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HERNIA

A hernia is the protrusion of an organ or fascia of an organ through the wall of the cavity that normally contains it. There are many types since many organs or part of organs can herniate through many orifices. Hernias where the herniating tissue arises within the abdominal cavity include inguinal (groin) hernias, umbilical hernias (at the site of the belly button), incisional hernias (at the site of a previous surgical incision) diaphragmatic hernia (part of stomach or intestine protruding into chest cavity). Hernias may be noticed by pain or a burning sensation at the site or a visible bulge or lump. Hernias can be repaired with a laparoscope or through an open incision, depending on the type of hernia and other factors involving each individual patient. Hernia repairs are varied and multiple with very good results obtained.

Hiatal hernias are also numerous and often are associated with GERD. This hernia occurs when the stomach protrudes through the esophageal opening into the diaphragm. Symptoms of acid reflux are often present with hiatal hernias and may eventually lead to surgical treatment with laparoscopic Nissen fundoplication.

NISSEN FUNDOPLICATION ("STOMACH WRAP")

This is a surgical procedure known as a "stomach wrap" used to treat gastroesophageal reflux disease (GERD) and hiatal hernia. This is usually performed if medical therapy for acid reflux has failed. In this procedure the gastric fundus, or upper part of the stomach, is wrapped around the lower end of the esophagus and stitched in place. This reinforces the closing function of the lower esophageal mechanism. and prevents the reflux of gastric acid (GERD) into the esophagus. It is almost always done as a laparoscopic procedure.

CHOLECYSTECTOMY (GALLBLADDER REMOVAL)

Cholecystectomy is surgical removal of the gallbladder. It is the most common method of treating symptomatic gallstones and gallbladders that do not function well. Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow insertion of operating ports. A camera illuminates the surgical field allowing the surgeon to watch a monitor and perform the operation by manipulating the surgical instruments through the ports.

PILONIDAL CYST (RECTAL ABSCESS)

A pilonidal cyst develops along the tailbone near the cleft of the buttocks. A person with a pilonidal cyst may develop infection and experience pain and inflammation. Treatment depends on many factors including presence of symptoms and extent of the disease. Often these are treated with drainage and dressing changes, followed by formal excision after the infectious process is resolved.

PACEMAKER

A pacemaker is a small device that is placed in the chest to help control abnormal heart rhythms. This device uses electrical pulses to prompt the heart to beat at a normal rate. Pacemakers are used to treat arrhythmias, which are problems with the rate or rhythm of the heartbeat. During an arrhythmia the heart can beat too fast, too slow or with an irregular rhythm.

HEMORRHOID

Hemorrhoids are vascular structures in the anal canal that help with stool control. They can become swollen or inflamed causing problems with pain and bleeding. They can be external (occurring outside of the anal canal) or internal (occurring inside the rectum). Recommended treatment consists of increasing fiber intake, increasing oral fluids to maintain hydration, analgesics, sitz baths and rest. Surgery is reserved for those who fail to improve with these measures. Stapled hemorrhoidectomy is the newest surgical technique and is rapidly becoming the treatment of choice for some hemorrhoids. Patients tend to experience less pain and postoperative problems with this operation as compared to a traditional hemorrhoidectomy.

ESOPHAGOGASTRODUODENOSCOPY (EGD)

This is commonly known as an EGD and is a diagnostic procedure that allows the physician to diagnosis and treat problems in the upper gastrointestinal tract. A long, flexible, lighted tube called an endoscope is guided through the mouth and throat, then through the esophagus, stomach and duodenum (the first part of the small intestine). The physician can examine the inside of these organs and detect abnormalities. The endoscope can also be used to obtain tissues for biopsy, remove foreign objects, stop bleeding, etc. An EGD is preformed to diagnosis many different problems, some of which are difficulty swallowing (dysphagia), loss of appetite, upper abdominal pain or chest pain that is not heart related, gastroesophageal reflux disease (GERD), gastrointestinal bleeding, ulcers, hiatal hernia.

