Alain R. Elian, MD

Products And Services

• Bariatric Surgery

  Bariatric surgery is a surgical treatment for patients who are seriously obese or obese with another dangerous medical condition. There are several types of bariatric surgery, each of which makes surgical changes to the stomach and digestive tract which limit how much food can be ingested and how much nutrition can be absorbed. All types of bariatric surgery are performed to promote weight loss. Reasons for Bariatric Surgery Since morbid obesity can lead to early mortality and interferes with quality of life, patients who are unable to lose weight through diet and exercise may decide, with medical consultation, that bariatric surgery is a good solution. Morbid obesity is usually defined as having a body mass index, or BMI, of 40 or more. In male patients, this translates into being 100 pounds or more over ideal body weight. In female patients, it means the patient is carrying an excess of 80 pounds or more. Morbid obesity not only interferes with normal daily activities, but can also lead to many serious medical conditions, including type 2 diabetes, high blood pressure, heart disease, severe sleep apnea and cancer. A patient may become morbidly obese for a variety of reasons, including genetic, environmental and psychological factors. Candidates for Bariatric Surgery Bariatric surgery is a last resort for weight loss and is never undertaken lightly. Patients are carefully screened to determine if they are good candidates for the procedure. Insurance will cover the procedure only if it is deemed medically necessary. Patient guidelines for the surgery must be met. These may include: History of inability to lose weight with diet, exercise or medication BMI of 40 or higher, indicating morbid obesity BMI of 35 to 39.9 combined with a serious weight-related medical problem Slightly lower BMI if combined with an extremely serious weight-related medical condition Candidates for bariatric surgery must be motivated to make permanent lifestyle changes since the surgery alone does not guarantee permanent weight loss. In the screening for patients for whom bariatric surgery is appropriate, physicians investigate the following: Medical conditions Nutrition and weight history Psychological status Personal motivation Age It is possible for patients who do not follow directives about diet and exercise to regain weight after the procedure. Types of Bariatric Surgery There are several different types of bariatric surgery, but there are two basic ways in which such procedures affect weight loss. Bariatric surgery can help to limit the amount of food ingested or it can restrict the amount of food digested. Some bariatric procedures work in both ways. Most focus on reducing the size of the stomach. When the stomach is smaller, the patient feels full sooner and presumably ingests less food. Some bariatric surgery procedures prevent the small intestine from absorbing all of the calories taken in which also results in weight loss. The latter surgeries are highly successful in weight loss, but carry risks of malnutrition and vitamin deficiencies. Bariatric surgery may be performed laparoscopically or as open surgery, depending on the patient's overall health. Generally speaking, laparoscopic procedures are more desirable since they result in smaller incisions, less pain and scarring, shorter recovery time and fewer risks. Types of bariatric surgery include: Gastric bypass or gastric diversion Biliopancreatic diversion, BPD Biliopancreatic diversion with duodenal switch Gastric banding Sleeve gastrectomy Roux-en-Y stomach bypass Laparoscopic procedures are often more desirable since they result in smaller incisions, less pain and scarring, shorter recovery time and fewer risks. Risks of Bariatric Surgery Immediate surgical risks of bariatric surgery may include excessive bleeding, blood clots, damage to adjacent organs and an adverse reaction to anesthesia. Longer term risks and complications of weight-loss surgery vary according to the type of surgery performed and may include: Bowel obstruction Gastric dumping syndrome, including vomiting and diarrhea Gallstones Incisional hernia Hypoglycemia, low blood sugar Malnutrition Ulcers While there are risks associated with bariatric surgery, there is often greater risk to the patient in remaining morbidly obese. In spite of the risks of bariatric procedures, the mortality rate is very low. Recovery from Bariatric Surgery Following surgery, most patients remain in the hospital for several days. Many patients are able to return to work after 2 weeks. Patients are usually able to manage at home without assistance if they follow the instructions and restrictions given by their doctor.

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• Bariatric Revision Surgery

