General Surgery

General Surgery

General Surgery is a specialty that focuses on abdominal contents, thyroid, skin diseases, hernias, and much more. The scope of this specialty is wide and encompasses many areas. Some common procedures that our surgeons perform routinely at Midland Surgical Associates include:

Hemorrhoidectomy

Hemorrhoids are collections of blood vessels in the anal canal. They can be either internal (causing rectal bleeding) or external (causing an inflamed mass) around the anus. Constipation is a common cause. Other causes can be poor diet, lack of exercise, genetics, and aging.

There are several different hemorrhoidectomy techniques, depending upon your case. After the procedure, you will be given diet restrictions for a period of time.

  • Excisional Hemorrhoidectomy

In an excisional hemorrhoidectomy, the hemorrhoid is excised with the patient under general anesthesia. This procedure has a greater long-term benefit for severe hemorrhoids.

Transanal Hemorrhoidal Dearterialization

This procedure is minimally invasive and used for internal hemorrhoid tissue that is protruding from the anus. The arterial blood inflow is located with ultrasound, and the arteries are tied off. The protruding tissue is then sutured back to its normal state.

Stapled Hemorrhoidectomy

This procedure removes most of the internal hemorrhoid tissue and repositions the rest of the hemorrhoidal tissue back to its anatomic position. It is less painful than complete removal, and is recommended for less severe disease.

Hernia Repair

A hernia is a protrusion of tissue or part of an organ through a defect in the abdominal wall. These can be painful and are either congenital or acquired. A bulge or sac may form near the groin or in the abdomen causing pain during lifting, coughing, urination, or bowel movements. Surgery may be performed either open or laparoscopically.

The surgical techniques to repair hernias vary depending upon the type and severity of the hernia. Laparoscopic surgery is sometimes possible. In some cases, mesh is inserted to reinforce the portion of the abdominal wall in which the herniated tissue is protruding. Below are the four types of hernias:

  • Inguinal Hernia: This is one of the most common hernias. The groin area is weakened either at birth or later in life, causing a hernia, which forms a bulge.
  • Hiatal Hernia: This type of hernia occurs higher in the abdomen where the stomach meets the esophagus. When this happens, a part of the stomach will periodically herniate into the chest.
  • Incisional Hernia: A type of hernia that protrudes through scars of previous surgical incisions. They are more often associated with postoperative coughing, weight issues, or wound issues during the original operation.
  • Umbilical Hernia: This is a hernia at the site of the umbilicus or “belly button.” It is a protrusion of the abdominal contents either congenital or acquired.

Portacath (Venous Access)

A Portacath is a small medical implant inserted beneath the skin. The portacath (port) has a catheter that connects to a vein. Medications can then be injected, and blood samples can be drawn through this port.

Portacaths are usually inserted in the upper chest below the clavicle for ease of access. They are most commonly used for cancer and kidney dialysis patients.

Pancreatectomy

This procedure involves the surgical removal of part of the pancreas or, in severe cases, the entire pancreas in cases of cancer, tumors, or cysts. This surgery can be done using traditional open surgery or, in some cases, less invasive laparoscopic surgery.

A pancreaticoduodenectomy or Whipple procedure is a more complex procedure that involves the removal and reconstruction of parts of the pancreas, intestine, gallbladder, bile duct, and regional lymph nodes.

Thyroid Surgeries

The thyroid gland is found in the neck and serves to regulate the body’s metabolism by making thyroid hormone.

Thyroidectomy: This surgical procedure removes part or all of the thyroid gland. It is performed when a patient has thyroid cancer, hyperthyroidism, or goiter (enlarged thyroid). Sometimes, an obstruction that causes difficulty in breathing or swallowing can also require thyroid surgery.

Below are some of the techniques that may be involved in a thyroidectomy:

Thyroid lobectomy: If a thyroid nodule is confined to just one area, one side of the thyroid can be removed in this procedure.

Subtotal thyroidectomy: For hyperthyroidism caused by an overactive thyroid or small cancers, this procedure involves removal of one complete side and part of the other side of the thyroid.

Total thyroidectomy: In this procedure, the entire thyroid gland and surrounding lymph nodes are removed. This is the most common procedure for thyroid cancer, in order to completely remove the disease. 

Parathyroidectomy: This procedure involves the surgical removal of one or more parathyroid glands. Normally, parathyroid glands help regulate the amount of calcium in the blood. Tumors or an overactive condition of these glands may require surgery.

