares waste to be expressed from the body. The last four inches of the colon are called the rectum. Common problems associated with the colon include polyps, cancer, infection, and inflammation.

Symptoms:

• Difficulty passing gas or stools
• Fever and chills
• Nausea
• Vomiting
• Severe abdominal pain
• Rectal bleeding
• Bloody stools

Surgical Treatment

A colectomy is the removal of part of the colon (partial colectomy) or the entire colon (total colectomy). Colectomy can be used to treat a variety of diseases, including colon or rectal cancer, large polyps, diverticular disease, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), or bleeding that cannot be stopped. During a laparoscopic colectomy, the surgeon makes several small incisions and removes part of the colon and lymph nodes. The portion of the colon removed depends on the nature of the disease.

Recovery Time:

Recovery time is dependent on the level of surgical intervention. Your doctor will discuss specific details with you.

General Information:

The gallbladder stores the bile that the liver produces and then releases it into the main bile duct, where it then drains into the small intestine to assist with digesting fats. If your body is not processing cholesterol correctly, the gallbladder can produce gallstones. Occasionally, the gallbladder will produce symptoms associated with gallstones even if stones are not present (a condition called biliary dyskinesia).

Symptoms:

• Indigestion
• Nausea
• Vomiting
• Diarrhea
• Back pain
• Shoulder pain
• Pain after eating (specifically in the upper mid- or right-side of the belly)

Surgical Treatment:

Surgery to remove the gallbladder (cholecystectomy) is used to treat gallstones or biliary dyskinesia. In a cholecystectomy, the gallbladder is removed laparoscopically via a small incision by the naval.

Recovery Time:

You may experience right-shoulder pain for the first day or two after surgery. Patients can resume normal activities within one or two weeks. You may experience some food intolerances, though these are usually temporary.

General Information:

Gastrointestinal surgery can be used to treat a range of conditions, from cancer of the stomach to digestive ailments.

Conditions/surgeries:

Stomach cancer

Appendicitis

Colectomy

Esophageal cancer

Pancreatic cancer

Gallbladder

General Information:

Gastroesophageal Reflux Disease (GERD) is when acid backflows from the stomach and into the esophagus. This backflow is caused by an abnormally relaxed or weakened valve (the esophageal sphincter) between the stomach and esophagus. Acid in the esophagus can cause frequent heartburn and can damage the esophageal lining. GERD is a clinical condition associated with reflux so severe that the patient experiences decreased quality of life or esophageal damage. Some GERD can be treated by lifestyle/diet changes and medication. Diet changes may include avoiding smoking, caffeine, alcohol, chocolate, peppermint, citrus, sodas, and fatty foods. Lifestyle changes may include smaller meals, eating more slowly, no eating close to bedtime, raising the head of your bed, and losing excess weight. You can also try over-the-counter antacids. If these changes do not help, surgical treatment may be recommended.

Symptoms:

• Frequent heartburn
• Acid taste in back of throat or mouth (bitter- or sour-tasting fluid)
• Belching
• Pain in upper abdomen
• Worsening symptoms when bending or lying down
• Chest pain
• Difficulty swallowing
• Cough, hoarseness, or sore throat

Surgical Treatment:

Laparoscopic fundoplication reinforces the esophageal sphincter, preventing the excessive backflow of stomach acid into the esophagus. In this procedure, the top of the stomach is wrapped around the lower esophagus.

Recovery Time:

Laparoscopic fundoplication usually requires a one-night stay in the hospital. You should be able to return to normal activities within one to two weeks. You should continue to take your anti-reflux medication until your follow-up appointment.

General Information:

Sentinel node biopsy is used to determine whether cancer has spread beyond a primary tumor and into the lymphatic system. A sentinel lymph node is the first node into which a cancer drains. Sentinel node biopsy is most commonly used in cases of breast cancer or melanoma.

Surgery Details:

Tracer material (either radioactive material or blue dye) is injected into the body to help the surgeon locate the sentinel nodes during surgery. Once the nodes are identified, they are removed and biopsied. If no cancer is found, it is generally unnecessary to remove additional lymph nodes. If cancer is found in the sentinel nodes, additional lymph nodes will need to be removed in order to determine the extent to which the cancer has spread.

Recovery Time:

Lymph node removal is usually done under general anesthesia as an outpatient procedure. Your activity level and hospital stay will be determined in part by your overall cancer treatment plan.

General Information:

The small bowel, also known as the small intestine, is a long tube that carries food from the stomach to the large intestine (also known as the colon). Conditions affecting the small bowel include Crohn’s Disease, obstructions, and cancer. There are several types of cancer found in the small bowel. These include adenocarcinoma, gastrointestinal stromal tumor (GIST), carcinoid tumors, and lymphoma.

Symptoms:

• Abdominal pain
• Uncontrolled weight loss
• Weakness and fatigue
• Low red blood cell count
• Obstructed bowel
• Bloody stool

Surgical Treatment:

Small bowel resection (removal of a part of the small bowel) can often be done laparoscopically.

Surgical treatment of small bowel cancers depends on the type, location, and size of tumor; whether the cancer has spread; and other health conditions. Surgical treatment may be done in combination with chemotherapy and radiation therapy.

Recovery Time:

For laparoscopic small bowel resection, you should expect to be in the hospital for several days. You can resume driving and some normal activities after two weeks, but you should avoid strenuous activities for several weeks. Recovery time for small bowel cancer surgery is dependent on the surgical intervention used.

General Information:

The stomach is a muscular organ located under the ribs. It connects the esophagus and the small intestine. Stomach acids begin the digestive process and prepare fats, starches, and proteins for entry into the small intestine. Common conditions affecting the stomach include ulcers and tumors (both benign and malignant). An ulcer is a sore resulting from the erosion of the mucous membrane. Stomach cancers are most often found in the inner layers of the stomach lining.

Symptoms:

Ulcer:

• Burning pain
• Feeling of fullness or bloating
• Belching
• Fatty food intolerance
• Nausea
• Heartburn

Stomach Cancer:

• Abdominal discomfort
• Black/bloody stools
• Vomiting after meals
• Vomiting of blood
• Weakness
• Fatigue
• Weight loss

Surgical Treatment:

Ulcers can often be treated with medicine and dietary changes. When necessary, endoscopy (a long tube inserted through the mouth and into the stomach) can be used to stop bleeding. In severe cases, surgery may be needed to remove a damaged part of the stomach wall.

Some stomach cancers can also be treated with an endoscopy, in which the surgeon navigates the tube into the stomach and removes the tumor. In more advanced cases, a partial or full gastrectomy may be required. A partial gastrectomy removes part of the stomach, after which the remaining stomach is connected to the small intestine. In a full gastrectomy, the stomach is removed altogether, and the esophagus is connected directly to the small intestine.

Recovery Time:

After an endoscopy, you may experience bloating, cramping, or a sore throat. Patients who undergo a partial or full gastrectomy can live a normal life, though modifications may have to be made to diet and meal size. Recovery time for endoscopy and gastrectomy are dependent on the extent of the surgical intervention. Your surgeon will discuss specific details with you.