  Bariatric surgery is usually a successful procedure that helps a patient achieve significant weight loss. In addition, there are normally minimal to no complications associated with the surgery. However, some patients may experience problems with the surgery or they may not succeed in losing the expected amount of excess weight. In these situations, a follow-up bariatric revision surgery is sometimes necessary. The revision may be recommended for individuals who have been experiencing complications, had poor weight loss results from the initial procedure or recently gained a substantial amount of weight, increasing the risk of developing obesity-related diseases. There are several different situations when a bariatric revision surgery may be required. It commonly involves the failure of a LAP-BAND®, gastric sleeve or gastric bypass, however, most of these problems can be corrected for most patients with a revision procedure. While most bariatric procedures are considered safe, complications may occur, including ulcers, stomach obstruction, chronic vomiting, hernia, band leakage, and dilation of the esophagus. These complications can often be improved through bariatric revision surgery. Revision of Failed LAP-BAND The LAP-BAND Adjustable Gastric Banding System is designed to reduce the size of the stomach so it will hold less food, facilitating weight loss in morbidly obese patients. If complications occur, revision surgery may be necessary. During a revision procedure, the LAP-BAND is removed from the stomach. If a gastric sleeve is selected as the optimal technique to meet the patient's needs, the surgeon will then suture the stomach into the shape of a tube, or sleeve. Sleeve gastrectomy enables rapid weight loss since the patient's intake of food will be lessened and hunger will be decreased. Since no equipment is implanted, fewer complications tend to occur and the patient does not require as many post-surgical visits to the doctor for adjustments to be made. In other cases, a gastric bypass may be more appropriate for a patient requiring LAP-BAND removal and revisional bariatric surgery. In the procedure, the surgeon uses suture-like staples to create a pouch in the top of the stomach that will take the place of the patient's original stomach. The pouch is then connected directly to a section of the small intestine called the Roux limb, bypassing the part of the small intestine in which most calories are absorbed. Revision of Failed Gastric Sleeve A gastric sleeve, or sleeve gastrectomy, is a restrictive form of bariatric surgery that effectively shrinks the stomach to approximately 15 percent of its original size. It is often very successful, however, in some cases it may fail to produce or maintain the significant weight loss that patients are seeking. Depending on the reasons for the failure of the gastric sleeve, the surgeon will choose a suitable form of revision. If the gastric sleeve has stretched out and is losing its effectiveness, a new sleeve may be created. This entails the use of the same procedure as the initial bariatric surgery, which involves revising the sleeve so it is the same size or even slightly smaller than it was after the original surgery. However, if there were complications that resulted in the failure of the gastric sleeve, a gastric bypass may be recommended as an alternative. The gastric sleeve may be left in place, but the bypass will offer the added advantage of rerouting the digestive process away from a portion of the small intestine. This results in a significant restriction of caloric intake. Revision of Failed Gastric Bypass Gastric bypass surgery helps patients lose weight by both restricting food intake and altering the digestive process. However, over time, the pouch or bypass opening may be subject to stretching. As a result, the patient's hunger level and consumption of food may increase. To address this problem, a revision procedure may be recommended. The surgery may primarily focus on reducing the size of the pouch back to its original post-surgery capacity using sutures. In other cases, the segment of the small intestine that is bypassed may be lengthened to ensure a greater amount of calorie malabsorption can take place. Results of Bariatric Revision Surgery Bariatric revision surgery can be more complex and involve more risks than general bariatric surgery. Weight loss following a revision procedure may not be as pronounced as the initial bariatric procedure, but weight loss may become substantial over time. As with any bariatric procedure, the most significant weight loss results are achieved by individuals who follow the diet and exercise recommendations of their bariatric surgeon and nutritionist.

  Link: Bariatric Revision Surgery

• Gastrectomy

  A gastrectomy is the surgical removal of part or all of the stomach. When part or all of the stomach is removed, a gastric resection is necessary to reconnect the gastrointestinal tract so that digestion may continue to occur as normally as possible. Candidates for a Gastrectomy Candidates for a gastrectomy and gastric resection may include patients with the following medical conditions: Cancer of the stomach or esophagus Severe gastric ulcers Gastric bleeding Inflammation of the stomach Life-threatening obesity necessitating gastric bypass Non-malignant polyps or tumors Types of Gastrectomy Depending on the reasons for a gastrectomy, more or less tissue may be extracted. In the case of stomach cancer, surrounding lymph nodes as well as the tumor may be removed. Types of gastrectomy include: Total gastrectomy Partial gastrectomy Sleeve gastrectomy Esophagogastrectomy The Gastrectomy Procedure Gastrectomy, particularly for the treatment of stomach cancer, is most commonly performed as an open surgery, though in some cases the surgeon may opt to perform the surgery laparoscopically. While the laparoscopic procedure involves a smaller incision, less scarring, and a shorter recovery time, open gastrectomy provides the surgeon with a better visualization of the targeted area. Gastrectomy is performed under general anesthesia. There is always a reconnection, or gastric resection, included in the gastrectomy procedure so that digestion may proceed as normally as possible. In the case of a partial gastrectomy, the remaining portion of the stomach is reconnected to the small intestine. In a total gastrectomy, the intestine is reattached to the esophagus. Risks of a Gastrectomy There are risks associated with any type of surgery. Though unlikely, a gastrectomy and gastric resection may have some of the following complications: Excessive bleeding Blood clots Adverse reactions to anesthesia or medications Post-surgical infection Damage to adjacent organs Breathing problems Leakage from the connection to the intestine Recovery from a Gastrectomy Sometimes a nasogastric tube is temporarily inserted through the nose and threaded into the stomach region after a gastrectomy to provide for drainage of intestinal fluid and gas and to minimize nausea and vomiting. The necessity of using the nasogastric tube has, however, become controversial in recent years. In the period immediately after surgery, the patient is fed intravenously. After about a week, the patient can usually resume a light diet, eating smaller meals than usual at more frequent intervals. Gradually, over the course of a few months, the patient will be able to resume eating a normal diet and will be comfortable ingesting a normal quantity of food at a sitting. The patient will, however, usually have to make some dietary changes after undergoing a gastrectomy, such as less fiber and the inclusion of certain vitamin and mineral supplements.

