Digestive Surgeries

Appendectomy

An appendectomy is the surgical removal of the appendix. This is done if your appendix is causing you pain, such as when it becomes infected or inflamed, or it has ruptured. This can be a scheduled surgery or it may be done as an emergency if the appendix has ruptured.

Before Surgery

  • Your doctor will review all allergies and medications you are taking including any herbs and over the counter medications you are taking.
  • You will not be allowed to eat or drink anything after midnight the night before surgery
  • Your doctor will explain the procedure to you and what to expect afterwards.

During Surgery

There are two methods for removing the appendix. Your doctor will choose which method is safer for you.

  • Open appendectomy: One incision (several inches long) is made in your lower right side. A bigger incision may be used if the appendix has burst. General anesthesia is used for this procedure.
  • Laparoscopic appendectomy: 2 to 4 small incisions are made. One is near your bellybutton. The others are elsewhere on your abdomen. A laparoscope, a thin tube with a camera attached, is inserted through one incision. The camera shows the inside of your abdomen on a monitor. This image helps guide the surgery. Surgical tools are inserted in the other incisions. The appendix is removed using these tools. General anesthesia is used for this procedure.

After Surgery

  • Depending on the type of surgery you have will depend of the recovery time. With a laparoscopic appendectomy the small incisions may be closed with steri strips or bandaids. With an open appendectomy the incision may be closed with stitches or staples or even have the outer layer of skin left open to prevent infection if the appendix had ruptured. You will be in the hospital 1-3 days to recover.

Risks and Complications of Surgery

  • Infection or bleeding from incision site
  • Infection or swelling in the abdomen
  • Leakage of bowel material
  • Bowel ileus or bowel blockage
  • Complications of anesthesia

Cholecystectomy

You've had painful gallbladder attacks. To treat the problem, your doctor wants to remove your gallbladder. This surgery is called cholecystectomy. This can be done laparoscopically, open, or robotically using the daVinci Single Site surgery method. You can live a healthy life without your gallbladder.

Before Surgery

  • Tell your provider all medications you take including over the counter and any herbs or vitamins. Have any tests your provider asks for, such as blood tests.
  • Don't eat or drink after midnight, the night before your surgery. This includes water, coffee, and mints.

During Surgery

There are two methods for removing the gallbladder. Your doctor will choose which method is safer for you.

  • Laparoscopic cholecystectomy- This is most common. During surgery, 2 to 4 small incisions are made. A thin tube with a camera is used. This is called a laparoscope. The scope is inserted and the images on seen on a screen. Surgical tools are put through other incisions. The gallbladder is then removed using the scope and these tools. General anesthesia is used for this procedure.
  • Open cholecystectomy- One larger incision is made and the gallbladder is removed through this incision. Open surgery may be used depending on your risk factors. In some cases, safety requires a change from laparoscopic to open surgery during the procedure. General anesthesia is also used for this procedure.
  • da Vinci Single Site Surgery- With this type of surgery one small incision is made through your belly button and you gallbladder is removed. General anesthesia is used for this procedure.

After Surgery

  • Laparoscopic- You will go to recovery to wake up and should go home the same day. You should be able to return to normal activities within 7-10 days.
  • Open- You will go to recovery to wake up and then will spend 2-4 days in the hospital to recover. You should be able to return to normal activities in 4-6 weeks.
  • da Vinci Single Site- You will go to the recovery room to wake up and should go home the same day. This type of procedure offers less pain and scarring. You should be able to return to normal activities within a week.

Risks and Possible Complications of Gallbladder Surgery

All surgeries have risks. The risks of gallbladder surgery include:

  • Bleeding
  • Infection
  • Injury to the common bile duct or nearby organs
  • Blood clots in the legs
  • Prolonged diarrhea
  • Bile leaks
  • Hernia at incision site

Colon Resection

A colon resection or colectomy is the surgical removal of all or part of the colon to treat diseases and disorders such as cancer, bowel obstruction, Crohn's Disease, and diverticulitis. A colectomy can be total where the entire colon is removed or partial where only the diseased portion is removed. There are 4 types of colectomies.

  • Left Hemicolectomy- the removal of the left side of the colon and the remaining healthy colon is reattached
  • Right Hemicolectomy- the removal of the right side of the colon and the remaining healthy colon is reattached
  • Sigmoid Colectomy- the removal of the lower portion of the colon
  • Proctocolectomy- the removal of the entire colon including the rectum and anus. When this is done an ileostomy is formed with the small intestine being attached to the abdominal wall and a stoma being formed. This is called an ileostomy.

Before Surgery

  • Your doctor will review all allergies and medications including any herbs and over the counter medications you take.
  • You will be given a prep to do for several days before surgery to make sure you colon is completely clean. You may also be on a clear liquid diet for several days before surgery.
  • You will not be allowed to eat or drink anything after midnight the night before surgery.

