Inguinal Hernia Repair
Inguinal hernia repair is surgery to repair a hernia in the abdominal wall of the groin. A hernia is tissue that bulges out of a weak spot in the abdominal wall. During hernia repair, this bulging tissue is pushed back in. The abdominal wall is then strengthened and supported with sutures (stitches), and sometimes mesh. The procedure is typically performed under general anesthesia (asleep and pain-free) or spinal anesthesia. If the hernia is small, the patient may receive local anesthesia, and be awake but pain-free. The surgery is performed either laparoscopically or as an open surgery. Laparoscopic surgery may not be recommended for larger or more complicated hernias, or for growing hernias on both sides.
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A colectomy is a surgical procedure to remove all or part of the colon. The colon, also called the large intestine, is a long tube-like organ at the end of your digestive system. Colectomy may be necessary to treat or prevent diseases and conditions that affect the colon. These include Crohn’s disease, colon cancer tumors, or severe constipation, called colonic inertia. There are various types of colectomy operations: a total abdominal colectomy is the removal of the large intestine from the lowest part of the small intestine (ileum) to the rectum. After it is removed, the end of the small intestine is sewn to the rectum. A partial colectomy involves removing part of the colon and may also be called subtotal colectomy. A hemicolectomy involves removing the right or left portion of the colon. A proctocolectomy involves removing both the colon and rectum. For these surgeries, the patient receives general anesthesia.
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A diagnostic laparoscopy is a procedure that allows the doctor to look directly at the contents of a patient’s abdomen or pelvis. This procedure is done in the hospital under general anesthesia (while you are asleep and pain-free). Very rarely, this procedure may also be done using local anesthesia. This numbs only the area affected by the surgery and allows the patient to stay awake.
A diagnostic laparoscopy involves a surgeon making a small cut below the belly button (navel) and inserting a needle into the area. Carbon dioxide gas is passed into the abdomen to expand the area. This gives the surgeon more room to work, and helps the surgeon see the organs more clearly. Then a tube is placed through the cut in the abdomen. A tiny video camera (laparoscope) goes through this tube and is used to see the inside of the pelvis and abdomen. More small cuts may be made if other instruments are needed to get a better view of certain organs. If it is a gynecologic laparoscopy, dye may be injected into the cervix area so the surgeon can better see the fallopian tubes. Our partners at Hospital Clinico San Rafael Arcangel have recently installed the most modern and sophisticated laparoscopy equipment available today.
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Laparoscopic Gall Bladder Removal
Gallbladder removal is one of the most commonly performed surgical procedures in the United States. Today, gallbladder surgery is performed laparoscopically. The medical name for this procedure is Laparoscopic Cholecystectomy. Gallbladder problems are usually caused by the presence of gallstones: small hard masses consisting primarily of cholesterol and bile salts that form in the gallbladder or in the bile duct. It is uncertain why some people form gallstones and there is no known means to prevent them. Gallstones do not go away on their own. Some can be temporarily managed with drugs or by making dietary adjustments, such as reducing fat intake. This treatment has a low, short-term success rate. Symptoms will eventually continue unless the gallbladder is removed. Surgical removal of the gallbladder is the time honored and safest treatment of gallbladder disease.
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A laparoscopic splenectomy is the extraction of the spleen through laparoscopic surgery. Numerous case reports have repeatedly demonstrated the safety (mortality rates <1%) and efficacy of this technique. Indeed, it is now considered standard of care for most elective normal size spleens. The spleen is removed while the patient is under general anesthesia (asleep and pain-free). Depending on the situation, the surgeon may do either an open splenectomy or a laparoscopic splenectomy. Some conditions that may require spleen removal include an abscess or cyst in the spleen, cirrhosis of the liver, certain disorders of blood cells (e.g., idiopathic thrombocytopenia purpura), lymphoma, Hodgkin disease, leukemia, or trauma to the spleen.
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A laparoscopic salpingectomy refers to the surgical removal of a Fallopian tube. The fallopian tubes are part of the reproductive system in women and form the needed connection between the ovaries and the uterus. Sometimes disease is present in one or both of the tubes, or other conditions like fluid build-up or ectopic pregnancy damages a single tube. In these instances and in other circumstances, salpingectomy could be considered. Occasionally it’s necessary to remove both tubes, which is called a bilateral version of the procedure.
The basic procedure for a salpingectomy is to use laparoscopy. This creates a tiny incision, which allows removal of the tube. Under certain circumstances, a larger incision is required, and laparotomy or stomach incision is necessary instead. Patients can’t always know ahead of time what incision to expect since a doctor may have to change his/her mind based on conditions found during surgery. It is fair to state that laparoscopic removal is more common, however, and that some women might expect to go home on the day of their surgery or could spend a few days in the hospital recovering first. A laparoscopic salpingectomy is normally done in the hospital under general anesthesia. Very rarely, this procedure may also be done using local anesthesia. This numbs only the area affected by the surgery and allows the patient to stay awake.
