Month: March 2019

Surgery for Colon Cancer

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Surgery is often the main treatment for earlier-stage colon cancers. The type of surgery used depends on the stage (extent) of the cancer, where it is, and the goal of the surgery.

Any type of colon surgery needs to be done on a clean and empty colon. You will be put on a special diet before surgery and may need to use laxative drinks and enemas to get all of the stool out of your colon. This bowel prep is a lot like the one used before a colonoscopy.

Polypectomy and local excision

Some early colon cancers (stage 0 and some early stage I tumors) and most polyps can be removed during a colonoscopy. This is a procedure that uses a long flexible tube with a small video camera on the end that’s put into the person’s rectum and threaded into the colon. These surgeries can be done during a colonoscopy:

  • For a polypectomy, the cancer is removed as part of the polyp, which is cut at its stalk (the part that looks like the stem of a mushroom). This is usually done by passing a wire loop through the colonoscope to cut the polyp off the wall of the colon with an electric current.
  • A local excision is a slightly more involved procedure. Tools are used through the colonoscope to remove small cancers on the inside lining of the colon along with a small amount of surrounding healthy tissue on the wall of colon.

When cancer or polyps are taken out this way, the doctor doesn’t have to cut into the abdomen (belly).

Colectomy

A colectomy is surgery to remove all or part of the colon. Nearby lymph nodes are also removed.

  • If only part of the colon is removed, it’s called a hemicolectomy, partial colectomy, or segmental resection. The surgeon takes out the part of the colon with the cancer and a small segment of normal colon on either side. Usually, about one-fourth to one-third of the colon is removed, depending on the size and location of the cancer. The remaining sections of colon are then reattached. At least 12 nearby lymph nodes are also removed so they can be checked for cancer.
  • If all of the colon is removed, it’s called a total colectomy. Total colectomy isn’t often needed to treat colon cancer. It’s mostly used only if there’s another problem in the part of the colon without cancer, such as hundreds of polyps (in someone with familial adenomatous polyposis) or, sometimes, inflammatory bowel disease.

How it’s done

A colectomy can be done in 2 ways:

  • Open colectomy: The surgery is done through a single long incision (cut) in the abdomen (belly).
  • Laparoscopic-assisted colectomy: The surgery is done through many smaller incisions and special tools. A laparoscope is a long, thin lighted tube with a small camera and light on the end that lets the surgeon see inside the abdomen. It’s put into one of the small cuts, and long, thin instruments are put in through the others to remove part of the colon and lymph nodes.

Because the incisions are smaller in a laparoscopic-assisted colectomy than in an open colectomy, patients often recover faster and may be able to leave the hospital sooner than they would after an open colectomy. But this type of surgery requires special expertise, and it might not be the best approach for everyone. If you’re considering this type of surgery, be sure to look for a skilled surgeon who has done many of these operations.

Overall survival rates and the chance of the cancer returning are much the same between an open colectomy and a laparoscopic-assisted colectomy.

If the colon is blocked

When cancer blocks the colon, it usually happens slowly and the person can become very sick over time. In cases like this, a stent may be placed before surgery is done. A stent is a hollow metal or plastic tube that the doctor can put inside the colon and through the blockage using a colonoscope. This tube to keeps the colon open and relieves the blockage to help you prepare for surgery.

If a stent can’t be placed in a blocked colon or if the tumor has caused a hole in the colon, surgery may be needed right away. This usually is the same type of colectomy that’s done to remove the cancer, but instead of reconnecting the ends of the colon, the top end of the colon is attached to an opening (called a stoma) made in the skin of the abdomen. Stool then comes out this opening. This is called a colostomy and is usually only needed for a short time. Sometimes the end of the small intestine (the ileum) instead of the colon is connected to a stoma in the skin. This is called an ileostomy. Either way, a bag sticks to the skin around the stoma to hold the waste.

Once the patient is healthier, another operation (known as a colostomy reversal or ileostomy reversal) can be done to put the ends of the colon back together or to attach the ileum to the colon. Rarely, if a tumor can’t be removed or a stent placed, the colostomy or ileostomy may need to be permanent.

Common Surgical Procedures

inside-edition-surgical-servicesCommon Surgical Procedures

According to the American Medical Association and the American College of Surgeons, some of the most common surgical operations performed in the United States include

  • Appendectomy is the surgical removal of the appendix, a small tube that branches off the large intestine, to treat acute appendicitis. Appendicitis is the acute inflammation of this tube due to infection.
  • Cholecystectomy is surgery to remove the gallbladder (a pear-shaped sac near the right lobe of the liver that holds bile). A gallbladder may need to be removed if the organ is prone to troublesome gallstones, if it is infected, or becomes cancerous.
  • Hemorrhoidectomy is the surgical removal of hemorrhoids, distended veins in the lower rectum or anus.
  • Partial colectomy is the removal of part of the large intestine (colon) which may be performed to treat cancer of the colon or long-term ulcerative colitis.