Lymph Node Surgeries

  • Lymph Node Excision: This procedure involves the surgical removal of one or more groups of lymph nodes. It is most often done to remove tumors and cancer cells found in the lymphatic system. Depending on the type of cancer, a specific set of lymph nodes is tested and/or removed via surgery to help manage the cancer.
  • Sentinel Lymph Node: This is a test procedure involving the excision of a key lymph node to determine if cancer is present. If this lymph node does not contain cancer, there is a high likelihood that the cancer has not spread to other lymph nodes. It is an alternative to other types of more extensive lymph node operations.

Skin Cancer Surgeries

Surgical excision is the most common form of treatment for skin cancers. If the amount of skin removed is extensive, reconstructive surgery may be necessary to restore a healthy and normal appearance to the area.

Mohs surgery is a method that is often used to excise skin cancer. Small amounts of tissue are taken at a time and examined under a microscope until no more signs of cancer are present. In this way, the maximum amount of healthy tissue is maintained.

Basal Cell Carcinoma: This is the least aggressive form of skin cancer, and it originates from the lowest layer of the epidermis. This cancer usually presents as a raised, smooth, pearly bump on the head, neck, face, or shoulders.

Squamous Cell Carcinoma: This type of skin cancer lesion often looks like a red, scaling, thick patch on an area that has been sun-exposed. Ulceration and bleeding may accompany this type of cancer. It is more aggressive than basal cell carcinoma but not as serious as melanoma.

Melanoma: This is the most aggressive of all skin cancers. The lesions are usually brown, black, or pink/red. Warning signs of melanomas can be seen in changes in size, shape, color or elevation, or bleeding from the moles.

Esophageal Cancer Surgeries

Esophageal cancer can be squamous cell in the upper part of the esophagus or adenocarcinoma in the glandular cells at the junction of the esophagus and stomach. Symptoms include difficulty swallowing and weight loss. Depending on the size and location of the tumor, a surgical procedure can be performed to remove a segment of the esophagus.

Gastrectomy

A gastrectomy involves the partial or full removal of the stomach. The main reason for performing a gastrectomy is to treat cancer. Duodenal ulcers can also warrant removal of the lower portion of the stomach and the upper portion of the small intestine. A patient whose stomach is removed will have to follow a special diet for the rest of his life to prevent unwanted side effects.

Liver Resection

Also known as a hepatectomy, a liver resection is done to treat benign or malignant tumors or cysts of the liver. This procedure is a traditional open surgery under general anesthesia in which a portion of the liver is removed. No one can live without a liver, so if the entire liver had to be removed, a transplant would have to take place during the surgery.

Colon Surgeries

Colorectal Cancer: Colorectal cancer develops from abnormal cell growth in the colon or rectum. Some common symptoms are rectal bleeding and anemia accompanied by weight loss and a change in bowel habits. If the cancer is localized, an open laparotomy or a laparoscopic procedure can be done to remove it.

Colostomy

A colostomy is surgery to remove part of the colon and reconnect it to the abdominal wall. An opening called a stoma is created through the abdominal wall where stool can exit the body using a colostomy bag. The types of colostomy are:

  • Sigmoid Colostomy: This involves removal of the last section of the colon, or it is disconnected and reconnected to the stoma, which is usually on the lower left side of the abdomen.
  • Descending Colostomy: In this procedure, the sigmoid colon and part of the descending colon are removed or disconnected, and the stoma is usually on the left side of the abdomen.
  • Transverse Colostomy: This technique involves removal or disconnection of the sigmoid, descending, and part of the transverse colon. The stoma is on the right, middle, or left side of the upper abdomen.

Diverticulosis/Diverticulitis

Diverticulosis is a condition in which small pouches have formed on the colon wall. Over time, these pouches can become infected, causing diverticulitis. Symptoms include pain, fever, and chills. Surgery can become necessary if the intestine ruptures.

Surgical procedures for diverticular disease include a bowel resection or a bowel resection with a colostomy. These can be done as open surgery or, in some cases, laparoscopically. A bowel resection consists of removing the diseased or ruptured part of the intestine and reconnecting it to healthy segments of the colon. If the resection necessitates a colostomy, it is often done temporarily with the option to reverse the colostomy after the postsurgical inflammation of the colon heals.

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