COLONOSCOPY

Colonoscopy is an endoscopic examination of the colon and distal part of the small bowel with a camera on a flexible tube that is passed through the anus. The entire large bowel is examined and gives the opportunity for biopsy and removal of suspected lesions, such as polyps. The polyps can then be examined by a pathologist to see if they are precancerous or not. Conditions that call for colonoscopies include rectal bleeding, unexplained changes in bowel habit and anemia. They can be used to detect conditions such as inflammatory bowel disease or colitis.

Due to the high mortality associated with colon cancer and low risks associated with colonoscopy, it is now becoming a routine screening test for people 50 years of age or older. Patients with a family history of colon cancer are considered high risk for developing that disease and are often screening earlier than age 50. Subsequent colonoscopies are then scheduled based on initial results found with a 5-10 year recall being common for colonoscopies that produce normal results.

VNUS CLOSURE (VARICOSE VEIN TREATMENT)

This is a minimally invasive treatment with less pain and less bruising compared to traditional vein stripping and laser treatment. Using the Closure system physicians close the diseased veins by inserting the Closure catheter into a vein and heating the vein wall using temperature controlled radiofrequency energy. Heating the vein wall causes collagen in the wall to shrink and the vein to close. After the vein is sealed shut, blood then naturally reroutes to healthy veins. Venous reflux or insufficiency develops when the valves that usually keep blood flowing out of the legs become damaged or diseased.

LUNG RESECTION

Lung resections are commonly performed to remove disease areas of the lung. This can be benign disease or cancerous tumor. In a procedure known as a wedge resection a healthy margin of tissue is taken as well to confirm that the entire tumor has been removed, reducing the risk of recurrence. In a lobectomy procedure an entire lobe of one of the lungs is removed. Lung resections can also be done to address congenital abnormalities and other problems related to the lungs, such as abscesses in the lung.

VASCULAR ACCESS FOR HEMODIALYSIS

Vascular access is an essential step before a patient starts regular hemodialysis sessions. This is the site on your body where blood is removed and returned during dialysis. To maximize the amount of blood cleansed during hemodialysis treatments, the vascular access should allow continuous high volumes of blood flow.

A vascular access should be prepared weeks or months prior to starting dialysis. The early preparation of the vascular access will allow easier and more efficient removal and replacement of your blood with fewer complications.

The three basic kinds of vascular access for hemodialysis are arteriovenous (AV) fistula, an AV graft, and a venous catheter. A fistula is an opening or connection between any two parts of the body that are usually separate- for example, a hole in the tissue that normally separates the bladder from the bowel. While most kinds of fistula are a problem, an AV fistula is useful because it causes the vein to grow larger and stronger for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow, lasts a long time, and has a lower complication rate than other types of access. If an AV fistula cannot be created, and AV graft or venous catheter may be needed.

BREAST BIOPSY

A Breast Biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer or abnormalities. A breast biopsy is usually done the check a lump found during a breast examination or a suspicious area found on mammogram, ultrasound, or magnetic resonance imaging (MRI). There are several different ways to do a breast biopsy. These procedures include the following:

Fine needle aspiration - the physician places a thin needle through the skin, into the lump, and removes cells to look at. Needle aspiration may be done to see if the lump is solid or fluid-filled (cyst). If the lump is a cyst, it will go away after the fluid is removed. If there is no fluid, another type of biopsy will be done.

Core needle biopsy - the physician uses a device with a large fitted needle with a special tip. The needle goes through the skin to the lump or area to take out a sample of tissue about the size of a pencil lead to be examined.

Stereotactic biopsy - the physician utilizes a special type of x-ray during a core needle biopsy to find the area of the breast where the biopsy samples will be taken. This technique can check a lump that cannot be felt on breast examination but is seen on mammogram or MRI. A small incision is then made in the skin of the breast, and the core needle is guided by the x-ray to the biopsy site to take tissue samples. This may not be appropriate for all types of breast lumps.