  Link: Gastrectomy

• Biliopancreatic Diversion

  Biliopancreatic diversion is a weight loss procedure that is performed to make the stomach smaller and cause a reduced absorption of calories. This procedure helps to create a metabolic effect that allows most patients to lose 75 to 80 percent of their excess weight. The Biliopancreatic Diversion Procedure Biliopancreatic diversion can be performed either as a laparoscopic or traditional open procedure depending on the overall health of the patient. It can be performed with or without a duodenal switch, which involves attaching the remaining portion of the stomach to the duodenum, or upper part of the small intestine. This optional part of the procedure helps to bypass even more of the intestine, allowing for the absorption of even fewer calories. Recovery form Biliopancreatic Diversion Biliopancreatic diversion require a short hospital stay and a recovery period of several weeks. Since the results of bariatric surgery are not immediate, it is important for patients to see their doctors on a regular basis after surgery to help monitor their weight loss and general health. Since biliopancreatic diversion involves both malabsorptive and restrictive techniques, it is important for the patient to take vitamin and mineral supplements after the surgery to prevent malnutrition and possible complications, such as anemia. Risks of Biliopancreatic Diversion As with any surgical procedure, there are certain risks involved with biliopancreatic diversion. Risks may include infection or development of a hernia at the incision site, leakage from the stomach, a blood clot in the lung or a hemorrhage.

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• Sleeve Gastrectomy

  A sleeve gastrectomy, sometimes known as a gastric reduction or a vertical gastroplasty, is a restrictive form of bariatric surgery that effectively shrinks the stomach to approximately 15 percent of its original size. During the procedure, the surgeon sutures the stomach into the shape of a tube, or sleeve. Sleeve gastrectomy is commonly performed on severely obese patients who are not healthy enough to undergo a successful gastric bypass, biliopancreatic diversion or similar weight loss surgery. Sleeve gastrectomy enables rapid weight loss with fewer complications than the more conventional weight loss surgeries, but its effectiveness is not as predictable since it does not involve a malabsorptive component. The patient's intake of food will be lessened and hunger will be decreased, but any calories are ingested will be absorbed during digestion. It may be performed as the first part of a two-part bariatric procedure. In certain cases, after some major weight loss has taken place, the patient may undergo a duodenal switch bypass procedure to promote further weight loss. Sleeve gastrectomy is one of the newer bariatric procedures. Since it has less of a track record than some other bariatric operations, it may not be covered by insurance. Candidates for Sleeve Gastrectomy Candidates for a sleeve gastrectomy must be prescreened to make sure the procedure is appropriate for them. Patients are typically good candidates for this procedure if they: Have a history of morbid obesity for several years Have demonstrated an inability to lose weight with diet, exercise or medication Have no medical or psychological conditions that preclude bariatric surgery Are between 18 and 65 years of age In addition, candidates must be highly motivated to make the necessary lifestyle changes after the surgery, for their weight loss program to be successful. Benefits of a Sleeve Gastrectomy Like many bariatric procedures, a sleeve gastrectomy is performed laparoscopically, so the surgery is minimally invasive, resulting in smaller scars, less blood loss, less pain, and a shorter recovery period. There are a number of benefits particular to the sleeve gastrectomy as compared to other, more complex, bariatric surgeries. These include: No Malabsorptive Complications No Gastric Dumping Syndrome Less Hunger No Foreign Bands or Tubes Remain in the Body Many weight-related medical problems are resolved after gastric sleeve gastrectomy. These may include hypertension, type 2 diabetes. high cholesterol, severe sleep apnea, heart disease and asthma. If necessary for additional weight loss, a sleeve gastrectomy can also be modified at a later date. In some cases, where weight loss resulting from the sleeve gastronomy is not sufficient, a revision surgery, such as a gastric bypass or the placement of a gastric band, may be performed. The Sleeve Gastrectomy Procedure The actual sleeve gastrectomy procedure is quite simple. The surgeon uses miniature tools, entering the abdomen through a small incision and stapling the stomach into the shape of a tube. This greatly reduces the stomach's capacity. Once the created "sleeve" is examined to ensure that there is no leakage or bleeding, excess stomach tissue is removed. The removal of this stomach tissue also removes part of the stomach, the fundus, where ghrelin, the hunger hormone, is produced. and secreted, decreasing the patient's desire to eat. Because sleeve gastrectomy does not alter the digestive process itself as do bariatric bypasses, no malabsorption occurs and supplemental nutrition is usually unnecessary. Risks and Complications Associated With a Sleeve Gastrectomy Weight-loss surgery may increase the risk for gallstones. The doctor may recommend a cholecystectomy, a surgery to remove the gallbladder, at the same time the sleeve gastrectomy is performed. Other risks of this procedure may include: Inflammation of the stomach Heartburn, or stomach ulcers Gastric leakage Scarring in the abdomen Vomiting may sometimes occur in individuals who have had a sleeve gastrectomy, when they eat more than the stomach pouch can hold. Recovery from a Sleeve Gastrectomy Recovery from a sleeve gastrectomy is fairly routine. Because this procedure is less invasive than some other types of bariatric surgery, recovery tends to occur more quickly. Generally, patients remain in the hospital for a day or two, during which they ingest a liquid diet. Once they go home, they can begin to gradually reintroduce soft and then more solid foods. Doctors instructions should be followed carefully. Although a sleeve gastrectomy can be an effective tool in the struggle for weight loss, there will still be serious work for the patient to accomplish. Without serious, ongoing changes to the patient's diet and exercise regimen, the positive effects of the surgery will not be long-lasting.

