What is a Surgicalist?

A surgicalist is a surgeon, trained like any other surgeon with the same specialty. The difference lies in where and how they practice. Surgicalists work only within a hospital and their practice centers on emergent/urgent care of patients, with no other patients outside of the ER. This allows for dedicated scheduling, and at a surgicalist-staffed hospital, there is always a surgicalist available to take emergent/urgent surgery cases. This translates to shorter wait times for patients, and better post-operation results. It’s simple: surgicalists are the newer, better way to provide emergency surgery to patients in need.

Typical procedures that our surgeons perform are Appendectomy, Cholecystectomy, and Colectomy. Please note: If you would like a Valley Surgicalist Group surgeon to perform your surgical procedure please call (623)-512-4326..

APPENDECTOMY

What is appendicitis?

Quite simply, appendicitis is the inflammation of the appendix. It is the most common medical emergency in the United States, and if left untreated can be deadly. It is unclear what actually causes appendicitis, though researchers believe that it is caused by an obstruction in the appendix. This obstruction can be partial or complete, in the latter case, emergency surgery is performed. 

What are the signs and symptoms?

Common signs and symptoms of appendicitis include:

 

  • Lower right side abdominal pain
  • Loss of appetite
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Inability to pass gas
  • Abdominal swelling
  • Low grade fever
  • A sense you might feel better after passing stool

 

Pain associated with appendicitis often starts off mild, becoming more severe over time. If the patient feels right side tenderness along with any of the above symptoms, it is extremely important to call a doctor. A majority of patients who experience symptoms will end up with a ruptured appendix within 48 hours.

 

How is appendicitis diagnosed?

A doctor will perform a physical examination of the abdominal region, looking for any signs of swelling, tenderness, or hardness. To rule out other possibilities, a doctor might also perform a urinalysis to check for kidney stones, a pelvic exam to rule out reproductive problems, or a pregnancy test. A patient may also have abdominal imaging done to look for abscesses or other complications, or a chest x-ray to rule out pneumonia. In addition a CT scan may also be performed.

 

In most cases, appendicitis will require surgery, however treatment varies with each case. This surgery is performed more than 90% of the time laparoscopically. If an abscess is involved, the abscess may first need to be treated with antibiotics and drainage before surgery is performed. If rupture (without an abscess) of the appendix has happened, surgery is immediately necessary.

AFTER SURGERY

What is the recovery time?

Immediately following surgery, and depending on the type of pain medicine, a patient may feel out of sorts for 2-3 days. Full recovery can take up to 6-8 weeks. Some patients are able to return to work after 1 week, as long as no heavy lifting takes place. Heavy lifting and strenuous activity is not allowed for up to 6 weeks after surgery.

Are there any possible complications?

Like with any operation the most common complications are bleeding and infection. By infection what is meant is an abscess in the area where the appendix rests. As that area is infected in appendicitis, there is a chance that an abscess can develop about a week after surgery. In this case a drainage procedure may be required along with antibiotics. Other rarer complications may include the intestinal inability to move food (ileus), blood clots to the lungs or leakage of bowel contents from the site where the appendix was removed.

Are there long term consequences?

Generally there are no long term consequences. Some patients are at an increased risk of hernia or a stump appendicitis (an infection due to a retained portion of the appendix).

CHOLECYSTECTOMY

What is a cholecystectomy?

A cholecystectomy is the removal of the gall bladder. This procedure is prompted by either the presence of gallstones causing pain and possibly infection or a nonfunctioning gallbladder.

What are the symptoms of gallstones?

  • Sharp pain in the upper right abdomen which may extend around to the back
  • Low grade fever
  • Nausea
  • Feeling bloated
  • Jaundice

How is a cholecystectomy performed?

Before surgery is recommended, the patient may undergo a series of exams and tests to determine the severity of the problem.

 

Besides a complete physical exam, a patient may also require:

 

  • Blood tests and complete blood count
  • Liver function tests
  • Coagulation profile
  • Abdominal ultrasound
  • Cholescintigraphy (a test which evaluates possible obstruction)
  • Endoscopic retrograde cholangiopancreatography (ERCP) which diagnoses and treats problems with the biliary or pancreatic ductal system
  • Magnetic Resonance Cholangiopancreatography (MRCP) which is an MRI for the bile ducts Upon completion of all testing and exams,

 

Upon completion of all testing and exams, if a surgery is required there are two methods to remove the gall bladder: laparoscopic and open.