During Surgery

  • Open Colon Resection- With this procedure general anesthesia will be used. A large incision will be made on your abdomen and a portion of your colon will be removed. The recovery time will be longer with this procedure
  • Laparoscopic Colon Resection- With this procedure general anesthesia will be used. Several small incisions will be made on your abdomen and surgical tools will be inserted. Then a portion of your colon will be removed. You may a shorter recovery time with this procedure.

After Surgery

  • You will be taken to recovery and from there to your hospital room.
  • You will be in the hospital 4-7 days after surgery.
  • Your diet will be slowly advanced from clear liquids, to a soft diet, to a full diet.
  • After about 6 weeks you will be fully recovered and should be able to return to all normal activities.

Risks of the Procedure

  • Reactions to anesthesia
  • Bleeding inside your belly
  • Incisional hernia
  • Damage to nearby organs such as bladder, small intestine, and ureters
  • Possible colostomy (temporary or permanent)
  • Scar tissue formation that can cause a blockage
  • Infection
  • Anastomotic leak (where the edges of your colon that are sewn together come open)

Gastric Feeding Tube Placement

If you are having ongoing or serious problems swallowing and cannot receive enough nutrition by mouth your doctor may suggest that you have a feeding tube placed. This procedure is called a percutaneous endoscopic gastrostomy or PEG. This tube allows you to receive nutrition directly into your stomach and bypass your mouth and esophagus.

Before Surgery

  • Your doctor will review allergies and all of your medications including over the counter medications and any herbs or vitamins
  • You will not be allowed to eat or drink anything after midnight the night before your procedure.

During Surgery

  • General anesthesia will be used for this procedure
  • Your doctor will use a scope with a small camera attached and insert it through your mouth and into the stomach to help determine where to place the tube.
  • A small incision is then made in the abdomen and the tube is inserted.

After Surgery

  • You will be taken to recovery for a short time to wake up; you may then be able to go home.
  • The tube will be secured to your abdomen with tape and a dressing will be in place around the tube. Some drainage may be noted for about 1-2 days.
  • You will learn how to care for your tube and how to use it correctly. You will also be told when you can start using it for feeding.

Risks of this Procedure

  • Infection
  • Bleeding

Hemmorrhoidectomy

A hemorrhoid is a swollen vein in the anal canal. There are two types of hemorrhoids internal and external. You can have one or both of these at the same time. Symptoms of hemorrhoids can include bleeding during bowel movements, rectal pain, and itching.

Before Surgery

  • Your doctor will review your allergies and any medications including all over the counter medications and any herbs and vitamins you are taking.
  • Your doctor will explain the procedure to you and answer any questions you may have.

During Surgery

There are two types of hemorrhoidectomies that your doctor can perform. General anesthesia is used for both procedures.

  • Excisional hemorrhoidectomy- This procedure removes the hemorrhoidal tissue by cutting it. The wound may then be left open or closed with stitches.
  • Stapled hemorrhoidpexy- This removes a portion of the hemorrhoidal tissue and then the remaining tissue is then put back in the anal canal and stapled in place.

After Surgery

  • You will be taken to the recovery room and after you are stable discharged home.
  • You can expect pain after surgery. You will be given pain medication to take and also given instructions on sitz baths, increasing you daily fiber intake, and taking stool softeners to help reduce straining.

Risks of the Procedure

  • Pain
  • Infection
  • Bleeding
  • Swelling
  • Constipation
  • Recurrence of hemorrhoids

Inflammatory Bowel Disease

Inflammatory bowel disease is a group of disorders that can affect the large or small intestines. Symptoms can include diarrhea, pain, weight loss, bleeding from the rectum, and fever. The most common of this group of diseases is ulcerative colitis and Crohn's disease. In order to obtain a diagnosis of one of these diseases you may have several tests done including blood tests, stool samples, Colonoscopy, or CT scan.

Before Surgery

  • Your doctor will review allergies and all of your medications including over the counter medications and any herbs or vitamins
  • You will not be allowed to eat or drink anything after midnight the night before your procedure.

During Surgery

  • General anesthesia will be used for both types of surgery
  • Ulcerative Colitis- With this type of surgery the entire large intestine is removed. Once this is done one of tw
  • procedures will be done to allow to body to get rid of waste
    • Ileostomy- A small opening is made in the abdominal wall and the end of the ileum is brought through this hole and the waste will drain out into an external pouch that can be emptied
    • J-Pouch- The ileum is attached to the inside of the anus where the rectum was and this forms a pouch. Waste is collected and stored in this pouch and then passes out of the anus as usual.
  • Crohn's Disease- Surgery for Crohn's disease is used as a way to relieve symptoms but because Crohn's occurs in patches, surgery can not cure the disease. There are 3 types of surgery for Crohn's Disease
    • Strictureplasty- In this procedure the doctor widens the narrowed part of the small intestine without removing any part of it.
    • Bowel Resection- In this procedure the damaged part of the small or large intestine is removed and the healthy ends sewn back together.
    • Removal of the Large Intestine- The entire large intestine is removed and an ileostomy is formed to allow the waste to drain into an external bag.