  Link: Sleeve Gastrectomy

• Roux-en-Y Gastric Bypass Surgery

  Roux-en-Y gastric bypass surgery is performed to help severely obese patients lose significant amounts of weight. The surgeon uses suture-like staples to separate a portion of the top of the stomach and create a pouch which is then connected directly to a section of the small intestine called the Roux limb. The name of this procedure derives from the surgical connection to the Roux limb and from the Y-shaped junction between stomach and small intestine. Candidates for Roux-en-Y While Roux-en-Y bypass surgery is an effective obesity solution for many patients, it is not right for everyone. There are several qualifications that a patient must meet to be considered a good candidate for this surgery. Many of these qualifications are medically required for patients seeking insurance coverage for their procedure. Most candidates for this procedure must be considered morbidly obese with a body mass index, or BMI, of 40 or higher. There may be exceptions made for individuals with a BMI of 35 or higher and a serious obesity-related medical condition. In order for a surgeon to consider performing Roux-en-Y gastric bypass, the patient should: Be between the ages of 18 and 65 Have been obese for at least 5 years Have tried other methods of weight loss with little to no success In addition, the patient must be committed to making lifestyle changes relative to diet and exercise. Benefits of Roux-en-Y Along with the significant weight loss results this procedure often provides, Roux-en-Y bypass surgery may increase the patient's longevity and quality of life, making it easier to perform everyday functions. Roux-en-Y bypass also helps to improve many obesity-related health conditions, such as hypertension, heart disease, gastroesophageal reflux (GERD), or type 2 diabetes. The Roux-en-Y Bypass Surgery Procedure During Roux-en-Y bypass, the surgeon decreases the size of the stomach by creating a small pouch, then attaches the pouch to the small intestine below the duodenum. Creation of the smaller stomach pouch restricts the amount of food that can be consumed at one sitting. In addition, the bypass technique limits the body's ability to absorb much of the food's caloric content. This combination of malabsorptive and restrictive techniques makes the Roux-en-Y procedure one of the most successful gastric bypass surgeries. Risks of Roux-en-Y Although Roux-en-Y bypass offers an unmatchable weight-loss solution for many obese patients, there are certain risks associated with this type of surgery. These risks may include: Excessive bleeding Blood clots Adverse reactions to anesthesia or medications Post-surgical infection Damage to adjacent organs Breathing problems Hernia at the incision site In addition, risks particular to Roux-en-Y bypass may include: Gastric leaking Pouch stretching Gastric dumping syndrome Nutritional deficiency Dehydration In almost all cases, these risks are outweighed by the medical advantages of weight loss. Recovery from Roux-en-Y Recovery from Roux-en-Y bypass is usually relatively smooth. While some discomfort is to be expected during the immediate aftermath of the procedure, patients should begin to experience beneficial results in a short time. After spending a few weeks on a liquid diet, patients can begin gradually reintroducing soft and then ordinary foods. They are instructed to eat small meals at regular intervals and to avoid heavy lifting for several months. Patients who undergo Roux-en-Y bypass must be willing to make lifestyle changes to achieve and maintain weight loss and to prevent complications from the surgery. With determination, good nutrition and regular exercise, the results can be dramatic. Most patients lose about one to two pounds per week and reach a stable weight 18 to 24 months after surgery. After gastric bypass surgery, patients must follow a program including: Regular exercise Careful nutrition Vitamin and mineral supplementation After any bariatric procedure, counseling or psychotherapy is usually recommended to assist patients in adjusting to lifestyle changes and maintaining weight loss.

  Link: Roux-en-Y Gastric Bypass Surgery

• Abdominal Wall Reconstruction

  Abdominal wall reconstruction is a surgical repair used to treat an abdominal hernia. An abdominal hernia occurs when an abdominal organ protrudes through a weakened area in the abdominal wall and is diagnosed through physical examination. Abdominal hernias are usually a relatively simple matter to correct. If left untreated, however, the protruding tissue may become obstructed and lose blood supply. This can result in a hernial incarceration and gangrene which may be life-threatening. Abdominal Wall Reconstruction Procedure The purpose of an abdominal wall reconstruction surgery is to return the protruding tissue to its original location and to strengthen the weakened area of the abdominal wall with either stitching or synthetic mesh. The goal of the procedure is to repair the damaged area so that the intestines or other organs cannot push through to create another hernia. Abdominal wall reconstruction can be performed as a traditional open surgery or laparoscopically. The laparoscopic technique offers patients the benefits of smaller incisions, shorter recovery time, less scarring, and less bleeding. Recovery from Abdominal Wall Reconstruction Recovery from an abdominal wall reconstruction may vary depending on the size of the hernia repair. It is important for patients to seek treatment as soon as possible when the hernia is first discovered. Laparoscopic hernia repair usually requires only an overnight stay in the hospital. After surgery, a patient should expect tenderness, swelling and possible bleeding at the site of the abdominal hernia repair. Risks of Abdominal Wall Reconstruction Procedure While abdominal wall reconstruction is considered a safe procedure, there are risks associated with any type of surgery. Possible complications may arise and are signaled by the following: Fever Excessive bleeding Severe pain If any of these symptoms appear after the procedure, the patient should seek immediate medical attention.

