Complex Surgery

Surgery on a number of solid intra-abdominal organs such as the liver, the pancreas and the spleen can be quite complex and requires special skill and experience. Patients should seek not only surgeons who are comfortable performing such operations with excellent outcomes, but also hospitals that provide specialized services in interventional radiology, gastroenterology and other advanced procedures.

Surgery of the pancreas can be required for cancers, benign tumors, cysts and pancreatitis. Surgery may involve removal of a portion of the pancreas - sometimes with adjacent organs, drainage of a cyst, or removal (enucleation) of a tumor. In certain cases, laparoscopic surgery may be performed on the pancreas, particularly to drain a cyst (cyst-gastrostomy) or remove the tail of the pancreas (distal pancreatectomy). At Surgical Associates, we have multiple types of experience in pancreatic surgery for tumors, infections, cysts, pancreatitis and cancer.

Disorders of the spleen are relatively rare. If surgery is ever needed, it is often in the case of trauma, where the spleen has irreparably ruptured. In cases of certain blood disorders (idiopathic thrombocytopenia for example), the specialist may suggest removal of the spleen to help treat the condition. If this is the case, the surgery can proceed laparoscopically. Laparoscopic splenectomy can allow quicker recovery than open splenectomy and usually requires only one day in the hospital. At Surgical Associates, we have extensive experience in laparoscopic spelenectomies for spleens of all sizes and for various disease conditions.

Surgery of the liver is a complex undertaking. The liver is the largest intraabdominal organ and contains the bile system as well as multiple blood vessels. The liver is critical to blood clotting and protein synthesis. Up to 60-75% of the liver can be removed under certain conditions. In cases where the surgery cannot be performed, there are other options such as radiofrequency ablation, or chemoembolization. Both of the latter therapies involve destroying the tumor, not removing it. The decision regarding which treatment option to undertake requires careful consideration. The surgeons at Surgical Associates have experience with all modalities of therapy, from open and laparoscopic resection to ablation- and even transplantation! We have the capability to offer all treatment modalities short of transplantation. As therapy is obviously highly individualized, patients and physicians can call and we will be happy to discuss your case prior to referral.

In some cases, complex repair of bile ducts is needed due to injury or tumor. This can be accomplished in several types of operations. At Surgical Associates we have reconstructed bile ducts after injury, cancer obstruction and stone disease. This experience includes multiple reconstructions even as complex as transplantation. We would welcome the opportunity to discuss options with patients or referring physicians.

In addition to their surgical experience, surgeons at Surgical Associates have published papers and given presentations on various topics related to surgery of the pancreas, spleen and liver. If you are considering surgery somewhere else, we would be happy to provide you with a second opinion.

Below is a small sample of our publications:

1. Obermeyer RJ, Fisher WE, Salameh JR, Jeyapalan M, Sweeney JF, Brunicardi FC. Laparoscopic pancreatic cystogastrostomy. Surg Laparosc Endosc Percutan Tech. 2003 Aug; 13(4):250-3.
2. Essien FA, Ojeda HF, Salameh JR, Baker KR, Rice L, Sweeney JF. Laparoscopic splenectomy for chronic recurrent thrombotic thrombocytopenic purpura. Surg Laparosc Endosc Percutan Tech. 2003 Jun; 13(3): 218-21.
3. Mayes JT. Pancreatico-Duodenectomy in-patients over age 70. American Hepatobiliary Assoc., (presentation) Miami, FL, 1998.
4. Walsh RM, Henderson JM, Vogt DP, Mayes JT, Grundfest-Broniatowski S, Hermann RE: Trends in Biliary Tract Injuries from Laparoscopic Cholecystectomy. Hepatology. 1995; 22:146.
5. Rouch DR, Emond JC, Thistlethwaite JR, Mayes JT, Broelsch CE: Choledocholedochostomy without a T-tube or internal stent in liver transplantation. Surg Gynecol Obstet. 1990; 170:239.
6. Emond J, Mayes JT, Rouch DR, Thistlethwaite JR, Broelsch CE: Experience with radical resection in the management of proximal bile duct cancer. HPB Surg. 1989; 1:297.

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