Jeffrey Eric Criste

 Removal by surgery of the appendix, the

small worm-like appendage of the colon (the large bowel). An appendectomy is performed because of probable appendicitis , inflammation of the wall of the appendix generally associated with infection.  Appendicitis usually is suspected because of the medical history and physical examination. The pain of developing appendicitis is at first diffuse and poorly localized (not confined to one spot) but, as the inflammation extends through the appendix to its outer covering and then to the lining of the abdomen, the pain changes and becomes localized to one small area between the front of the right hip bone and the belly button. The exact point is named after Dr. Charles McBurney - McBurney's point. If the appendix ruptures and infection spreads throughout the abdomen, the pain becomes diffuse again as the entire lining of the abdomen becomes inflamed. Ultrasonography and computerized tomography also may be helpful in diagnosis.  Due to the varying size and location of the appendix and the proximity of other organs to the appendix, it may be difficult to differentiate appendicitis from other intraabdominal diseases.  The treatment for appendicitis is antibiotics and surgical removal of the appendix

Despite the development of non-surgical techniques, it is the most common method for treating symptomatic gallstones, although there are other reasons for having this surgery done. Each year more than 500,000 Americans have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. A cholecystectomy is performed when attempts to treat gallstones with ultrasound to shatter the stones or medications to dissolve them have not proved feasible.  One common complication of Cholecystectomy is an anomaly known as Ducts of Luschka, occurring in 33% of the population, is non-problematic until the gall bladder is removed, and the tiny supravesicular ducts may be incompletely cauterized or remain unobserved, leading to biliary leak post operatively. The patient will develop biliary peritonitis within 5 to 7 days following surgery, and will require a temporary biliary stent. It is important that the clinician recognize the possibility of bile peritonitis early and confirm diagnosis via HIDA scan to lower morbidity rate. Aggressive pain management and antibiotic therapy should be initiated as soon as

 Is the surgical removal of the gallbladder.

 Large bowel resection is surgery to

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remove part of your large bowel. The large bowel connects the small intestine to the anus. It is also called the large intestine or colon. Alternative Names: Large intestine surgery; Colon resection; Resection of part of large intestine; Colectomy; Proctocolectomy Description: In most cases, your bowel is cleaned before the surgery with enemas and medication. The surgery is performed while you are under general anesthesia. This means you are unconscious and pain-free. A cut is made in your abdomen. The diseased part of the large bowel is removed and the two healthy ends of the bowel are sewn back together (resected). The cut is closed. If the entire colon and rectum is removed, it is called a proctocolectomy.

 A bowel resection may be performed as

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a traditional "open" procedure or as a minimally invasive laparoscopic procedure . Indications: Large bowel resection is used to treat a variety of conditions, including: Colon cancer Diverticular disease A block in the intestine due to scar tissue Convalescence: Most patients will stay in the hospital for 5 to 7 days. Complete recovery from surgery may take 2 months. During the first few days after surgery, eating is restricted. Laparoscopic bowel resection for colon cancer may result in a faster recovery time than traditional open surgery.

A colostomy is an incision (cut) into the

colon (large intestine) to create an artificial opening or "stoma" to the exterior of the abdomen. This opening serves as a substitute anus through which the intestines can eliminate waste products until the colon can heal or other corrective surgery can be done. The bowel movements fall into a collection pouch. Our ostomy nursing staff will teach you skin care and how to change the bag.

 When is a colostomy needed?  A colostomy may be needed to divert intestinal contents in

conditions such as necrotizing enterocolitis ( an acute inflammatory disease of the bowel), imperforate anus (absence of anal opening) or Hirschsprung's Disease (a condition in which the nerves controlling bowel function are abnormal). Each one of these conditions will be explained in detail by your pediatric surgeon.  How is a colostomy created?  an abdominal opening is created  the intestines are brought out through the skin  the intestine is sutured to the skin

 Gastrectomy is the surgical removal of all or part of the  

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stomach. Purpose Gastrectomy is performed for several reasons, most commonly to remove a malignant tumor or to cure a perforated or bleeding stomach ulcer. Description Gastrectomy for cancer Removal of the tumor, often with removal of surrounding lymph nodes, is the only curative treatment for various forms of gastric (stomach) cancer. For many patients, this entails removing not just the tumor but part of the stomach as well. The extent to which lymph nodes should also be removed is a subject of some debate, but some studies show additional survival benefit associated with removal of a greater number of lymph nodes. Gastrectomy, either total or subtotal (also called partial), is the treatment of choice for gastric adenocarcinomas, primary gastric lymphomas (originating in the stomach), and the rare leiomyosarcomas (also called gastric sarcomas). Adenocarcinomas are by far the most common form of stomach cancer and are less curable than the relatively uncommon lymphomas, for which gastrectomy offers good