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• Esophagectomy And Esophageal Resection

  Esophagectomy and esophageal resection are surgical procedures that involve the removal of a portion, or all, of the esophagus, surrounding lymph nodes and sometimes a portion of the stomach. Most frequently, an esophagectomy and an esophageal resection are performed to treat early-stage cancer of the esophagus before the cancer has metastasized to the stomach or other organs. These procedures may also be a treatment for Barrett's esophagus or esophageal dysplasia, precancerous conditions of the cells lining the esophagus. Less often, an esophagectomy and esophageal resection are performed when there has been irreversible damage to the esophagus as a result of traumatic injury, the swallowing of a caustic substance, chronic inflammation or motility issues which interfere with the passage of food during the digestive process. Indications of esophageal disorders which may necessitate an esophagectomy and esophageal resection may include the following: Difficult or painful swallowing, known as dysphagia Unexplained weight loss Hiccups Pressure or burning in the chest region Hoarseness Lung disorder Types of Esophagectomy Procedures Esophagectomy and esophageal resection may be done as open abdominal surgery or laparoscopically. When possible, a laparoscopy is the preferred surgery since it is less invasive and involves smaller incisions, resulting in less pain, less scarring and a shorter recovery period. Laparoscopic surgery may be done if the procedure is performed to remove cancerous tissue and the cancer has not metastasized. If open surgery is required, it may take one of three forms: Transhiatal Esophagectomy In a transhiatal esophagectomy procedure, the surgeon makes two large incisions, one in the patient's neck and one in the upper belly. After removing the diseased tissue, the surgeon will rejoin the rebuilt esophagus and the stomach. Transthoracic Esophagectomy In a transthoracic procedure, the surgeon will make one incision in the patient's chest and one in the upper belly. The esophagus will be removed and the stomach will be used to form a new tube to replace it. En Bloc Esophagectomy The en bloc procedure is the most invasive type of esophagectomy. In this procedure, the surgeon makes cuts in the neck, chest and belly. All of the esophagus and part of the stomach are removed. The remaining piece of the stomach is formed into a tube and attached to the remnant of the esophagus. In all three of these procedures, the patient will have a feeding tube in place during early recovery to allow the digestive tract to heal. In all three, the surgeon will remove nearby lymph nodes for biopsy to ascertain whether the existing cancer has spread. Risks of Esophagectomy and Esophageal Resection As with any surgical procedure, there are risks associated with this surgery. The usual risks of surgery are present, and may include: Excessive bleeding Blood clots Adverse reactions to anesthesia or medications Post-surgical infection Damage to adjacent organs Breathing problems Hernia at the incision site Risks particular to esophagectomy and esophageal resection include the following: Acid reflux Leakage of digestive contents at the site of reconnection Narrowing of the connection between stomach and esophagus Risks after surgery will be greater if the patient is: Not yet an adult Mobility impaired Age 60 or older A heavy smoker Obese Underweight On corticosteroids Recovery from Esophagectomy and Esophageal Resection Procedure Depending on the extent of the surgery, recovery from an esophagectomy and esophageal resection will require one to two weeks of hospitalization, two to three days of which will be spent in intensive care. For several days, the patient will be fed through a feeding tube until normal eating is gradually resumed. The patient will have a chest drain to remove excess fluid from around the lungs and will be required to wear special stockings to prevent blood clots. Pain medications and medication to prevent blood clots will be administered either orally of intravenously. The patient will be taught breathing exercises to prevent a lung infection from developing. During recovery, if the procedures have been performed as a treatment for cancer, the patient will begin or resume cancer treatments including chemotherapy or radiation therapy.