 

In a laparoscopic surgery (more than 90%), small incisions are made through which a narrow tube called a port is placed. Carbon dioxide is then pumped into the opening allowing the surgeon to see surrounding organs. The gallbladder is removed through this opening, and the area is closed with sutures or glue. The surgery typically take less than an hour.

 

During an open operation, an incision is made along the upper abdomen. The gallbladder is removed and the site is stapled or sutured closed. This process takes from 2-3 hours to complete.

AFTER SURGERY

What happens after surgery?

Upon waking up from anesthesia, the patient may be able to start drinking small glasses of water. If the patient is not feeling sick, eating may also be allowed. It will be important to continue to drink 8-10 glasses of water per day while recovering. A high fiber diet is also prescribed in order to ease potential pain from bowel movements.

 

Patients are urged to gradually increase activity levels and get up every hour or so to prevent blood clots.

What is the recovery time?

Immediately following surgery, and depending on the type of pain medicine, a patient may feel out of sorts for 2-3 days. Full recovery can take up to 6-8 weeks. Some patients are able to return to work after 1 week, as long as no heavy lifting takes place. Heavy lifting and strenuous activity is not allowed for up to 6 weeks after surgery.

What are the complications that may arise?

Complications that may possibly arise include:

 

  • Injury to the bile duct
  • Bleeding
  • Infection

 

There may be other risks due to the condition of the patient. Concerns should be addressed with the surgeon before the procedure. Patients experiencing any of the following should contact their doctor immediately:

 

  • Fever/chills
  • Swelling, redness, or bleeding at the incision site
  • Increased pain at the incision site
  • Abdominal pain or swelling
  • Pain behind the breastbone

COLECTOMY

What is a colectomy?

A colectomy is either the partial removal or total removal of the colon, also known as the large intestine.

There are many reasons why a patient may require this type of surgery. Some of these reasons include diverticulitis, inflammatory bowel disease, colon or rectal cancer, polyps, or bleeding that cannot be stopped.

How is a colectomy performed?

There are two methods of surgery for a colectomy, open and laparoscopic.

 

For an open (conventional) surgery, a long incision is made down the middle of the abdomen. If this method is required, the patient recovery time in the hospital is generally longer.

 

A laparoscopic surgery, or minimally invasive, requires the surgeon to uses several incisions with specialized tools. Once inside, the surgery is the exact same as an open surgery, however the recovery period is much faster and usually with less pain associated, as the incision site is much smaller than in an open operation. However in emergent situations the chance of a laparoscopic approach are greatly diminished.

What happens during surgery?

During a laparoscopic surgery, the surgeon places a narrow tube into a small incision in the abdomen measuring less than half an inch. Once inside, CO2 is pumped into the abdomen to create space for the surgeon to work. Using a laparoscope, which is a tiny telescope with an attached video camera placed inside the tube, the surgeon works by moving the tube through the organ while projecting a magnified image onto a high definition screen. Multiple tubes may be placed inside the abdomen so that assistants may aid the surgeon.

 

At the site of the removal, the colon is detached from surrounding abdominal walls and organs. Blood vessels which supply only that section of the colon are then sealed off. When the removed portion of the colon is ready to be taken out, one incision site is then enlarged to accommodate removal from the abdomen. The two sides of the remaining colon are then attached to one another with sutures or staples. The same process of removal applies during an open surgery, however, the surgeon is working with one incision site and with traditional handheld instruments.

 

AFTER SURGERY

What happens after surgery?

Immediately following the surgery, a patient is continued on IV to maintain hydration and wheeled to the recovery room where he or she will wake up from anesthesia.
Post-operative pain medication is administered to keep pain at a minimum. The patient can start drinking liquids once bowel function has returned, which could take 3-7 days. Being a major surgery, a patient can expect to be in the hospital anywhere from five to ten days.

What is the recovery time?

Recovery can take up to 6-8 weeks, though normal activity can resume in as little as two to three weeks following surgery.
During the six weeks following the surgery, a low-residue diet is recommended to cut down on the amount of bowel movements. As the intestinal tract heals, normal digestion will resume at varying lengths.

What are the complications that may arise?

A colectomy is regarded as a fairly safe procedure, but like with any operation complications do occur.
Some of the complications that could arise are:
  • A leak where the colon is sewn together
  • Internal bleeding
  • Infection
  • Hernia
  • Blood clot
  • Damage to nearby organs
  • Hernia
  • Scar tissue

 

A patient can minimize the risk for complications by following the guideline for pre and post operation.