Robert G. Cooper, Jr. MD FACS Minimally Invasive General Surgery  & Weight Loss Surgery  "Major Surgeries, Minor Incisions"

General Surgery

Appendicitis

Appendicitis or infection of the appendix can happen to anyone. Symptoms tend to appear quickly, often over a day or two. Symptoms can include: pain that starts in the center of the abdomen and moves to the lower right side. It can be associated with nausea, vomiting or decreased appetite, and frequently, fever. Medication can not cure appendicitis. Appendectomy (surgery to remove an infected appendix) can. This is a very common procedure and removing the appendix does not affect your long term health. It is best to remove the appendix before it bursts. If an infected or burst appendix is not removed, it can cause serious health problems including but not limited to pelvic abscess, septic peritonitis or even death. After a thorough evaluation and when the diagnosis of appendicitis is made, surgery is needed. The goal of surgery is to remove the appendix safely. In most cases, the surgery lasts from 1-2 hours. If the appendix has perforated, surgery may take longer. One of two techniques may be used to reach the appendix: open or laparoscopically. The surgeon will decide which technique is best on an individual basis. In most cases, the incisions are closed with staples or stiches. A temporary drain may be placed in the abdomen. Most patients recover quickly after appendectomy and may leave the hospital the same day of surgery. Perforated appendicitis will require longer hospital stay for intravenous antibiotics to help ward off infection or abscess. After discharge from the hospital, plan on a follow-up visit with your surgeon in 1-2 weeks.

Gallbladder Surgery

The gallbladder is an organ that concentrates and stores bile made by the liver. Bile is used to help absorb fat and certain types of vitamins. When you eat, there is a chemical (or hormone) in the blood that goes to the gallbladder. This chemical tells the gallbladder to contract and empty it's bile into the intestines. For some reason in some adults, the gallbladder doesn't function properly and the bile isn't concentrated appropriately. When this happens "sand" or even stones form. This material doesn't easily empty from the gallbladder when the chemical signal is sent and the gallbladder is supposed to contract. The sand or stones "clog" up the drainage tube of the gallbladder and thus symptoms occur. Usual symptoms can include upper mid-abdominal pain, upper right abdominal pain, pain going to the upper right back. Lower mid-line chest pain can also occur. Other symptoms can include abdominal bloating, or a gassy feeling, right shoulder pain, nausea, vomiting and fever in some cases. the symptoms are frequently brought on by foods high in fat content. Evaluation for gallbladder problems usually include a complete history and physical examination. In addition, a gallbladder ultrasound is an important imaging test that looks for stones or sand in the gallbladder or abnormalities in the wall of the gallbladder. Sometimes the sand in the gallbladder is too small to be seen but you can still have symptoms. A HIDA scan can also be ordered which evaluates the function of the gallbladder (how it empties). The gallbladder will not empty properly if there is a problem with the bile inside. BR> Sometimes the stones empty with the bile into a main bile duct which leads to the intestines. This causes similar symptoms but usually worse and turning yellow or jaundice can occur as well. When this type of problem occurs, a special type of endoscopy "light scope test" may need to be ordered. this is called an ERCP. During this special endoscopy, an x-ray of the bile duct is performed and any stones in the main bile duct can usually be retrieved and removed. Finally, if your gallbladder has caused symptoms, removing it would be recommended. This is usually done laparoscopically (surgery using tiny incisions and a special camera). This is considered an outpatient surgery. Most people go home the same day. After surgery, your pain should be minimal and a return to normal activity can occur as tolerated. There are no real weight lifting restrictions once the incisional pain subsides. After your gallbladder is removed, your liver and main bile duct will supply the bile to the intestines for help in the absorption of food.

Hernia Surgery

Hernias are defects in the abdominal wall muscles or occasionally the muscles of the flank or back. Some hernias occur from minor defects or weaknesses in the muscle that are left from birth and some occur after surgery. Heavy lifting, straining or coughing can put stress in these weak areas of defects and cause them to enlarge and bulge. Symptoms occur when the stretching of the tissue or when intestine or other structures get caught in them. Symptoms can include abdominal wall pain, burning or tingling. If intestine gets trapped, symptoms can include crampy abdominal pain, nausea and vomiting. You may also feel a mass in the weakness area. Once a hernia is present, it needs to be repaired. Depending on the location, the type of surgery recommended will change. In general, mesh will be used to strengthen the muscles and cover the defect. Hernias are repaired open or laparoscopic, depending on the location and prior surgical history. Almost all hernias are repaired on an outpatient basis or, at most, an overnight stay basis. Return to work and full activity depends on the type of repair and the location. For most repairs, once you are pain-free, you have no lifting restrictions.

Colon Surgery

There are many common conditions that may affect the colon. Common conditions affecting the colon that may require surgery include but are not limited to: diverticulosis, diverticulitis, colonic volvulus, ulcerative colitis, Crohn's Disease, colonic polyps or colon cancer. To diagnose your colon condition, your surgeon or doctor will take a careful medical history, perform a thorough physical evaluation and do one or more diagnostic tests. After the evaluation, a treatment plan will be made to control your condition. Diagnostic tests such as barium enema or colonoscopy may be used to pinpoint the problem. Imaging tests such as CT scans may also be done for further evaluation. If you suffer from a benign condition and if your symptoms do not improve with nonsurgical treatment, surgery may be required. This may be done through open surgery or laparoscopic surgery. In some severe cases of infection or bleeding, even obstruction, emergency surgery may be necessary. If you have been diagnosed with colon cancer, more tests may be performed prior to surgery to assur ethat the cancer has not spread. Tests may include a chest x-ray, CT scan and blood tests. After these tests have been performed, surgery is done to remove the cancerous portion of the colon. Treatment post-operatively may include radiation or chemotherapy.

GERD

Repeated bouts of heartburn and sour-tasting fluid in your throat are classic symptoms of a common health problem called gastroesophageal reflux disease, or GERD (also known as reflux disease). The heartburn caused by GERD may strike after you eat a large meal or when you bend over or lie down. Without treatment, GERD can lead to serious problems, even cancer. GERD can sometimes be controlled with simple lifestyle changes and medication. If your symptoms persist, surgery may offer more lasting relief. GERD is caused by acid that escapes from your stomach through a weakened valve or sphincter near the top of your stomach. The acid can travel as far upward. Eating certain foods and taking certain medications can add to the problem. Smoking, caffeine and alcohol all increase the level of acid in the stomach and make symptoms worse. Symptoms of GERD include: heartburn, bitter or sour taste in the back of the mouth, belching, upper abdominal pain, worsening symptoms when bending over, lying down, chronic cough or even asthma. Once the diagnosis is confirmed and the medical types of treatment have not been effective in controlling GERD, surgical laparoscopic fundoplication may be recommended. Before surgery, the patient's general health will be checked and routine blood work performed. Admission to the hospital will usually be on the same day as the surgery. The procedure is accomplished by recreating the lower esophageal sphincter (LES) by wrapping the very top of the stomach around the lower part of the esophagus. The surgery usually lasts from 2-3 hours. Laparoscopic surgery is performed through several small incisions instead of a single long incision, as in the traditional open procedure. As a result, there is less pain, and a quicker recovery. Most people go home 1-2 days after the surgery and return to work in 1-2 weeks. If, for some reason, it is unsafe to perform the laparoscopic surgery, an open procedure will be performed. This surgery requires a longer recover time, up to 3-4 days in the hospital and from 4-6 weeks avoiding strenuous activity.