Yes, Dr Matt Johnson does them all!

Trauma Surgery

downloadTrauma surgery is the branch of surgical medicine that deals with treating injuries caused by an impact. for example, a trauma surgeon may be called to the emergency room to evaluate a patient who is a victim of a car crash.

Trauma Explained

Trauma is the injuries suffered when a person experiences a blunt force. You may also hear trauma referred to as a “major trauma.” Many trauma patients are the victims of car crashes, stabbings, and gunshot wounds. Trauma can also be caused by falls, crush type injuries, and pedestrians being struck by a car.

Traumatic injuries can affect internal organs, bones, the brain, and the other soft tissues of the body. No area of the body is immune to trauma, but trauma can range from minor (hitting your finger with a hammer) to major (being hit by a car traveling at a high rate of speed or falling off of a building).

Who Performs Trauma Surgery

In the case of severe trauma, such as a catastrophic car crash, the trauma surgeon may be one part of a surgical team that includes general surgeons (to repair internal abdominal injuries), vascular surgeons (to repair damage to blood vessels), orthopedic surgeons (to repair broken bones), and other surgeons as needed.

The trauma team will include not only one or more surgeons, but also the paramedics who stabilize and transport the patient, nurses, anesthetist, respiratory therapist, radiographer, and the support of the medical laboratory scientists, including the blood bank.

For surgeons, extensive education is required in order to practice in their chosen field. As with all physicians, they first graduate from college with a bachelor’s degree and enter medical school for four years. For general surgeons, five years of surgical training as a residency is required. For surgeons who want to specialize, the same five-year residency is completed, followed by additional years of training in the area of specialization. Trauma surgery fellowships are usually one to two years long. Trauma surgeons often also serve a critical care fellowship. They take their boards for a certification in Surgical Critical Care.

From the Emergency Room to Surgery

A trauma surgeon has a different set of skills and functions from an emergency room doctor. When you arrive in the emergency room for any complaint, the ER doctor will see you, stabilize your condition, examine you, and order tests and imaging studies. She will alert the specialists needed, which may include the trauma surgeon. The ER doctor’s function includes referring you for admission or discharging you with appropriate treatment and follow-up referrals.

If your condition requires trauma surgery, you will be handed off to the trauma surgeon, who will become your provider. She will not only perform the surgery but you will also be followed by her and her team through recovery, rehabilitation, and discharge. When you need emergency surgery, you may be treated at the facility where you arrived, or you may be transported to a facility that has the specialists needed for your condition. The trauma surgeon may not be available to examine you until you arrive at her facility.

The trauma surgeon is often the person responsible for prioritizing which of your injuries will be treated first and determining the order of the diagnostic and operative procedures needed.

What is ERCP

What is ERCP?

Endoscopic Retrograde Cholangio Pancreatography (ERCP) is a method for getting into the bile duct and pancreas though the mouth. When invented over 40 years ago, ERCP was a breakthrough that allowed doctors to find local diseases. Today, most local diseases can be detected safely by non-invasive imaging tests such as Computed Tomography (CT), Magnetic Retrograde CholangioPancreatography (MRCP) scans and an endoscopic method of imaging called Endoscopic Ultrasound (EUS). ERCP is used mainly to treat diseases that have been detected by these means.ercp_medium

ERCP uses an endoscope, which is a long flexible narrow tube with a camera at the end. After the patient is sedated, the specialist passes the endoscope through the mouth and esophagus, to view the lining of the stomach and first part of the small intestine (the duodenum). The goal is to access the papilla of Vater, a small nipple in the duodenum. This papilla is the drainage hole for the bile and pancreatic duct, which bring digestive juices from the liver, gallbladder and pancreas. The doctor injects contrast dyes through the papilla into the ducts and takes X-rays to show lesions such as stones, strictures or blockages. Some of these can be treated right away with other instruments passed through the endoscope.

Hernia Basics

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Hernia Basic
A bulging of an organ or tissue through an abnormal opening.
Common
More than 200,000 US cases per year
Treatable by a medical professional
Usually self-diagnosable
Lab tests or imaging rarely required
Medium-term: resolves within months
Typically, a hernia involves the stomach or intestine.
Symptoms include a bulge, swelling, or pain. In some cases, there are no symptoms.
Treatment includes monitoring the condition. If needed, surgery can return tissue to its normal location and close the opening.
Ages affected
0-2 Common
3-5 Rare
6-13 Rare
14-18 Common
19-40 Common
41-60 Very common
60+ Very common
Genders affected
Males Very common
Females Common