Procedures

Walden Surgical Associates performs a spectrum of general surgical procedures and specializes in treating gastrointestinal conditions – diseases of the stomach and intestines – with laparoscopic (minimally invasive) surgery, as well as breast surgery and melanoma surgery.

Cholecystectomy (Gallbladder Removal)

Cholecystectomy is performed when the gallbladder needs to be removed—in most cases, due to gallstones. Laparoscopic cholecystectomy is the gold standard treatment; 90 percent of patients have their surgery performed this way.

The surgery is performed through four small incisions, or ports, used for laparoscopic procedures. The gallbladder can then be placed in a small bag and removed through one of the ports. Laparoscopic gallbladder surgery rarely requires a hospital stay.

Laparoscopic gallbladder surgery offers the patient several benefits:

  • Quick recovery. Some patients experience very little pain. Most patients can return to normal daily activities within a few days or a week.
  • No dietary restrictions following the surgery. The body adjusts rapidly to not having a gallbladder.

Hernia Repair

Surgery to repair a hernia—a defect in the abdominal wall that results in a bulge or tear—has advanced steadily during the past decade. Many hernias require no treatment; surgical repair is usually recommended when they cause pain or a burning sensation.

Hernia repairs are now performed laparoscopically using mesh materials to patch the defect. There are two broad categories of hernia: inguinal and ventral.

  • Inguinal hernias are located in the groin area, are more common in men and are often easily repaired. In this procedure, mesh is placed over the hernia. When scar tissue forms over the mesh, the hernia closes up. Patients experience less pain, need less pain medication and return to their normal activities, including work, fairly quickly. Most patients are able to return home a few hours after their surgery.
  • Ventral hernias are more complex, as they often develop near the site of previous surgery; these are called incisional hernias. This procedure requires tacks and sutures to attach the mesh over the defect, which often results in more pain than inguinal hernia repairs. However, when ventral hernia repairs are performed laparoscopically, there is less chance of wound complications and a possible lower recurrence rate. Patients typically stay in the hospital for one day.

Breast Surgery

Surgery to treat breast cancer ranges from breast-conserving surgery, such as a lumpectomy, to a partial or full mastectomy, which removes the entire breast. A lumpectomy removes the cancer and some of the surrounding breast tissue in order to obtain a clean margin of at least 2 millimeters. Lumpectomy typically is followed by additional treatment, such as radiation, chemotherapy or hormonal therapy.

Surgery also is performed to check the lymph nodes located under the arm, as this can determine if the cancer has spread. This procedure, sentinel lymph node biopsy, uses radiosensitive and blue dye to determine if, and how many, lymph nodes are positive. The surgeon can then proceed appropriately in removing the nodes (sentinel nodes). In some cases, all nodes under the arm must be removed, a procedure known as axillary lymph node dissection. Breast reconstruction, which is performed by one of our skilled plastic surgery colleagues, often can be done during the initial surgery or after the course of treatment is complete.

Colorectal Surgery

Many colorectal surgical procedures can be performed laparoscopically. The main reasons to perform colorectal surgery include:

  • A diagnosis of colon (large intestine) cancer
  • To remove polyps that either are too large to remove during a colonoscopy or appear to be cancerous
  • To treat diverticulitis, a condition where small sacs or pouches form in the intestinal lining, usually the colon, and become inflamed or infected

In addition, small bowel (small intestine) surgery can also be performed to treat:

  • Small bowel obstruction
  • Tumors
  • Inflammatory bowel disease

There are several benefits to laparoscopic colorectal surgery:

  • Less pain
  • Fewer wound complications, blood transfusions and intestinal blockages
  • Shorter hospital stay

Patients who have laparoscopic colorectal surgery can expect a hospital stay of three to four days. Those who have traditional open surgery may need five to seven days before their bowel function returns to normal, and they can go home.

Anorectal Surgery

A number of disorders can occur at the junction of the anal canal and rectum, including hemorrhoids, anal fissures and abscesses.

Hemorrhoids

Internal hemorrhoids, which bleed painlessly, can be treated via rubber-band ligation, an office procedure that cuts off the blood supply and causes the hemorrhoid to fall off.

Large internal hemorrhoids or external hemorrhoids can cause pain and burning. Surgical treatment is very effective and has a low recurrence rate. However, this surgery usually requires a recovery period of up to two weeks.

Anal Fissures

Anal fissures are tears in the rectal lining that can occur due to either hard stool or diarrhea, resulting in involuntary spasm in the sphincter. If conservative therapy fails, surgery is often the next step. During surgery, a small cut is made in the sphincter that stops the spasm and allows healing to occur.

Peri-anal Abscesses

Anal abscesses result when a crypt or gland becomes blocked, which can be very painful and cause a fever. During surgery, the abscess is drained, either in the office or the operating room, to avoid formation of a fistula—an abnormal tract that may develop when an anal gland is blocked.