  Link: Esophagectomy And Esophageal Resection

• Thyroid Surgery

  The thyroid gland, located in the neck just below the larynx, regulates the body's energy levels, releasing hormones to regulate metabolism. Thyroid hormones influence virtually every system in the body, regulating the rate at which organs function, as well as the body's consumption of oxygen and production of heat. When hyperthyroidism, the production of too much thyroid hormone, occurs, and cannot be adequately controlled with medication or other treatment, thyroid surgery is necessary. Reasons for Thyroid Surgery Thyroid surgery is used to treat a variety of thyroid conditions such as thyroid cancer, thyroid nodules, or Graves' disease, an immune disorder that results in hyperactivity of the gland. When the thyroid gland produces too much thyroid hormone for any reason, the condition is called hyperthyroidism. Hyperthyroidism results in the speeding up of the body's metabolism. This increased metabolic rate can have serious medical consequences, resulting in any or all of the following symptoms: Goiter, enlargement of the thyroid gland Rapid heartbeat Unexplained weight loss Diarrhea or frequent bowel movements Irritability, anxiety Intolerance to heat Visual problems Menstrual irregularities Infertility Surgery is rarely necessary to treat hyperthyroidism unless there is either a suspicion of cancer, a benign nodule that has grown large enough to interfere with swallowing or breathing, a cyst on the gland that refills after drainage, or if hyperthyroidism treatment with medication or radioactive iodine alone is not effective. Another reason for surgery is pregnancy, since it may not be safe for a pregnant woman to take the necessary medications or treatment. Thyroid Surgery Procedures There are several types of thyroid surgery, all involving partial or total removal of the gland. Which surgery is performed depends on the reasons for the procedure. The types of surgery for thyroid disease include: Biopsy, removal of a tissue sample for microscopic examination Lumpectomy, removal of a small diseased part of the thyroid gland Lobectomy, removal of one lobe and the isthmus which connects the lobes Subtotal thyroidectomy, removal of one lobe, the isthmus, and part of the second lobe Total thyroidectomy, removal of the entire gland and the surrounding lymph nodes Depending on several factors, especially how extensive the necessary procedure will be, the operation may be performed traditionally or with a minimally invasive video-assisted, sometimes robotic, procedure. The patient will have a breathing tube in the throat during surgery and a drain may remain in the neck for 12 hours after the procedure. The length of the surgery depends on how much needs to accomplished. Minimal operations may be performed outpatient, while for more complex surgeries the patient may be hospitalized for a night or two. Recovery from Thyroid Surgery After the operation, the patient's throat will be sore due to the breathing tube inserted during surgery. While most patients are able to return to their normal activities in one day or several, depending on the extent of the surgery, strenuous activities, such as heavy lifting or vigorous sports, must be avoided for at least 10 days after the operation. Most thyroid surgeries are very successful, but the majority of patients develop hypothyroidism as a consequence of the procedure. This will require ongoing treatment with hormone therapy, but is not usually problematic. The patient may also need follow-up treatment with radioactive iodine to shrink thyroid tissue either because hyperactivity of the gland continues to be an issue or in order to stem the growth of a thyroid cancer. Risks of Thyroid Surgery Thyroid surgery is generally a safe procedure, but complications may occur. In a very small number of cases, the nerves controlling the vocal cords may be damaged, resulting in hoarseness or other changes in voice quality. Laryngeal monitoring of the vocal cord nerves, however, enables the surgeon to be in careful control of the situation. Another possible cause for concern is that the parathyroid glands, which are tiny and difficult to differentiate from other tissue on the thyroid gland, may be inadvertently damaged during surgery. Other risks are the risks inherent in any surgical procedure. These include: excessive bleeding, abnormal blood clots, adverse reaction to anesthesia or medication, infection, or breathing problems.

  Link: Thyroid Surgery

• Laparoscopy

  Laparoscopy is a minimally invasive surgical procedure used to diagnose and treat conditions in the abdominal and pelvic areas. During a laparoscopic procedure, a thin tube with a camera on the end, known as a laparoscope, is inserted through a tiny incision to allow the doctor to closely examine the organs of the area. Surgical instruments can be inserted through additional incisions to treat any identified problems or to retrieve tissue specimens. Laparoscopy is much less stressful than traditional open surgery, for the patient, both physically and psychologically, and usually involves lower costs and fewer complications. Laparoscopy is often performed as an outpatient procedure. Reasons for Laparoscopy This procedure may be performed for a number of reasons, including to: Perform a biopsy Examine and possibly remove any growths, such as cysts, adhesions or tumors Diagnose and treat conditions such as endometriosis, ectopic pregnancy or pelvic inflammatory disease Check for metastasis of cancer Perform a tubal ligation Check for abdominal or pelvic injury Repair a hernia Remove organs such as the uterus, spleen, gallbladder, ovaries or appendix Determine the cause of pelvic pain Determine the cause of infertility The Laparoscopy Procedure Laparoscopy is performed under general anesthesia, and usually takes from 30 to 90 minutes. It may take longer to perform if the doctor needs to extract tissue or organs, or to make surgical repairs. A laparoscopic procedure typically involves the following: Creation of several small abdominal incisions Inflation of the belly with gas to make the organs more visible Insertion of the laparoscope to examine the area of concern Possible insertion of other tools to take tissue samples, remove cysts or make repairs Closure of the incision with stitches Risks of Laparoscopy Risks from laparoscopic procedures are noticeably less than the possible risks of open surgery., but they do exist. Risks of laparoscopy may include: Infection Excessive bleeding from the incisions Damage to an organ or blood vessel Allergic reaction to medications or anesthesia Recovery from Laparoscopy Recovery from laparoscopy is much quicker than from traditional surgery. The patient usually returns home the same day, and can resume normal activities within a few days. Patients are generally advised to avoid strenuous activity for about a week and to avoid drinking carbonated beverages for a day or two to prevent gas pains and vomiting. After laparoscopy, the patient may experience one or more of the following symptoms, none of which is serious, and all of which should disappear after a few days. Bloating Bruising around the incision site Pain at the incision site Irritation or pain in the shoulder or diaphragm Crackling sound if the skin near the stitches is rubbed due to gas leakage More rarely, symptoms may indicate the presence of infection or other complications. The physician should be contacted immediately if the patient develops: An area of redness or swelling around an incision Bleeding or drainage from the stitches Fever Severe belly pain Hoarseness that persists or gets worse