 After gastrectomy, the surgeon may "reconstruct" the

altered portions of the digestive tract so that it continues to function. Several different surgical techniques are used, but, generally speaking, the surgeon attaches any remaining portion of the stomach to the small intestine. Gastrectomy for gastric cancer is almost always done by the traditional "open" surgery technique, which requires a wide incision to open the abdomen. However, some surgeons use a laparoscopic technique that requires only a small incision. The laparoscope is connected to a tiny video camera that projects a picture of the abdominal contents onto a monitor for the surgeon's viewing. The stomach is operated on through this incision. The potential benefits of laparoscopic surgery include less postoperative pain, decreased hospitalization, and earlier return to normal activities. The use of laparoscopic gastrectomy is limited, however. Only patients with early stage gastric cancers or those whose surgery is only intended for palliation-pain and symptomatic relief rather than cure-should be considered for this minimally invasive technique. It can only be performed by surgeons

 This procedure involves dissecting the gall

bladder off of the liver, making a hole in the gall bladder and sewing it to a hole made in the small intestine  This allows bile to flow from the liver to gall bladder, then directly to the intestine - this is in essence a by-pass for bile so that it no longer needs to flow through the common bile duct  Indications for cholecystoduodenostomy  scarred or constricted common bile duct which does not allow bile to pass through to the intestine  tumor of the common bile duct  pancreatitis which causes the common bile duct to swell shut

 A colectomy is surgery to remove all or part of the

colon, which is the large intestine, measuring  about 5 feet (150 centimeters) long. The colon stores and mobilizes waste until it is eliminated from the body. It extends from the small intestine to the rectum, which is the lower 6 inches (15 centimeters) or so of the large intestine. A hemicolectomy (removal of about one-half of the colon) is the primary treatment for colorectal cancer. The amount of colon removed during the procedure depends on how extensive the cancer has penetrated the wall of the bowel. It also depends on whether or not the cancer has metastasized (spread) to the lymph nodes or other areas of the body.

 Most people have a good outcome following a colectomy.

Statistics reveal no recurrence of cancer in more than 80 percent of early-stage patients more than four years after surgery, according to the American Academy of Family Physicians.  The types of colectomies include:  Total colectomy. The entire colon is removed.  Right hemicolectomy. Right part of the colon is removed. This procedure is called ileocolectomy when the lower small intestine is removed as well.  Left hemicolectomy. Left portion of the colon is removed.  Segmental resections or partial colectomies. Smaller colon segments are removed.

 During a colectomy, the surgeon removes the part of the colon that

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contains the cancer. A portion (margin) of surrounding normal tissue is also removed to reduce the chances of stray cancer cells remaining in the body. Nearby lymph nodes may be removed for biopsy to determine if the cancer has spread. The surgeon will then try to reconnect the healthy portions of the colon or rectum. In some cases, this is not possible because of the location of the cancer or other factors. In such situations, the patient may need an operation known as a colostomy. This procedure temporarily or permanently redirects body waste to an opening created in the patient’s abdomen where it is drained from the body into an attached bag. Colectomy is also used to treat other medical disorders that may or may not be related to colorectal cancer. For example, a rare, inherited syndrome known as familial adenomatous polyposis (FAP) sometimes requires removal of the entire colon and rectum. This procedure is known as ileal pouch-anal anastomosis, in which the surgeon usually constructs a pouch from the end of the small intestine that attaches directly to the anus. Waste is then expelled normally, although bowel movements frequently are watery. Other conditions that may require a colectomy include: Precancerous polyps Diverticular disease Intestinal blockage due to scar tissue Chronic inflammatory bowel disease, such as ulcerative colitis or Crohn's disease Fecal incontinence Traumatic injuries

 A lobectomy is the removal of a lobe of one of the

organs, usually referring to the brain, the lung, or the liver.  Purpose  Lobectomies are usually performed to prevent the spread of cancer from part of one organ to other parts of the organ or other parts of the body. Lobectomies are also performed on patients with severe seizure disorders (such as some forms of epilepsy) to prevent further seizures. However, there are differences in each of the three organs on which lobectomies may be performed.  The liver has an amazing ability to repair itself. Even if up to three-quarters of the liver is removed it will start to re-grow very quickly, and may be back to normal size within a few weeks.