After Surgery

  • You will be taken to recovery for a short time to wake up; you will then be taken to your hospital room. It will depend of the type and extent of surgery that you have as to how long you will remain hospitalized after surgery.

Risks of this Procedure

  • Infection
  • Injury to other organs
  • Bleeding
  • Obstruction

Liver Biopsy

A liver biopsy is done when a problem is difficult to diagnose with blood test or imaging or to estimate the degree of liver damage.

Before Surgery

  • Your doctor will review all allergies and medications including any herbs and over the counter medications you are taking. You may be asked to stop certain medications you are taking such as blood thinners or NSAID's.
  • Your doctor will discuss the procedure with you and also what to expect after surgery.

During Surgery

There are 3 ways to do a liver biopsy. Your doctor will discuss these options with you the best way will be decided by you and your doctor.

  • Percutaneous Liver Biopsy- A hollow needle is inserted through the abdomen using ultrasound guidance or CT to make sure no other organs are punctured. Local anesthesia is used and a small incision is made and the biopsy needle is inserted to obtain the sample. While the sample is being obtained you will be asked to hold your breath for a very short time.
  • Transvenous Liver Biopsy- During this procedure you will lay on your back and local anesthetic is applied to one side of your neck. A small incision is then made in the neck and a small hollow tube called a sheath is inserted down to the liver and contrast is then inserted and this shows up on x-ray. A small needle is then inserted and a liver sample is quickly taken.
  • Laparoscopic Liver Biopsy- During this procedure you will lay on your back and sedation will be used so you will not feel any pain. This is used to take multiple liver samples from different areas of the liver. Several small incisions will be made and surgical instruments will be inserted. The samples can then be taken quickly and the incisions are closed.

After Surgery

  • You will be taken to recovery and monitored for up to 6 hours. With a percutaneous liver biopsy you will be required to lay on your right side for up to 2 hours to reduce the risk of bleeding. With a transvenous liver biopsy you will be monitored for 4-6 hours for signs of bleeding. With a laparoscopic liver biopsy you will be monitored for several hours for the sedatives to wear off. Once you are stable you will be discharged home.

Risks of this procedure

  • Pain
  • Excessive bleeding
  • Hemorrhage

Splenectomy

This is a procedure to remove a diseased or damaged spleen. Some reasons to have your spleen removed are abscess of the spleen, cirrhosis of the liver, sickle cell anemia, Leukemia, and trauma to the spleen.

Before Surgery

  • Your doctor will review all allergies and medications including over the counter medications and any vitamins and herbs.
  • You will not be allowed to eat or drink anything after midnight the night before surgery.
  • You will need to have immunizations prior to surgery. These include pneumococcal, meningococcal, and Haemphilus vaccine.

During Surgery
There are 2 ways to remove your spleen, open and laparoscopic. You and your doctor will decide which is best for you.

  • Open Splenectomy- An incision is made in the middle of the abdomen just below your ribs. The doctor will find and remove your spleen. The incision will then be closed with sutures, staples, or surgical glue.
  • Laparoscopic Splenectomy- Several small incisions are made on your abdomen and surgical instruments are inserted. Using a small camera the doctor will locate your spleen and remove it. The incisions are then closed.

After Surgery

  • You should be able to leave the hospital in about 4-7 days if done as an open procedure. If you have it done as a laparoscopic procedure you will stay about 1-2 days.
  • Upon discharge you will be given instructions on wound care, medications you may need to take, and also any follow up appointments.

Risks of this Procedure

  • Increased risk for infection
  • Injury to nearby organs
  • Hernia at surgical site
  • Blood clots

Whipple Procedure

This is a procedure that is done to remove the head of the pancreas, the gallbladder, a portion of the common bile duct, and the duodenum (part of the small intestine). This procedure may be done if there is a diagnosis of cancer of the pancreas.

Before Surgery

  • Your doctor will review all allergies and medications including over the counter medications and any vitamins and herbs.
  • You will not be allowed to eat or drink anything after midnight the night before surgery.

During Surgery
For this procedure, general anesthesia will be used and the procedure will be done laparoscopically. Several incisions will be made in your abdomen and the surgical tools will be inserted through these openings. The organs will be removed through these openings and your GI tract will be reconstructed.

After Surgery

  • You will be taken to recovery and then to your hospital room. You will probably have an NG tube in place, as well as a drain coming from your abdomen. These will most likely be removed before going home.
  • You should be able to leave the hospital in about in about 7-10 days.
  • Upon discharge you will be given instructions on wound care, medications you may need to take, and also any follow up appointments.

Risks of this Procedure

  • Increased risk for infection
  • Injury to nearby organs
  • Increased risk of diabetes
  • Blood clots
  • Infection