  Link: Laparoscopy

• Upper Endoscopy

  Upper endoscopy, also known as esophagogastroduodenoscopy or EGD, is a diagnostic procedure used to visually examine and diagnose conditions of the upper gastrointestinal, or digestive tract. The upper gastrointestinal tract includes the esophagus, stomach and duodenum, or upper part of the small intestine. An upper endoscopy is performed using a flexible tube with an attached light and camera, called an endoscope. It is inserted through the mouth and guided along to thoroughly examine the upper gastrointestinal tract. Candidates for Upper Endoscopy Patients experiencing any signs of digestive problems, such as difficulty swallowing food, unexplained weight loss, nausea or vomiting, are usually considered good candidates for upper endoscopy. However, before undergoing the procedure, the doctor should be made aware of the presence of any preexisting or current medical conditions that may affect the patient's eligibility for an upper endoscopy such as pregnancy, allergies to medication or any existing medical conditions. Reasons for Upper Endoscopy Upper endoscopy can be extremely beneficial for identifying and treating various conditions that affect the upper digestive tract, including anemia and cancers of the digestive system. Unlike surgical techniques, it requires no incisions or stitches. Upper endoscopy is usually recommended for investigating troublesome digestive symptoms, such as abdominal pain, bleeding, nausea, difficulties swallowing, vomiting, heartburn and ulcers. Upper endoscopy is also used to treat certain problems of the digestive system, which may involve cauterizing blood vessels to stop bleeding or widening a narrow esophagus. In addition to the diagnostic and investigative purposes of an upper endoscopy, the following may be performed: Tissue samples can be obtained for biopsy Matter lodged in the gastrointestinal tract can be removed Therapeutic procedures may be performed Upper endoscopy may also be combined with other imaging procedures, such as an ultrasound. The Upper Endoscopy Procedure Patients are required to abstain from food and drink for at least 8 hours prior to the procedure. Upper endoscopy is typically performed as an outpatient procedure at a hospital, surgery center or outpatient clinic. A sedative may be given to help the patient relax. During the procedure, the patient is positioned on his or her back, with sensors attached to the body to monitor blood pressure and heart rate. Usually, a numbing medication will be sprayed into the patient's mouth in preparation for the insertion of the endoscope. The endoscope will then be passed through the mouth and guided along the upper gastrointestinal tract, transmitting images on to a video monitor in the treatment room. Any abnormalities found in the digestive tract during the procedure will be recorded. Recovery from Upper Endoscopy After the upper endoscopy is completed, the patient will be monitored in a recovery area for approximately 1 hour. A sore throat is common after this procedure, but it can be soothed with lozenges. Driving is not permitted for up to 24 hours after the procedure, so the patient should arrange for transportation home. With the doctor's approval, the patient can usually resume their regular activities the next day. Risks of Upper Endoscopy Upper endoscopy is generally considered a very safe procedure. However, while considered rare, there are risks which may include: Reaction to sedatives or anesthesia Bleeding Puncture of the gastrointestinal tract Infection Difficulty breathing After the procedure, some patients may suffer from persistent pain in the area of the endoscopy. Results of Upper Endoscopy The results of an upper endoscopy are commonly available immediately after the procedure. If a biopsy was performed, the tissue sample is sent to a pathology lab for detailed testing, and results may be available within 1 to 2 weeks. An appropriate treatment plan is created after a review of all test results.

  Link: Upper Endoscopy

• Vagotomy

  A vagotomy is a surgical procedure that is performed, in the treatment of chronic duodenal or peptic ulcers, to reduce the amount of acid secreted within the stomach. The vagus nerve, which stimulates the production of stomach acid, is surgically cut during the vagotomy procedure. The vagotomy procedure is performed either laparoscopically or as an open surgical procedure, with general anesthesia. A vagotomy is performed as a last resort in the treatment of ulcers, because most ulcers are responsive to medication. Preparing for the Vagotomy Procedure Before undergoing a vagotomy, the doctor will conduct a full physical and medical examination. The following diagnostic procedures that may be performed include the following: X-rays Upper endoscopy Blood tests Urinalysis The doctor should be informed of any medications being used, as they may need to be stopped before the surgery. A detailed list of instructions will be provided to the patient in preparation for the procedure. The Vagotomy Procedure Vagotomy is performed either as an open procedure or laparoscopically, with general anesthesia. A vagotomy procedure may be performed by one of the following methods: Laparoscopic Vagotomy A laparoscopic vagotomy cuts portions of the vagus nerves, depending on the patient's individual condition. Truncal Vagotomy A truncal vagotomy, also known as a total abdominal vagotomy, cuts the main trunk of the vagus nerve. This method affects the ability of the stomach to empty, and an additional procedure must be performed simultaneously to promote stomach emptying. Selective Vagotomy A selective vagotomy, also known as proximal gastric vagotomy, dissects the main trunk of the vagus nerve. This procedure is rarely performed. Highly selective vagotomy A highly selective vagotomy, also known as parietal vagotomy, cuts the parietal cells of the vagus nerve. Thoracoscopic Vagotomy A thoracoscopic vagotomy cuts the posterior trunk of the vagus nerve and is typically performed on those patients who have previously undergone a vagotomy procedure. After the Vagotomy Procedure Patients that undergo a laparoscopic vagotomy usually spend an average of 1 to 3 days in the hospital, while a longer hospital stay is required for those patients that have had an open procedure or if multiple procedures have been performed at the same time. Patients with desk jobs can usually be return to work within 10 days after surgery, while additional recovery time is needed for those patients with a job that involves physical labor. Patients should follow all postoperative instructions carefully to ensure a speedy recovery and avoid complications. Risks and Complications of the Vagotomy Procedure As with most surgical procedures, there are certain risks associated with a vagotomy, although they rarely occur. These risks may include the following: Complications from general anesthesia Bleeding Infection Accidental perforation of the stomach or esophagus Dumping syndrome Diarrhea Only a qualified doctor can determine if you are a candidate for the vagotomy procedure. Call us or contact us to schedule a consultation.

