Conditions: Conditions treated include, but are not limited to, the following: Acid Reflux Breast Cancer Breast Lump Cancer Complex Surgery Endocrine (Thyroid and Adrenal) Gallstones Hernia Intestinal Liver Pancreas Second Opinion Spleen Morbid Obesity What is Acid Reflux? Millions of Americans suffer from chronic heartburn, which is usually a symptom of gastro-esophageal reflux disease or GERD. It is due to the acid from the stomach refluxing up into the esophagus. It is often frequent enough to have a significant impact on the individual's quality of life by keeping him from enjoying certain foods or even keeping him up at night. It can also sometimes lead to serious conditions such as asthma, burning of the esophagus (esophagitis), and even cancer of the esophagus. Surgery provides a definitive treatment for patients suffering from reflux and allows them to avoid a lifetime of taking various drugs. The anti-reflux surgery is called "Nissen fundoplication" and consists of wrapping part of the stomach around the lowest part of the esophagus in order to stop the reflux. The surgery also repairs the hernia ("hiatal hernia") that is usually present and that is responsible for making GERD symptoms worse. The surgery is highly effective and is done using laparoscopy ("key-hole" surgery) with tiny cuts (less than a quarter inch in size). Patients usually spend at the most one night in the hospital. Useful on-line resources: http://www.gerdsurgery.info http://www.heartburnhelp.com http://digestive.niddk.nih.gov/ddiseases/pubs/gerd/ Useful recent articles: - A Randomized Controlled Trial of Laparoscopic Nissen Fundoplication Versus Proton Pump Inhibitors for Treatment of Patients With Chronic Gastroesophageal Reflux Disease: One-Year Follow-Up (Anvari M, et al. Surgical Innovation. December 2006) http://sri.sagepub.com/cgi/content/abstract/13/4/238 - Laparoscopic antireflux surgery: long-term outcomes and quality of life (Rosenthal R, et al. Journal of Laparoendoscopic and Advanced Surgical Techniques. December 2006) http://www.liebertonline.com/doi/abs/10.1089/lap.2006.16.557 Return to conditions What is Breast Cancer? Breast cancer is a condition in which breast cells grow abnormally and divide without control or order. Breast cancer is the most common form of cancer in women. Early detection and prompt treatment help many women live long productive lives. The two most common forms of breast cancer are those arising from the breast milk ducts (ductal carcinoma) or from the lobular cells that produce milk (lobular carcinoma). Two categories of cancer are named as in-situ for those cancers that are staying within the ducts or lobules and invasive cancer for those cancers that have invaded outside of the breast ducts or lobules and into surrounding tissues. Should you be given a diagnosis of breast cancer there are several surgical options. These options will be discussed with your surgeon as each individual situation is unique and equal success in cancer treatment can be achieved in a variety of ways: Breast conservation surgery with and without lymph node removal or sampling. (sentinel node) Simple mastectomy Modified radical mastectomy Re-construction There are multiple internet sources (too many to list) to research the topic of breast cancer. It is helpful to gather this information, and discuss all options. Surgical Associates at Virginia Hospital Center have had many years of experience and have many therapeutic options at their disposal in the treatment of breast cancer. These include all modalities (such as radiation or chemotherapy) that are available at Virginia Hospital Center. Return to conditions What is a Breast Lump? "I've found a lump in my breast!" Don't panic, 80% of all breast lumps are benign (non-cancerous). There are several common causes of breast lumps: Benign breast changes Breast infection or injury Medicine related lumps or breast pain Breast cancer By far the most common lumps are fibrocystic changes, breast cysts and fibroadenomas. Most women have a certain degree of fibrocystic changes. These are often described as benign, tiny fluid-filled sacs that might feel like lumps. They might be hard or rubbery, and often fluctuate with the menstrual cycle. A woman can also have a single breast lump that might be large or small. Again, this is a fluid filled sac that might fluctuate with the menstrual cycle. A fibroadenoma is another benign lump and is the most common tumor found in the female breast. These most often occur in women who are in their reproductive years. What should I do? A lump in the premenopausal woman might be monitored for one to two months to see if it changes, and is related to hormone fluctuations and the menstrual period. Any unexplained beast lump that persists should be checked by your health care provider. Call and make and appointment. What may happen at the appointment? A detailed history will be taken and a thorough breast exam will be conducted. Breast imaging (mammogram or ultrasound) will be performed if your