Sometimes a lobe of the liver may be removed.  This is called lobectomy. If you have no underlying medical problems with your liver (such as cirrhosis) it is possible for the liver to grow back following surgery and work normally.  It is often possible to remove fibrolamellar HCC, as this is more likely to

 A splenectomy is a procedure that involves the removal of the spleen by

operative means.  The spleen, similar in structure to a large lymph node, acts as a blood filter. Current knowledge of its purpose includes the destruction of old red blood cells and platelets, and the detection and fight against certain bacteria. It's also known to create new blood cells. The spleen is enlarged in a variety of conditions such as malaria, mononucleosis and most commonly in "cancers" of the lymphatics, such as lymphomas or leukemia.  It is removed under the following circumstances:  When it becomes very large such that it becomes destructive to platelets/red cells  For diagnosing certain lymphomas  When platelets are destroyed in the spleen as a result of an auto-immune process  When the spleen bleeds following physical trauma  Following spontaneous rupture  For long-term treatment of congenital erythropoietic porphyria (CEP) if severe hemolytic anemia develops.

 The classical cause of traumatic damage to the

spleen is a blow to the abdomen during a sporting event. In cases where the spleen is enlarged due to illness (mononucleosis), the smallest things such as leaning over a counter or straining at stool can cause it to rupture.  Procedure  Vaccination for pneumococcus, H. influenza and meningococcus should be given pre-operatively if possible. In general, spleens are removed by laparoscopy (minimal access surgery) when the spleen is not too large and when the procedure is elective. It is performed by open surgery for trauma or large spleens. Both methods are major surgeries, and are performed under general anesthesia. The spleen is located and disconnected from its arteries. The ligaments holding the spleen in place are dissected and the spleen is removed. When indicated a drain is left in place and the incision(s) is closed. If necessary, tissue samples are sent to a laboratory for

 A laparotomy is a large incision made into the abdomen.

Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity.  Purpose  Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Injuries may occur as a result of blunt trauma (e.g., road traffic accident) or penetrating trauma (e.g., stab or gunshot wound). Because of the nature of the abdominal organs, there is a high risk of infection if organs rupture or are perforated. In addition, bleeding into the abdominal cavity is considered a medical emergency. Exploratory laparotomy is used to determine the source of pain or the extent of injury and perform repairs if needed.

 Laparotomy may be performed to determine the

cause of a patient's symptoms or to establish the extent of a disease. For example, endometriosis is a disorder in which cells from the inner lining of the uterus grow elsewhere in the body, most commonly on the pelvic and abdominal organs. Endometrial growths, however, are difficult to visualize using standard imaging techniques such as x ray, ultrasound technology, or computed tomography (CT) scanning. Exploratory laparotomy may be used to examine the abdominal and pelvic organs (such as the ovaries, fallopian tubes, bladder, and rectum) for evidence of endometriosis. Any growths found may then be removed.  Exploratory laparotomy plays an important role in the staging of certain cancers. Cancer staging is used to describe how far a cancer has spread. A laparotomy enables a surgeon to directly examine the abdominal organs for evidence of cancer and remove samples of tissue for further examination. When laparotomy is used for this use, it is called

 Description  The patient is usually placed under general anesthesia

for the duration of surgery. The advantages to general anesthesia are that the patient remains unconscious during the procedure, no pain will be experienced nor will the patient have any memory of the procedure, and the patient's muscles remain completely relaxed, allowing safer surgery.  Incision  Once an adequate level of anesthesia has been reached, the initial incision into the skin may be made. A scalpel is first used to cut into the superficial layers of the skin. The incision may be median (vertical down the patient's midline), paramedian (vertical elsewhere on the abdomen), transverse (horizontal), T-shaped, or curved, according to the needs of the surgery. The incision is then continued through the subcutaneous fat, the abdominal muscles, and finally, the peritoneum. Electrocautery is often used to cut through the subcutaneous tissue as it has the ability to stop bleeding as it cuts. Instruments called retractors may be used to hold the incision open once the abdominal cavity has been exposed.

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