  Link: Vagotomy

• Da Vinci® Surgical System

  In a relatively new approach to minimally invasive surgery (MIS), the da Vinci® system applies robotic technology to various types of surgery. Although laparoscopic surgery is also minimally invasive, it limits the surgeon to rigid and fairly restricted movements. The da Vinci surgical system offers flexibility and control, and permits precise, effective results in a wide range of surgical procedures, including those used in treating cardiac, colorectal, gynecologic, head and neck, thoracic, and urological problems. Benefits of the da Vinci Surgical System According to its manufacturer, Intuitive Surgical, the da Vinci surgical system, in addition to the benefits discussed below, offers patients a shorter hospital stay and reduces their need for narcotic pain medication. Less Invasive The da Vinci system uses several tiny incisions rather than one large one, which means less scarring, less pain, less bleeding, a more rapid recovery, and a smaller incidence of postoperative infection. Greater Surgical Control Although the robotic arms of the system's console carry surgical instruments and a camera to the targeted area, the procedure is under the complete control of the surgeon. Using EndoWrist technology, the robotic arms precisely mimic the movements of the surgeon's wrists and hands, providing superb dexterity and extreme control. More Accurate Imaging The surgeon is able to view the targeted area through the an imaging system that provides a magnified, three-dimensional view of the entire operative field. This provides a clearer and more detailed view than that from traditional open surgery. Variety of Surgical Uses The da Vinci system can be used in many types of surgical procedures, including cardiothoracic, abdominal and prostate surgeries. In these and other procedures, the control and accuracy the system provides may result in better outcomes than those from conventional surgeries. Risks of the da Vinci Surgical System According to Intuitive Surgical, the possible risks of MIS in general include the following: Long operation time Need to switch to a different surgical technique Incision-site hernia Temporary pneumoperitoneum (air or gas in abdomen) If a surgeon needs to switch from MIS to another type of surgery during the procedure itself, the time a patient spends on the operating table and under anesthesia may increase, and additional complications may result. Although the da Vinci surgical system offers significant advantages over traditional surgery, it is not the appropriate choice in every case. Pregnant women, and those who bleed easily, have issues with blood clotting, or are morbidly obese, are usually not suitable candidates for any type of MIS.

  Link: Da Vinci® Surgical System

• Appendectomy

  An appendectomy is a surgical procedure to remove the appendix, a small organ located at the junction of the small intestine and colon. The appendix, once thought to be only vestigial, is now known to help lubricate the colon and to assist the immune system. Appendectomies are, therefore, performed only when necessary. Reasons for an Appendectomy There are two main reasons for an appendectomy. Appendicitis Appendectomy is a necessary response to appendicitis, an inflammation or swelling of the appendix. Appendicitis may result in extremely serious complications, such as rupture of the appendix, peritonitis, intestinal blockage or sepsis. Tumors Appendectomy is also required to remove tumors of the appendix. Such tumors not only may be malignant, but may enlarge and perforate the appendix, causing serious consequences.. The Appendectomy Procedure Appendectomies may be performed as open surgery or laparoscopically. In the latter case, an endoscope and a few surgical instruments are inserted through a series of small incisions. The camera on the endoscope allows the surgeon to confirm the presence of appendicitis and perform the surgery without making a large incision. Patients can return home in as little as 24 hours. Laparoscopic surgery results in less pain and a shorter recovery period, but, due to the particular patient's situation, may not always be possible. Recovery from an Appendectomy As with any surgical procedure, it is important that the patient follow protocol during the recuperation period in order to ensure proper healing. The following steps should be taken after an appendectomy: Rest and avoidance of strenuous activity Wound care at the surgical site to avoid infection Use of antibiotics Use of painkillers and anti-inflammatory drugs Dietary restrictions to avoid constipation and intestinal distress Risks of an Appendectomy Risks and benefits should always be discussed with the physician before any surgery since there is the possibility, however slight, that complications, such as those listed below, may occur: Adverse reactions to anesthesia or medications Excessive bleeding Post-surgical Infection Damage to adjacent organs It is important to remember that the worst risks of appendicitis, a ruptured appendix and peritonitis, far outweigh the risk of the appendectomy itself.

  Link: Appendectomy