previous studies are not current. You might be scheduled for other diagnostics studies such as: Needle aspiration-may be all that's needed if the lump is a cyst Core biopsy-under mammogram guidance, a piece of the lump is removed for Microscopic study Open biopsy-this is the surgical removal of the mass done in the operating room Depending on these results, further testing, physician referral or even further surgery could possibly be recommended. Return to conditions What is Cancer? This single word probably causes more fear and anguish than any other single utterance in the English language. Both patients and physicians understand the implications of any diagnosis that is associated with the term "cancer". While cancer remains the second-most common cause of death in the US, great strides have been made in both the early detection and treatment of virtually all forms of cancer. Initial diagnosis is aimed at identifying potential cancers or malignancies as early in their course as possible. These include regular physical exams and routine lab and/or radiographic testing. Additional recommendations for screening colonoscopies have added to our ability to detect and treat cancers before they become advanced. Despite these advances, patients continue to present with malignancies which require urgent therapy. In the distant past, treatment of cancer usually entailed surgery alone. However, with advances in chemotherapy and radiation therapy, surgery for cancer has taken a more defined role. Today there is a team approach which involves the patient and a group of treatment physicians. Once a diagnosis of cancer is made, these physicians will recommend standard and/or alternative treatment fro a particular patient's malignancy. Since eradication of the cancer is the primary goal, surgery remains an important part of treatment. Specialized knowledge and skill is requires by the surgeon to enhance the patient's chance for cure in light of advancing improvement in chemotherapy and radiation therapy. At Virginia Hospital Center, the infusion center, teams of medical cancer specialists, the Radiation Therapy Center, and now Surgical Associates at Virginia Hospital Center, can provide comprehensive cancer care without the inconvenience of traveling to distant facilities. Return to conditions What is Complex Surgery? If your doctor feels that complex abdominal surgery such as liver or pancreas surgery is needed, Surgical Associates at Virginia Hospital Center has the experience to be of service. The surgeons have performed multiple pancreas, liver, and even spleen resections(open and laparoscopic). They have published papers and given presentations at national conferences regarding these very subjects. (Below) Virginia Hospital Center can also offer various means to either kill or remove cancers that have spread to the liver. It is usually to the patient's advantage to be as aggressive as possible to allow improved lifespan and life quality. The surgeon's at Surgical Associates can help in the decision-making about the options available to you. Some of these internet sites are quite useful for patients to review: http://www.medicinenet.com/surgery_questions/article.htm http://www.medicinenet.com/liver_resection/index.htm http://www.webmd.com/digestive-disorders/Liver-resection Papers from Surgical Associates: Evans PM, Vogt DP, Mayes JT, Henderson JM, Walsh RM: Liver Resection Using Total Vascular Exclusion. Surgery, 124 (4): 807-15, Oct. 1998 Pancreatico-Duodenectomy in-patients over age 70. American Hepatobiliary Assoc., (presentation) Miami, Fla, 1998 JT Mayes, MD Schaefer CJ, Whipple Procedure in the Community Hospital, Ann Surg 222(2):211- 212, 1995 Walsh RM, Henderson JM, Vogt DP, Mayes JT, et al. Trends in Bile Duct Injuries J. Gastrointest Surg, 2 (5): 458-62 Sept-Oct 1998 Return to conditions What is Endocrine Neoplasia? Endocrine neoplasia is a term physicians use to describe tumors that arise from the organs of the body that produce hormones. These tumors are often benign but occasionally can be malignant or cancerous. They are usually associated with the elevated production of hormones. These hormones can have a variety of effects on a patient's health. For example, severe high blood pressure can be caused by elevated hormone levels that are produced by the thyroid gland or by tumors of the adrenal glands. Routine blood bests often show elevated calcium levels in the blood. This is often caused by too much hormone being made by an overactive parathyroid gland. Left unattended serious health problems including heart diseases, pancreatitis, kidney stones, muscular dysfunction, and severe osteoporosis could occur. Thus, treatment of these hormonal disorders is necessary. The diagnosis of a health disorder caused by an over-abundance of hormone can usually be easily identified through laboratory tests. Treatment for some of these disorders, such as those associated with the thyroid gland can often be accomplished with medications. However, several of the