Melanoma Surgery

Melanoma is highly curable if detected early and can be removed via a same-day surgical procedure. Depending on the thickness of the melanoma—thicker than 1 millimeter—surgical treatment includes sentinel lymph node biopsy. This involves injecting radiosensitive and blue dye near the tumor; those lymph nodes that have changed color or look abnormal can then be removed. If more than three lymph nodes are found to be positive, some patients will need to have all lymph nodes in the area surgically removed. Sentinel node biopsy is the best way to determine whether or not the cancer has metastasized. It also helps obtain information for prognosis and decision-making about the need for additional treatment

Endocrine Surgery (Thyroid & Parathyroid surgery)

Thyroid surgery may be recommended for cancer, a suspicious nodule or some benign (non-cancerous) conditions, such as a large thyroid gland (goiter), overactive thyroid (Graves’ disease) or toxic nodule. The most common thyroid operations are the lobectomy, which removes half of the gland, and the total thyroidectomy, which removes all identifiable thyroid tissue. The advantage of having a lobectomy is that patients may not need to take thyroid hormone pills.

The most common reason for surgical removal of the parathyroid is hyperparathyroidism. Treatment typically consists of surgery to remove the one parathyroid gland (there are four) that is over-producing hormone. The abnormal gland often can be localized with imaging prior to surgery, which may allow the surgeon to perform a minimally invasive parathyroidectomy through a smaller incision. In about 10 percent of cases, where all four glands are involved, half of one gland is preserved and moved to the forearm to maintain hormonal function.

Diagnostic Laparoscopy

Diagnostic laparoscopy is performed for several reasons, including to conduct lymph node biopsies or when a diagnosis for unexplained abdominal pain cannot be made through other diagnostic testing. The diagnostic laparoscopy:

  • Enables a complete look at the entire abdomen without a major open surgical procedure
  • Prevents patients from having unnecessary open surgery
  • In some cases, allows immediate treatment

In some instances, a hernia or adhesion resulting from an earlier surgery, infection or inflammation is discovered through this procedure. In these cases, the surgeon can then perform a hernia repair immediately or, if adhesions are found, perform a procedure called lysis. During lysis of adhesions, the surgeon carefully cuts away the scar tissue, freeing the abdominal organs and the source of pain.

Appendectomy

An appendectomy—surgical removal of an inflamed appendix—is the most common acute emergency procedure performed in the U.S. Fortunately, over the last 20 years, the surgery is increasingly performed laparoscopically, with more than 60 percent of cases done this way. There are many benefits:

  • Fewer wound infections
  • Less pain
  • Shorter hospital stay, with many patients going home within 24 hours of having surgery.

Venous Access Devices

A central venous access device, or CVAD, includes a catheter (a thin, flexible hollow tube) that is inserted into and positioned within a vein to deliver therapy to the bloodstream. A CVAD allows intravenous medications to be given easily and saves the patient from the discomfort of repeated needle sticks.

There are two general types of CVADs: catheters and ports. Catheters have one end positioned outside the body, while ports are surgically placed under the skin and require a special needle for access. With both catheters and ports, the opposite end of the tubing is positioned within the large vein near the heart.

Soft Tissue Procedures

  • Sebaceous cysts and epidermal inclusion cysts are very common. They occur when skin grows ‘upside down.’ In cases where they become infected, they can be removed in the office.
  • Lipomas, which are slow-growing, benign lumps, may be removed in the office or the operating room, depending on their size and location. They most commonly occur on the neck, shoulders, back, abdomen, arms and thighs and can be painful if they begin to press on nearby nerves.
  • Muscle biopsy is the removal of a small piece of muscle tissue for examination. The biopsy involves making a small cut in the skin and into the muscle to remove the tissue. This test is performed to identify or detect diseases of the connective tissue and blood vessels, infections that affect the muscle, muscular disorders such as muscular dystrophy or metabolic defects of the muscle.
  • A temporal artery biopsy is a procedure in which a small piece of tissue is removed from the temporal artery and then studied under a microscope to check for signs of inflammation and damage. This procedure is performed when temporal arteritis (also known as giant-cell arteritis or cranial arteritis) is suspected. The patient can go home on the same day as the procedure.

Pilonidal Cysts

These cysts, which are caused by hairs that grow inward, are almost always located near the tailbone or buttocks. Pilonidal cysts occur most frequently in young men and women. They are harmless, but they are vulnerable to infection. If a patient develops pain and swelling in the area, and the skin becomes red, surgery is usually performed in the office to drain the cyst. If drainage becomes chronic, more definitive surgery is performed in the operating room to excise the “pits” that are the source of the inflammation. Wound closure can take two or more weeks.

Office Based Procedures

As a convenience for our patients and referring physicians, there are a number of small surgical procedures that we are able to do in our office environment. Please contact us for advice and consultation.