Open biopsy or lumpectomy - the physician makes a cut in the skin and removes a sample of the lump or the entire lump. If your doctor cannot feel a lump, a small wire can be placed in the suspicious area during a mammogram or MRI don just before surgery. The wire then guides the physician to the suspicious area to take a biopsy sample.

More tests or biopsies may be needed if problems are found during the initial biopsy or if your physician is concerned about a certain area of your breast.

VASECTOMY

Vasectomy is a surgical procedure in which the vasa deferentia of a man are severed, tied and cauterized. The procedure is performed in an outpatient office setting. With vasectomy, the surgeon uses a local anesthetic to numb the scrotum, then makes an incision using a scalpel to access each vas deferens. The vas deferens is severed, with a piece of tissue removed. It is then tied-off and cauterized (burned) to make a seal on the end. The primary goal of vasectomy is always the same, to prevent sperm from entering into a male's ejaculate. The procedure can usually be performed in less than 30 minutes.

COLON RESECTION

Colon resection surgery is performed to remove a part or the entire colon (large intestine). This procedure is also known as "colectomy". In a colon resection, the patient receives a general anesthesia right before surgery. This makes the patient unconscious and they are unable to feel pain. Colon resection surgery can be performed either Laparoscopically or by Open surgery.

In open colon surgery, the patient has to stay in the hospital for many days for recovery, frequently longer than 1 week. In this surgery, a large incision is made in the abdomen and the surgeon removes the affected part. The surgeon then attaches the two ends of the healthy colon using a surgical instrument or by hand suturing.

Laparoscopic colon resection is where a portion of the affected colon can be removed using several small incisions. These incisions are usually less than 0.5 cm. Special instruments are used to perform this approach. This procedure has many advantages including smaller incisions, less pain, less complications, a shorter hospital stay and quicker recovery for return to work. Colon resection surgery is utilized for a variety of colon diseases including, but not limited to:

  • strictures
  • fistula
  • abscesses
  • diverticular disease
  • crohn's disease
  • colon cancer
  • rectal cancer
  • colon polyps
  • ulcerative colitis

CAROTID ENDARTERECTOMY

Carotid Endarterectomy (CEA) is a surgical procedure used to prevent stroke, by correcting stenosis (narrowing) in the common carotid artery. Endarterectomy is the removal of material on the inside of an artery.

Atherosclerosis causes plaque to form in the carotid arteries, usually at the fork where the common carotid artery divides into the internal and external carotid artery. The plaque can build up in the inner surface of the artery (lumen), and narrow or constrict the artery.

Pieces of the plaque, called emboli, can break off (embolize) and travel up the internal carotid artery to the brain, where is blocks circulation, and can cause death of the brain tissue.

In endarterectomy, the surgeon opens the artery and removes the plaque. The patient is usually in the hospital for 24-48 hours and then recovers at home.

THYROID OPERATION AND TREATMENT

The thyroid gland is the biggest gland in the neck. It is situated in the anterior (front) neck below the skin and the muscle layers. The thyroid gland takes the shape of a butterfly with the two large wings representing the left and right lobe which wrap around the trachea. The thyroid makes our thyroid hormone, and regulates the body's metabolism.

The thyroid gland is prone to several distinct problems, some of which are extremely common. Some of these include:

  • Goiters - a dramatic enlargement of the thyroid gland
  • Solitary thyroid nodules - a nodular growth on the thyroid gland
  • Hyperthyroidism - making too much of the thyroid hormone
  • Thyroiditis - an inflammation of the thyroid gland
  • Hypothyroiditis - making to little of the thyroid hormone
  • Thyroid cancer - a cancer of the thyroid gland, most of which have excellent long term survival.

Surgical treatment options of the thyroid are common, and include the following based upon the problem occurring with the thyroid gland. These include:

  • Thyroid lobectomy - removal of one of the lobes of the thyroid for nodules
  • Partial thyroid lobectomy - removal of a portion of one of the lobes of the thyroid
  • Thyroid lobectomy with isthmusectomy - removal of a thyroid lobe and the isthmus the part that connects the two lobes)
  • Total thyroidectomy - removal of the entire thyroid gland