diseases involving the hormonal glands require surgery since there are no effective medications or other therapies. Surgery for hormonal disorders requires a high degree of experience. With 50 years of combined experience in the treatment of these disorders, and having performed many operations on patients with hormonal tumors, the surgeons at Surgical Associates are well qualified to diagnose and treat this class of diseases. In most adrenal procedures, the surgery is performed laparoscopically. Some helpful links: http://www.mdanderson.org/departments/endocrinology http://www.nlm.nih.gov/medlineplus/ency/article/000398.htm Return to conditions Gallstones, Gallbladder and Bile Duct System It is estimated the 10% of the population of the US has gallstones. This accounts for approximately 20 million people. Of these, more that 80% have no symptoms. These patients do not routinely require treatment. The remaining 20% may develop symptoms which may lead to treatment. Approximately 600,000-700,000 operations to remove the gallbladder (cholecystectomy) are performed each year. Gallstones form in the gallbladder because of an abnormal synthesis of bile within the liver. This is related to several fat ors including diet, genetics and flow of the bile. Gallstones become symptomatic when they occlude or block the mouth of the gallbladder. After eating, particularly fat-rich foods, the gallbladder is stimulated to squeeze and empty its contents of bile into the intestine to aid in digestion. Since the liver makes about one quart of bile daily and the gallbladder holds 2 ounces, the contribution from the gallbladder for digestion is minimal. However, when the gallbladder squeezes against a blockage (such as a stone) the patient will experience discomfort or pain of variable intensity. This is usually localized to the upper abdomen. Usually the pain is severe and subsides after a few hours. However, repeated attacks are often increasingly severe. The diagnosis of gallstones is made through the history and physical exam. Confirmation of the diagnosis is established by ultrasound of the gallbladder. Unfortunately, there are no nonsurgical therapies which effectively dissolve gallstones and/or relieve the intermittent pain. Fortunately, however, surgical removal of the gallbladder has been technically improved such that it is usually performed as an outpatient operation with a very low risk for complications. Surgery entails removing the gallbladder with the gallstones through one of four hollow tubes called trochars. Through one of these tubes a camera is passed to visualize the gallbladder. The instruments used to actually remove the gallbladder are passed through the remaining three tubes. This is all performed under general anesthesia. Most patients can be discharged from the hospital within 24 hours. In special circumstances there can be stones in the main bile duct system or cancer in the main bile duct system. In these instances, laparoscopic or sometimes open surgery is needed to remove blockages from these ducts. The following sites offer further information: http://.clevelandclinic.org/health/health-info/docs/1700/1715.asp?index=7017 http://sages.org/sagespublication.php Cholecystectomy Brochure Return to conditions What is a Hernia? Almost 600,000 hernia repairs are undertaken in the US each year. There are several types of hernias and several ways to repair each type. With so many choices, it is important that you discuss the specifics of your case with your doctor. It is important that your doctor have experience with the different choices as well. The doctors at Surgical Associates have a large experience in hernia repair, including publications on the subject. We have experience in open and laparoscopic techniques, simple and complex hernias, and hernias that have come back after repair done in the past. There are many internet sites that describe hernia surgery. Here is a selected list of the most accurate and informative ones we have found: http://www.facs.org./public_info/operation/brochures/hernrep.pdf http://sages.org/sagespublication.php?doc=PI06 Hernia Repair Brochure Selected publications: 1. Costanza MJ, Heniford BT, Arca MJ, Mayes JT, Gagner M: Laparoscopic Repair of Recurrent Ventral Hernias. Am Surgery, 64 (12) 1121-1127, Dec. 1998 2. Rosen M, Garcia-Ruiz A, Malm J, Mayes JT, Steiger E, Ponsky J: Laparoscopic Hernia Repair Enhances Early Return of Physical Work Capacity. Surg Laparosc Percutan Tech, 11 (1): 28-33, Feb. 2001 Return to conditions Intestinal The intestinal system is categorized into the esophagus, stomach, small bowel and the large bowel (colon). The most common intestinal operation is removal of the appendix, usually in a semi-emergency setting. However, in some instances, surgery on the intestine is needed for cancer, adhesions, or a condition called diverticulitis (inflammation of the colon). In these non-emergency settings, removal of the bowel section that is diseased and re-attaching the bowel ends comprises the major part of