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A vasectomy prevents the release of sperm when a man ejaculates and is considered a permanent method of birth control. During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body (this also happens to sperm that are not ejaculated after a long while). Because the tubes are blocked before the seminal vesicles and prostate, the patient will still ejaculate about the same amount of fluid. It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or be reabsorbed. As a result, the patient must use another method of birth control until a semen sample test shows a zero sperm count.
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Transurethral Resection of the Prostate (TURP)
A TURP is a type of prostate surgery done to relieve moderate to severe urinary symptoms caused by an enlarged prostate, a condition known as benign prostatic hyperplasia (BPH). During TURP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of the penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by the prostate. Using the resectoscope, the doctor trims away excess prostate tissue that’s blocking urine flow and increases the size of the channel that allows the bladder to empty. This method is one of the most compelling options for treating urinary symptoms caused by BPH and has a long history as an effective treatment with low mortality. However, there are a number of newer highly efficient methods that have recently become popular. To determine whether TURP or another treatment is the right choice, the doctor will consider how severe are the symptoms, and what other health problems the patient may have, and the size and shape of the prostate.
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Transurethral Vaporization of the Prostate (TUVP)
A TUVP is a prostate surgery using advanced laser methods to perform a prostatectomy. A telescope is placed into the urethra up to the prostate, and then the doctor uses a laser to vaporize prostate tissue that is obstructing flow of urine from the bladder. During the process, the small blood vessels in the prostate are sealed off. There is less bleeding during and after this procedure than there is with the TURP. As a result, patients can leave the hospital the same day or next morning. Laser Prostatectomy is done under general or spinal anesthesia as an outpatient procedure. Most patients keep a foley catheter for less than 24 hours. Other benefits include long-lasting relief of BPH symptoms, the ability to stop BPH medications, and faster return to normal activities.
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A radical prostatectomy is a surgical procedure that removes the prostate gland and attached seminal vesicles. Lymph nodes near the prostate can be removed at the same time. Radical prostatectomy is one treatment option for men with localized prostate cancer. This operation may be done by open surgery, or by laparoscopic surgery through small incisions. In open surgery, the surgeon makes an incision to reach the prostate gland. Depending on the case, the incision is made either in the lower belly or in the perineum between the anus and the scrotum. When the incision is made in the lower belly, it is called the retropubic approach. The surgeon may also remove lymph nodes in the area so that they can be tested for cancer. When the incision is made in the perineum, it is called the perineal approach. The recovery time after this surgery may be shorter than with the retropubic approach. If the surgeon wants to remove lymph nodes for testing, he or she must make a separate incision. If the lymph nodes are believed to be free of cancer based on the grade of the cancer and results of the PSA test, the surgeon may not remove lymph nodes.
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Varicocele is an abnormal enlargement of the pampiniform venous plexus in the scrotum. This plexus of veins drains the testicles. The testicular blood vessels originate in the abdomen and course down through the inguinal canal as part of the spermatic cord on their way to the testis. Upward flow of blood in the veins is ensured by small one-way valves that prevent back-flow. Defective valves, or compression of the vein by a nearby structure, can cause dilatation of the testicular veins near the testis, leading to the formation of a varicocele.
Most men diagnosed with a varicocele have no symptoms, but varicoceles are important for several reasons. Approximately 40 percent of cases of primary male infertility and 80 percent of cases of secondary male infertility are believed to be due to varicoceles. Varicoceles can be discovered through self-examination or during routine physical examination. They may look or feel like a mass in the scrotum, and they have been described as having a “bag of worms” both because of their appearance and the way they feel. Surgical intervention of varicoceles is an appropriate consideration in patients with infertility, pain or testicular atrophy. Surgical repair involves ligation (obstructing) of the spermatic veins thus interrupting blood flow in the vessels of the pampiniform venous plexus. The surgical approaches include open surgical repairs performed through a single 1 inch incision with or without the use of optical magnification. Laparoscopic varicocele repair which utilizes telescopes passed through the abdominal wall are advocated by some. The open procedures are performed under a variety of anesthetics, from local to general anesthesia, whereas the laparoscopic approach is uniformly performed under a general anesthetic agent. With the advent of smaller incisions, which avoid muscle transection, the open procedures are becoming closer to the laparoscopic techniques in both speed of recovery and postoperative pain.
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Urethral sling surgeries to treat urinary incontinence involve placing a sling around the urethra to lift it back into a normal position and to exert pressure on the urethra to aid urine retention. The sling is attached to the abdominal (belly) wall. The sling material may be muscle, ligament, or tendon tissue taken from the woman or from an animal, such as a pig. It may also be composed of synthetic material such as plastic that is compatible with body tissues or of absorbable polymer that disintegrates over time.
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Transurethral Resection of the Bladder
Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is often used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A camera lens at the end of the cystoscope will send pictures from the inside of the bladder to a monitor. The surgeon will look at these images on the monitor to locate the unusual growth or tumors on the bladder wall. Using a special wire loop, he or she will cut away the tumor and a border of healthy tissue around it. The surgeon may also pass an electric current down the wire loop to seal the wound. He or she will then take the cystoscope out and pass a thin, flexible tube (catheter) into your urethra. This will be left in place for about 24 hours. The tissue removed in the procedure will be sent to a laboratory for testing. The operation can take between 15 and 40 minutes.
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