General Surgeries

Gallbladder Surgery
Surgery for gallbladder problems are one of the most commonly performed surgeries in the country. The gallbladder is most often removed due to formation of gallstones (cholelithiasis), which can block flow of bile from the liver and gallbladder into the bowel. If left untreated this can lead to more serious problems like inflammation of another organ called the pancreas (pancreatitis), and inflammation of the gallbladder (cholecystitis).

Additionally the gallbladder on occasion will cease to function properly (biliary dyskinesia), which causes discomfort and pain in the abdomen when eating.

Gallbladder removal (cholecystectomy) is the standard treatment for most gallbladder-related problems. This is almost always performed laparoscopically, through small skin incisions, a telescopic camera, and long thin instruments.

Hernia Repair, including Groin (inguinal) and Abdominal Wall (umbilical, ventral, incisional)
Hernias occur when there is an abnormal opening in the muscular and fascial (tough tissue) layer of the abdominal wall, allowing contents to protrude through the opening.

Hernias can have several causes, including a defect present since birth, wear and tear from repeated heavy lifting or other causes of increased pressure in the abdomen, or from healing problems from prior abdominal surgery.

Symptoms normally include discomfort and a bulge in the area, worsened with heavy lifting, other strenuous activity or even straining from constipation, which all increase intra-abdominal pressure.

Hernias may occasionally cause serious complications if protruding contents get stuck and cannot be pushed back into their normal location (incarceration) or if the contents of a hernia become so swollen that blood cannot flow normally to the tissues and they become sick or even die off (strangulation).

Treatment is surgical repair of the hernia, frequently with placement of a synthetic mesh over the defect. Sometimes the optimal repair of a large hernia will require relaxing incisions on the sides of the abdominal fascial layer to allow for better closure of the natural tissue over the defect (component separation). Hernias may also be approached directly through an open incision or laparoscopically, from the underside of the defect.

Each hernia is different and unique, and it is important that the decision on how to treat each individual hernia be made together with you and your surgeon during your initial consultation.

Hiatal Hernia (Heartburn / Anti-Reflux Surgery)
Heartburn affects about 10-20% of people living in the United States. There are several causes of heartburn, one being an enlargement of the opening in the diaphragm that allows passage of the esophagus from the chest into the stomach – the hiatus. A hiatal hernia is essentially an abnormal enlargement of this opening, which allows a portion of the stomach to migrate into the chest. This disrupts the pressure valve function of the junction of the stomach and esophagus, allowing stomach acid and other fluids to inappropriately travel back up the esophagus. This can sometimes become dangerous if the constant irritation of the esophagus results in changes called Barrett’s esophagus, a transformation of the cells in the lining that if untreated can progress over time to esophageal cancer.

Initial treatment of reflux and heartburn normally involves antacid therapy, but if a significant hiatal hernia is present then surgery is truly the only way to definitively treat the problem. This normally involves surgery to bring the stomach back into its appropriate position, and closure of the hiatal hernia with sutures, and occasionally with biological mesh reinforcement. Additionally the stomach may be partially or fully wrapped around itself to prevent any future migration of the stomach back into the chest cavity (fundoplication).

Vascular Access Surgery
On occasion, repeated intravenous infusions or blood draws are necessary for treatment of certain diseases. Repeated IV placements or blood draws can cause the veins of the arm to scar down and become difficult to access. In this setting it is often beneficial to place an intravenous catheter (small plastic tubing) into a larger vein that can be accessed without having to needle-stick the actual vein, and can be left in place for an extended period of time. This is normally performed as a day surgery at an outpatient surgical center.

Colon/Rectal Surgery
Surgery to remove a portion or even the entire colon may sometimes be necessary for treatment of problems in the colon. These problems include:
• Colon cancer
• Diverticular disease (abnormal outpouchings of the colon wall, caused mainly by aging, but also with chronic constipation)
• Inflammatory bowel disease (e.g. Crohn’s disease, ulcerative colitis)

Depending on the specific problem, these surgeries can often be performed laparoscopically, with small skin incisions, long thin instruments and a telescopic camera. However in some cases a simple open surgery may be the optimal approach for colon removal.

Sometimes surgery is also necessary for issues that occur at the end of the colon, i.e. the rectum. This includes hemorrhoids, fissures, and masses.

Breast Surgery
Abnormal growths in the breast tissue, both benign and cancerous, can occur in women of all ages. These may be treated with simple removal in some cases; other cases (particularly in the setting of cancer) may require more extensive removal of breast tissue, and even removal of the entire breast. If surgery is for cancer, we will work closely with the oncologist (cancer doctor) in determining the best course of treatment for you.