the operation. Often the patient will undergo a bowel preparation (cleansing) before such surgery to minimize fecal contamination during the procedure. Some cases are amenable to laparoscopic surgery. For cases of colon cancer, most patients will also require chemotherapy after surgery. Some patients may require chemotherapy before surgery. Other bowel cancers are treated on an individualized basis through the comprehensive approaches available at Virginia Hospital Center available to Surgical Associates. http://www.righthealth.com/health/small_bowel_resection/m-1-s http://www.cancerhelp.org.uk/help/default.asp?page=3917 http://www.medicinenet.com/colon_cancer/article.htm Return to conditions Liver 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. In many instances, surgery is undertaken to remove a part of the liver that contains cancer. 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 (even transplantation!). Virginia Hospital Center has the capability to offer all modalities short of transplantation. If your cancer specialist wishes, we will be happy to discuss these options for treatment. In some cases, complex repair of bile ducts is needed for draining the bile. 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 if your doctor thinks you need an operation of this sort. Below is a small sample of our publications: 1. 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. 2. 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. 3. 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. Return to conditions Pancreas The pancreas is a digestive organ located towards the back of the abdominal cavity. It functions in making juices which digest our food. The pancreas also contains cells that secrete insulin to control blood sugar. Diseases of the pancreas include tumors, cancer, and inflammation or pancreatitis. Surgery of the pancreas can involve removal of sections, draining cysts, or removal of adjacent organs if cancer is a diagnosis. In certain cases laparoscopic surgery may be performed on the pancreas. At Surgical Associates, we have multiple types of experience in pancreatic surgery for tumors, infections, cysts, pancreatitis and cancer. Return to conditions Second Opinion When faced with the prospect of major abdominal surgery, it is perfectly appropriate to seek a second or even third opinion regarding the suggested operation. One should seek a qualified opinion, however. At Surgical Associates the surgical team consists of all American Board of Surgery-certified physicians. The surgeons are members of the American College of Surgeons. They have published papers in peer-reviewed journals. Their surgical expertise encompasses most facets of general surgery as mentioned throughtout this site. In short, the team is extremely well qualified to render a second opinion whenever major surgery is considered necessary. We welcome the opportunity to provide this information to the patient. We encourage patients to seek all resources and not to be hesitant in requesting a second opinion: http://www.facs.org/public_info/operation/consult.html Return to conditions Spleen 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 often proceed laparoscopically. Laparoscopic splenectomy can allow quicker recovery than open splenectomy. Surgeons at Surgical Associates have performed multiple laparoscopic splenectomies, in addition to other laparoscopic procedures. We would be happy to discuss laparoscopic splenectomy with you if your doctor requests the procedure. http://www.nlm.nih.gov/medlineplus/spleendiseases.html http://www.nlm.nih.gov/medlineplus/ency/article/002944.htm Return to conditions Morbid Obesity Almost two thirds of Americans are overweight or obese. When a patient becomes more than 100 lbs overweight, this is referred to as Morbid Obesity. This degree of obesity is dangerous as it can cause a number of illnesses such as diabetes, high blood pressure, joint problems, sleep apnea, etc, as well as significantly reduce the life span of the individual. Diet, exercise and medications are seldom successful in achieving sustained weigh loss in morbidly obese individuals. When all fails, surgery should be considered. Please review our weight loss surgery hand-out (in the patient information section of our website) for more detailed information about the surgical options available to you and to learn about the process to get to surgery. Our practice’s weight loss procedure of choice is the laparoscopic adjustable gastric banding. It is a minimally invasive procedure that is both adjustable and reversible. It is less risky than the gastric bypass and minimizes the risks of malnutrition associated with other weight loss procedures. It helps patients achieve steady and healthy weight loss as well as resolution or improvement in most obesity associated illnesses. Papers from Surgical Associates: Salameh JR. Bariatric surgery: past and present. Am J Med Sci. 2006; 331 (4): 194-200. http://www.bariatricedge.com http://www.lapband.com Return to conditions